Conflict In Afghanistan Research Articles

Neuropsychological assessments and psychotherapeutic services in Veterans with multiple sclerosis: Rates of utilization and their associations with socio-demographics and clinical characteristics using Veterans Health Administration-based data

BackgroundAs cognitive, emotional, and health-related behavioral issues are prevalent among persons with multiple sclerosis (MS), mental health services are a valuable component of comprehensive care. However, it is unknown how many participate in neuropsychological and psychotherapeutic services, and whether the presence of certain co-occurring conditions increase service use. This study aimed to examine the frequency and associated factors (e.g., age, gender, education, race/ethnicity, and co-occurring conditions) of neuropsychological and psychotherapeutic service utilization in the Veterans Health Administration (VHA) among Veterans with MS. MethodsData were extracted from VHA Corporate Data Warehouse as part of the Women Veterans Cohort Study (WVCS), a longitudinal project with Veterans who served during the Iraq and Afghanistan conflicts. Participants (n = 1,686) were Veterans from the overall WVCS dataset who had three or more VHA MS-related encounters (inpatient, outpatient, and/or disease modifying therapy) within one calendar year between fiscal years 2010 and 2015. Neuropsychological assessment participation was identified by procedural codes 96118 and 96119, while psychotherapeutic services were defined using 90804, 90806, 90808, 96150, 96151, and 96152. Bivariate analyses were conducted to identify socio-demographics and clinical characteristics that differed between Veterans who did and did not use these services. Service dates were compared to the diagnosis dates of the co-occurring conditions to determine whether the majority of the diagnoses preceded the service (e.g., a recognized problem) or were coded the day of or after the initial appointment (e.g., a suspected problem), which informed what co-occurring conditions and participants were included in the subsequent logistic regressions. ResultsTwo hundred eighty-one Veterans (16.67%) participated in a neuropsychological assessment. Veterans who had an evaluation had higher rates of several co-occurring conditions (ps <0.01), though no significant relationships emerged with any of the socio-demographic variables and participation. After controlling for age, gender, education, and race/ethnicity, two previously diagnosed co-occurring conditions predicted service utilization: traumatic brain injuries (TBIs; OR: 2.33, 95% CI: 1.60, 3.35) and mood disorders (i.e., depressive and bipolar disorders; OR: 1.71, 95% CI: 1.26, 2.31). Psychotherapeutic service usage was more common, occurring in over 45% (n = 771) of the sample. Service utilization was associated with several co-occurring conditions (ps <0.001), as well as level of education (p = .003). Focusing on participants who were diagnosed the day of or after the initial encounter, five co-occurring conditions were predictors of psychotherapeutic service use: mood disorders (OR: 1.81, 95% CI: 1.34, 2.46), anxiety disorders (OR: 1.38, 95% CI: 1.03, 1.85), sleep disorders (OR: 1.55, 95% CI: 1.19, 2.01), alcohol-related disorders (OR: 3.29, 95% CI: 1.79, 6.21), and cognitive disorders (OR: 3.72, 95% CI: 2.29, 6.16). ConclusionsThese findings suggest that these services are being utilized by clinicians and Veterans to address the clinical complexity related to having MS and one or more of these other conditions.

Multimorbidity and quality of life after blast-related injury among US military personnel: a cluster analysis of retrospective data

BackgroundBlast injury emerged as a primary source of morbidity among US military personnel during the recent conflicts in Iraq and Afghanistan, and led to an array of adverse health outcomes. Multimorbidity, or the presence of two or more medical conditions in an individual, can complicate treatment strategies. To date, there is minimal research on the impact of multimorbidity on long-term patient-reported outcomes. We aimed to define multimorbidity patterns in a population of blast-injured military personnel, and to examine these patterns in relation to long-term quality of life (QOL).MethodsA total of 1972 US military personnel who sustained a blast-related injury during military operations in Iraq and Afghanistan were identified from clinical records. Electronic health databases were used to identify medical diagnoses within the first year postinjury, and QOL was measured with a web-based assessment. Hierarchical cluster analysis methods using Ward’s minimum variance were employed to identify clusters with related medical diagnosis categories. Duncan’s multiple range test was used to group clusters into domains by QOL.ResultsFive distinct clusters were identified and grouped into three QOL domains. The lowest QOL domain contained one cluster with a clinical triad reflecting musculoskeletal pain, concussion, and mental health morbidity. The middle QOL domain had two clusters, one with concussion/anxiety predominating and the other with polytrauma. The highest QOL domain had two clusters with little multimorbidity aside from musculoskeletal pain.ConclusionsThe present study described blast-related injury profiles with varying QOL levels that may indicate the need for integrated health services. Implications exist for current multidisciