ABSTRACT
Ethical practice within military health care is a significant topic of professional and academic debate. The term "military health care ethics" enfranchises the entire health care team. Military health care professionals are subject to tension between their duties as military personnel, and their ethical duties as health care professionals, so-called "Dual Loyalty." Some military health care practitioners have suffered moral injury because of the psychological stress associated with ethical challenges on military operations. It is important to define military health care ethics and also to consider how it should be taught. The essence of ethical practice is ethical decision-making. It has become self-evident from our experience of teaching military health care ethics that a simple and agreed framework for analyzing an ethical problem is required. This paper describes the development of the King's Military Healthcare Ethics Framework in support of a military health care ethics policy on behalf of the NATO Military Healthcare Working Group. There is logic to using a stepped approach to analyze an ethical problem in military health care. These steps are: "Identify" the problem, "Analyze" the problem including consideration of perspectives, "Fuse" the analysis, and "Decide". Step 1-Identify-is intended to orientate the decision-making group, and to articulate the problem specifically and clearly in order to determine the exact ethical issue and the secondary issues that arise. Step 2-Analyse-considers the problem from 4 perspectives: patient, clinical, legal, and societal/military. These reflect the breadth of perspectives that impact on health care practice within a military context. Step 3-Fuse-is the culminating step. The conclusions from the analysis of perspectives should be summarized and key references cited. This will determine the exact decision(s) to be made. Step 4-Decide-clearly articulates the decision made and provides the record of the key reasons for making that decision. This may include areas of enduring uncertainly and any planned review of the decision. The King's Military Healthcare Ethics Analytical Framework has been evaluated for content validity through iterative discussion at 4 meetings of the NATO MHCWG and a specific workshop on military health care ethics over 2022/2023. It is included within the draft NATO Standardization Agreement on Military Healthcare Ethics.
ABSTRACT
Rivers are the main pathway for microplastics (MP) transport toward the ocean. However, the understanding of the processes involved in the deposition and mobilization of MP in rivers, specifically in sediment side bars (SB), remains very limited. The objectives of this study were: (i) to examine the effect of hydrometric fluctuations and wind intensity on the distribution of microplastics (MP < 5 mm) in the SB of large river (the Paraná River), (ii) to determine the characteristics of MP to infer their origin and fate, and (iii) to discuss potential similarities or differences between MP suspended in the water column and MP found in sediment. The SB and water column were sampled during the autumn, winter, and spring of 2018, and the summer of 2019 at different river discharges and wind intensities. >90 % of the MP items found were fiber of polyethylene terephthalate (PET; FT-IR analysis), the most common MP color was blue, and most were in the 0.5-2 mm size range. The concentration/composition of MP varied according to the river discharge and wind intensity. During the falling limb of the hydrograph when discharge is decreasing and sediments are exposed for short periods (13-30 days), MP particles transported by the flow were deposited on temporarily exposed SB, accumulating there in high densities (309-373 items/kg). However, during the drought, when sediments remained exposed for a long time (259 days), MP were mobilized and transported by the wind. During this period (no influence of the flow), MP densities significantly decreased on SB (39-47 items/kg). In conclusion, both hydrological fluctuations and wind intensity played a significant role in MP distribution in SB.
ABSTRACT
Microplastic pollution in aquatic ecosystems presents an emerging environmental threat that can have adverse effects on ecology, endanger aquatic species, and result in economic damage. Despite the numerous studies reporting the presence of microplastics in marine environments, research into their presence in freshwater systems or inland waters remains limited. This study aimed to assess the level of microplastic pollution transported by the Munzur and Pülümür Rivers and some small rivers that flow into the Uzunçayir dam lake, which is the confluence of the Munzur and Pülümür Rivers in Türkiye. Samples were collected from 23 stations, with the concentration of microplastics ranging from 0.01 MP/m3 at P-4 station to 28.21 MP/m3 at P-10, a station located near a city. Microplastics comprise four types: fiber, film, fragment, and glitter. The average size of microplastics was 1.46 ± 0.05 mm, with the average size of fibers, films, fragments, and glitter-type microplastics being 1.58 ± 0.07 mm, 1.23 ± 0.10 mm, 1.21 ± 0.11 mm, and 0.78 ± 0.16 mm, respectively. The most frequent polymers were polyethylene (31.8%), polystyrene (21.1%), and polypropylene (10.5%). Despite being considered remote and less populated rivers compared to other river systems in Türkiye, all sampling sites showed varying concentrations of microplastics.
Subject(s)
Microplastics , Water Pollutants, Chemical , Rivers , Plastics , Ecosystem , Environmental Monitoring , Water Pollutants, Chemical/analysis , LakesABSTRACT
Improving collection technologies is crucial to develop effective and economically feasible solutions for catching plastic from riverine environments. However, floating booms are being constructed and deployed in river around the world without rigorously testing its effectiveness. In this study, we tested the effectiveness of a boom under realistic conditions for several configurations and treatments (including "C-shape" and "Slash-shape" configurations). For this, we used the same macroplastics that leak out of waste management channels in order to be as realistic as possible. In total we used 52 plastic articles of 13 different polymers. The global effectiveness of the tested C-shape boom was lower than expected under such conditions (around 37 % of retention). The effectiveness of the Slash-shape boom was considerably worst (<10 %). However, the effectiveness varies greatly according to the particular characteristics of the plastic articles (i.e., shape and polymer composition), ranged from 0 to 100 %. For example, the boom could be 100 % effective retaining plastics such as Stylofoam trays and cups, 40-20 % for food-wrappers but 0 % for disposable plates and spoons, straws, monofilament fishing lines, packaging straps, hoses, pipes, elastic bands, etc. It seems that to have a reasonable catch-effectiveness and be cost-efficient, boom designs need to be improved and tested under different environmental conditions before to reach the market. In addition, it is unrealistic to select only high buoyancy plastics for testing them.
ABSTRACT
This article notes the significant increase in academic papers and policy guidance on the subject of ethical practice in military healthcare over the past two decades. This is usually within the domain of "military medical ethics," linking medical ethics as applied to the medical profession (doctors) with ethics as applied within the military (primarily from the perspective of officers). This article argues that this, highly elitist, perspective disenfranchises the majority of the military healthcare team who are nurses and allied health professionals and serve across the entire rank spectrum. We suggest that the subject should be reframed under the banner "military healthcare ethics" to include the concepts within military medical ethics but to emphasize the obligations of all military health professionals to comply with legal, regulatory, and ethical guidance for the practice of healthcare in the military environment. We recommend that the subject should be included in the curricula for education and training for all military health professions across their whole career.
Subject(s)
Ethics, Medical , Physicians , Humans , Health Personnel/education , Curriculum , Delivery of Health CareABSTRACT
This study presents a comparison between fishers' knowledge and fiscal records about the structure of inland fisheries in the Paraná River (Argentina). First of all, we characterized the fishing population according to the main demographic and economic indicators, identifying two different fishing areas: the northern and southern sections in the lower La Plata basin. Secondly, we carried out a comparative analysis of fiscal fishery records (from two commercial sets: 1930-1984 and 2011-2019) and local fishers' knowledge on inland commercial fisheries (frequency of occurrence and abundance). Finally, we contrasted current fishing regulations (allowed meshes and boats, fishing prohibitions, exports) to fishers' effective practices. The study area included 52 sites located along the floodplain of the middle and lower sections of the Paraná River, in the province of Santa Fe. Socioeconomic analyses identified two different groups of fishers throughout the river corridor. Results showed that fishers have detailed knowledge on nomenclature, ecology, reproductive strategy, habitat distribution, and usefulness of commercial fish species. By contrasting fishers' knowledge with fiscal records, we found similar and complementary information about the changes in abundance and frequency of occurrence in fisheries. These results highlight the need of including local knowledge as an outstanding source of information for well-planned management of fishing programs and sustainable policies. Supplementary Information: The online version contains supplementary material available at 10.1007/s11160-022-09722-x.
ABSTRACT
Plastic in the environment is considered an emerging pollutant of global concern. In spite of intensive research, many questions remain open, such as the processes that drive the deposition and remobilization of plastic debris on river beaches. The objectives of this study were: i) to analyze the influence of the natural hydrological fluctuations and wind intensity on the distribution of mesoplastic (0.5-2.5 cm) and macroplastic (>2.5 cm) debris in beach sediments of a large river, ii) to describe the type of plastic debris found and iii) to explore potential relations between the number of items and weight of macro- and mesoplastics. Our results suggest that, during lowering water levels, flow removes the plastic debris and transports it further downstream. Conversely, when the beach sediments remain exposed during long periods, the plastic debris accumulates considerably. Nevertheless, the influence of wind intensity on plastic debris transport was comparatively negligible. In other words, in our study the water flow had a greater capacity to remobilize and transport plastic debris than the wind. The most abundant mesoplastic items were foam, hard plastic, film and small fragments of fishing line. The dominant macroplastic items recorded were pieces of fishing line (nylon) and cigarette filters (cellulose acetate), typically discarded by beach users. Other items found in large quantities were soft packaging elements (expanded polystyrene), hard plastic containers (polystyrene, polyethylene terephthalate) and beverage bottles (polyethylene terephthalate), typical items of domestic use in the Paraná River region. Finally, we found that the density of macroplastic items is highly correlated to the density of mesoplastic items, serving as surrogate for further estimations. Our results could help to develop better mitigation strategies in seasonal riverscapes, based on the influence of the hydrological cycle and the characteristics of the most abundant meso- and macroplastics.
Subject(s)
Plastics , Wind , Argentina , Bathing Beaches , Environmental Monitoring , Hydrodynamics , Plastics/analysis , Waste Products/analysisABSTRACT
Encounters (or interactions) between plastic debris and wildlife can cause great harm to individuals and populations. The most common encounters are ingestion, entanglement and plastic usage (plastic as nesting material, vector for biota transport and refuge/shelter). Hundreds of plastic-encounters have been reported for marine species. However, there is a lack of studies reporting encounters in other ecosystems, such as freshwater and terrestrial ones. Based on a citizen science approach, we documented and analyzed 90 different cases of macroplastic-fauna encounters for 44 freshwater and terrestrial species. Herein, we provided evidence (photographically documented) of the negative consequences of macroplastic debris discarded in freshwater and terrestrial environments. Birds were by far the taxon most frequently reported in encounters (72.2% of the encounters, 30 different species). The dominant type of plastic-fauna encounter was the use of plastic as nesting material (42% of the total cases) and the second one was entanglement (33%). Most of the entanglements had lethal consequences for the organisms involved (almost 60%). Entanglement in ghost fishing gear and bottle (security) rings were particularly dangerous and comparatively frequent in this study. Some invasive species could benefit from the encounters to the detriment of the environment's health, using plastics as settlement substrata. Finally, we lay the foundation for creating worldwide lists of non-marine species impacted by encounters with plastic debris.
Subject(s)
Animals, Wild , Ecosystem , Animals , Environmental Monitoring , Fresh Water , Humans , Plastics , Waste Products/analysisABSTRACT
The disordered growth of large cities around water bodies causes environmental damage due to discarded plastics and microplastics (MPs) that aquatic organisms can ingest. This study analyzed the occurrence, type, and abundance of MPs in the gastrointestinal contents of four species of commercial fish (120 total specimens), namely, Brazilian mojarra (Eugerres brasilianus) and mullets (Mugil curema, Mugil curvidens, and Mugil liza), obtained in Porto Seguro in Bahia, Brazil, between March and May 2019. A priori probability distributions were generated using a Bayesian approach and simulations to assess MP intake based on varying exposure amounts (θ = 0.2, θ = 0.5, and θ = 0.8). E. brasilianus (53.33%) and Mugil spp. (41.66%) were contaminated with some types of MPs. Black, blue, and green MPs dominated in the extracted samples, and most measured 1.0 mm in length or smaller. The dominant polymers identified using Fourier transform infrared spectroscopy (FTIR) were polyester, polypropylene, semi-synthetic rayon fiber, and polyamide 6 (nylon). The a posteriori probabilities of more than half the E. brasilianus and Mugil spp. ingesting MPs were 0.336 and 0.008, respectively, indicating that E. brasilianus is much more likely to ingest MPs. These simulations can be useful tools for assessing the environmental quality and local anthropic impact of MP ingestion by fish populations.
Subject(s)
Microplastics , Water Pollutants, Chemical , Animals , Bayes Theorem , Brazil , Environmental Monitoring , Plastics , Water Pollutants, Chemical/analysisABSTRACT
Plastics are dominant pollutants in freshwater ecosystems worldwide. Scientific studies that investigated the interaction between plastics and freshwater biodiversity are incipient, especially if compared to the marine realm. In this review, we provide a brief overview of plastic pollution in freshwater ecosystems around the world. We found evidence of plastic ingestion by 206 freshwater species, from invertebrates to mammals, in natural or semi-natural ecosystems. In addition, we reported other consequences of synthetic polymers in freshwater ecosystems-including, for instance, the entanglement of animals of different groups (e.g., birds). The problem of plastic pollution is complex and will need coordinated actions, such as recycling programs, correct disposal, stringent legislation, regular inspection, replacement of synthetic polymers with other materials, and ecological restoration. Current information indicates that the situation in freshwater ecosystems may be as detrimental as the pollution found in the ocean, although highly underappreciated.
Subject(s)
Plastics , Water Pollutants, Chemical , Animals , Biodiversity , Ecosystem , Environmental Monitoring , Fresh Water , Plastics/toxicity , Water Pollutants, Chemical/analysis , Water Pollutants, Chemical/toxicityABSTRACT
INTRODUCTION: This article describes the evolution of first aid in the British Army from the Crimean War to the present day in order to interpret the processes of innovation, implementation, and diffusion of ideas to improve the clinical outcomes for military casualties. MATERIALS AND METHODS: The article is an analysis of policy and practice for training in first aid published in King's/Queen's Regulations for the Army, the Field Service Pocket Book, or generic military training policy. This is complimented by a review of medical training manuals and a search of articles in the Journal of the Royal Army Medical Corps (RAMC). Most sources have been accessed from the Museum of Military of Medicine and the Wellcome RAMC Muniments Collection. RESULTS: The narrative summarizes the evolution of clinical concepts in first aid and their translation for Army personnel; starting with RAMC stretcher bearers, extended to soldiers assigned to medical duties at unit level, and finally simplified into first aid training to be taught to all soldiers. Alongside this story of training is a secondary story of the development of field first aid equipment, principally dressings, tourniquets, and analgesia. The final part of the story is the transfer of knowledge from military first aid training into the civilian, community setting. The following themes were identified: the reality of conflict wounds, battlefield first aid is different from civilian first aid, progressive transfer of training from medics to soldiers, transfer of knowledge to civilian sector and internationally, and specific clinical innovations: first field dressings, tourniquets, and prehospital analgesia. DISCUSSION: The current generation of soldiers are at the highest ever standard of first aid training and equipment. This must be maintained through gathering of evidence in effectiveness and outcomes in prehospital emergency care in both military and civilian settings.
Subject(s)
Emergency Medical Services , Military Medicine , Military Personnel , First Aid , Humans , TourniquetsABSTRACT
Plastic pollution has become a globally pressing environmental issue. In birds, plastic may cause harm by entangling or ingestion when used for nesting. The use of anthropogenic nesting material has so far been mostly studied in birds of terrestrial or marine habitats, but there are yet very few reports for inland water-associated birds. The aim of this study is to better understand the extension and magnitude of the use of anthropogenic debris as nesting material by the greater thornbird (Phacellodomus ruber), a bird species preferably nesting in river floodplain wetlands in South America. We found that P. ruber uses disproportionally large quantities of plastic debris as nesting material (more than 90% of some nest chambers is plastic). This occurred even if ample vegetation (commonly used as soft material) was available. Most of the artificial nesting material was derived from wrapping material released into the environment. We suggest that this species has the potential to indicate vulnerable areas to plastic pollution associated with urban waste mismanagement.
Subject(s)
Waste Products , Wetlands , Animals , Birds , Environmental Monitoring , Plastics , South America , Waste Products/analysisABSTRACT
This paper reviews the historical evolution of the language and organization surrounding the health of personnel in the British Army from 'hygiene' through to 'wellbeing'. It starts by considering the health of the army in the mid-nineteenth century and the emergence of military hygiene as a professional subject. It continues by looking at advances in military hygiene in the two world wars. Hygiene was replaced by the term 'health' in the 1950s as the collective noun used by professionals working in this field. This unity split when the professions of occupational medicine and public health established separate faculties and training pathways. However, the health issues for the armed forces remain fundamentally unchanged. Going forward, the term 'wellbeing' is helping to refresh the close relationships between executives, their medical advisers and those within the population of health professions charged with keeping the British Army healthy. The core theme is the collaborations between civil society, executive leadership and medical services in maximizing the health of the military population from recruitment through to life as a veteran.
Subject(s)
Military Hygiene/methods , Military Personnel/psychology , Physical Fitness/psychology , England , History, 19th Century , History, 20th Century , Humans , Military Hygiene/history , Military Personnel/statistics & numerical data , Physical Fitness/physiology , Public Health/history , Public Health/standards , WarfareABSTRACT
OBJECTIVE: Rising incidence of HPV-positive head and neck cancers (HPV-HNC) means HPV infection is increasingly relevant to patient-provider consultations. We performed a systematic review to examine, in the context of patient-provider HNC consultations: discussions about HPV, attitudes towards discussing HPV and information needs. METHODS: We searched Embase, PsychINFO, and CINAHL + for studies to August 2018. Eligible studies included: HNC healthcare professionals (HCPs) and/or HNC patients investigated HNC patient-provider communication about HPV. RESULTS: Ten studies were identified: six including HCPs and four including HNC patients. HCPs varied in confidence in HPV discussions, which was related to their HPV knowledge. Both HCPs and patients acknowledged the need for reliable HPV information. Factors which facilitated HPV discussions included accessible HPV information for patients and HCPs and good HPV knowledge among HCPs. Barriers included the perception, among HCPs, that HPV was a challenging topic to discuss with patients. CONCLUSIONS: Information deficits, communication challenges and barriers to discussing HPV were identified in HNC patient-provider consultations. PRACTICE IMPLICATIONS: Appropriate HPV information is needed for HCPs and patients. Professional development initiatives which increase HCPs' HPV knowledge and build their communication skills would be valuable.
Subject(s)
Communication , Head and Neck Neoplasms/virology , Health Knowledge, Attitudes, Practice , Health Personnel/psychology , Papillomavirus Infections/complications , Professional-Patient Relations , Referral and Consultation , HumansABSTRACT
This paper deals with the hydrological variability effects on the primary commercial fish species inhabiting the main channel and the floodplain of the large Paraná River in its middle reaches in Argentina. Analysing more than eight decades (1935-2016) of information on the most frequent and abundant commercial species in conjunction with hydrological levels and temperature, our results show that spring-summer floods of a certain magnitude (c. 6 m) and durations (> 80 days) are crucial for sustaining commercial fisheries. Moreover, the frequency of these floods was modulated by the decadal climatic fluctuations that have occurred over the past 100 years in the Paraná Basin. An insight into the probable incidence of some anthropogenic influences is also provided.
Subject(s)
Conservation of Natural Resources , Fisheries , Fishes/physiology , Rivers , Animals , Argentina , Hydrology , Seasons , Temperature , Water MovementsABSTRACT
The aim of this study was to determine the amount, composition and origin of plastic debris in one of the world largest river, the Paraná River in Argentina (South America), focusing on the impact of urban rivers, relationships among macro, meso and microplastic, socio-political issues and microplastic ingestion by fish. We recorded a huge concentration of macroplastic debris of domestic origin (up to 5.05 macroplastic items per m2) dominated largely by bags (mainly high- and low-density polyethylene), foodwrapper (polypropylene and polystyrene), foam plastics (expanded polystyrene) and beverage bottles (polyethylene terephthalate), particularly downstream from the confluence with an urban stream. This suggests inadequate waste collection, processing and final disposal in the region, which is regrettably recurrent in many cities of the Global South and Argentina in particular. We found an average of 4654 microplastic fragments m-2 in shoreline sediments of the river, ranging from 131 to 12687 microplastics m-2. In contrast to other studies from industrialized countries from Europe and North America, secondary microplastics (resulting from comminution of larger particles) were more abundant than primary ones (microbeads to cosmetics or pellets to the industry). This could be explained by differences in consumer habits and industrialization level between societies and economies. Microplastic particles (mostly fibres) were recorded in the digestive tract of 100% of the studied Prochilodus lineatus (commercial species). Contrary to recently published statements by other researchers, our results suggest neither macroplastic nor mesoplastics would serve as surrogate for microplastic items in pollution surveys, suggesting the need to consider all three size categories. The massive plastic pollution found in the Paraná River is caused by an inadequate waste management. New actions are required to properly manage waste from its inception to its final disposal.
Subject(s)
Environmental Monitoring , Plastics/analysis , Rivers/chemistry , Water Pollutants, Chemical/analysis , Animals , Argentina , Cities , Developing Countries , Environmental Pollution/analysis , Polyethylene , Polypropylenes/analysis , Polystyrenes/analysis , Seafood , Waste Products/analysisABSTRACT
The overwhelming majority of research conducted to date on plastic pollution (all size fractions) has focused on marine ecosystems. In comparison, only a few studies provide evidence for the presence of plastic debris in freshwater environments. However, owing to the numerous differences between freshwater studies (including studied species and habitats, geographical locations, social and economic contexts, the type of data obtained and also the broad range of purposes), they show only fragments of the overall picture of freshwater plastic pollution. This highlights the lack of a holistic vision and evidences several knowledge gaps and data biases. Through a bibliometric analysis we identified such knowledge gaps, inconsistencies and survey trends of plastic pollution research within freshwater ecosystems. We conclude that there is a continued need to increase the field-data bases about plastics (all size fractions) in freshwater environments. This is particularly important to estimate river plastic emissions to the world's oceans. Accordingly, data about macroplastics from most polluted and larger rivers are very scarce, although macroplastics represent a huge input in terms of plastics weight. In addition, submerged macroplastics may play an important role in transporting mismanaged plastic waste, however almost no studies exist. Although many of the most plastic polluted rivers are in Asia, only 14% of the reviewed studies were carried out in this continent (even though the major inland fisheries of the world are located in Asia's rivers). The potential damage caused by macroplastics on a wide range of freshwater fauna is as yet undetermined, even though negative impacts have been well documented in similar marine species. We also noted a clear supremacy of microplastic studies over macroplastic ones, even though there is no reason to assume that freshwater ecosystems remain unaffected by macro-debris. Finally, we recommend focusing monitoring efforts in most polluted rivers worldwide, but particularly in countries with rapid economic development and poor waste management.
Subject(s)
Fresh Water , Plastics/analysis , Research/statistics & numerical data , Water Pollutants, Chemical/analysis , Animals , Bias , Ecosystem , Ecotoxicology , Environmental Monitoring , Fresh Water/analysis , Oceans and Seas , Rivers , Waste Products/analysisABSTRACT
Plastic pollution is considered an important environmental problem by the United Nations Environment Programme, and it is identified, alongside climate change, as an emerging issue that might affect biological diversity and human health. However, despite research efforts investigating plastics in oceans, relatively little studies have focused on freshwater systems. The aim of this study was to estimate the spatial distribution, types, and characteristics of macro-, meso-, and microplastic fragments in shoreline sediments of a freshwater lake. Food wrappers (mainly polypropylene and polystyrene), bags (high- and low-density polyethylene), bottles (polyethylene terephthalate), and disposable Styrofoam food containers (expanded polystyrene) were the dominant macroplastics recorded in this study. Contrary to other studies, herein macroplastic item surveys would not serve as surrogates for microplastic items. This is disadvantageous since macroplastic surveys are relatively easier to conduct. Otherwise, an average of 25 mesoplastics (mainly expanded polystyrene) and 704 microplastic particles (diverse resins) were recorded per square meter in sandy sediments. Comparisons with other studies from freshwater and marine beaches indicated similar relevance of plastic contamination, demonstrating for the first time that plastic pollution is a serious problem in the Paraná floodplain lakes. This study is also valuable from a social/educational point of view, since plastic waste has been ignored in the Paraná catchment as a pollutant problem, and therefore, the outcome of the current study is a relevant contribution for decision makers.
Subject(s)
Environmental Monitoring/methods , Lakes/chemistry , Plastics/analysis , Water Pollutants, Chemical/analysis , Argentina , Climate Change , EcosystemABSTRACT
OBJECTIVE: To estimate prevalence of post-colposcopy physical after-effects and investigate associations between these and subsequent psychological distress. DESIGN: Longitudinal survey. SETTING: Two hospital-based colposcopy clinics. POPULATION: Women with abnormal cytology who underwent colposcopy (±related procedures). METHODS: Questionnaires were mailed to women 4, 8 and 12 months post-colposcopy. Details of physical after-effects (pain, bleeding and discharge) experienced post-colposcopy were collected at 4 months. Colposcopy-specific distress was measured using the Process Outcome-Specific Measure at all time-points. Linear mixed-effects regression was used to identify associations between physical after-effects and distress over 12 months, adjusting for socio-demographic and clinical variables. MAIN OUTCOME MEASURES: Prevalence of post-colposcopy physical after-effects. Associations between the presence of any physical after-effects, awareness of after-effects, and number of after-effects and distress. RESULTS: Five-hundred and eighty-four women were recruited (response rate = 73, 59 and 52% at 4, 8 and 12 months, respectively). Eighty-two percent of women reported one or more physical after-effect(s). Multiple physical after-effects were common (two after-effects = 25%; three after-effects = 25%). Psychological distress scores declined significantly over time. In adjusted analyses, women who experienced all three physical after-effects had on average a 4.58 (95% CI: 1.10-8.05) higher distress scored than those who experienced no after-effects. Women who were unaware of the possibility of experiencing after-effects scored significantly higher for distress during follow-up. CONCLUSIONS: The prevalence of physical after-effects of colposcopy and related procedures is high. The novel findings of inter-relationships between awareness of the possibility of after-effects and experiencing multiple after-effects, and post-colposcopy distress may be relevant to the development of interventions to alleviate post-colposcopy distress. TWEETABLE ABSTRACT: Experiencing multiple physical after-effects of colposcopy is associated with psychological distress.
Subject(s)
Colposcopy/adverse effects , Hemorrhage/etiology , Pain, Procedural/etiology , Stress, Psychological/etiology , Vaginal Diseases/etiology , Adult , Colposcopy/psychology , Female , Hemorrhage/diagnosis , Hemorrhage/epidemiology , Hemorrhage/psychology , Humans , Linear Models , Longitudinal Studies , Middle Aged , Outcome Assessment, Health Care , Pain, Procedural/diagnosis , Pain, Procedural/epidemiology , Pain, Procedural/psychology , Prevalence , Stress, Psychological/diagnosis , Stress, Psychological/epidemiology , Vaginal Diseases/diagnosis , Vaginal Diseases/epidemiology , Vaginal Diseases/psychologyABSTRACT
This paper provides the definitive record of the UK Defence Medical Services (DMS) lessons from the organisation of medical services in support of Operation (Op) TELIC (Iraq) and Op HERRICK (Afghanistan). The analysis involved a detailed review of the published academic literature, internal post-operational tour reports and post-tour interviews. The list of lessons was reviewed through three Military Judgement Panel cycles producing the single synthesis 'the golden thread' and eight 'silver bullets' as themes to institutionalise the learning to deliver the golden thread. One additional theme, mentoring indigenous healthcare systems and providers, emerged as a completely new capability requirement. The DMS has established a programme of work to implement these lessons.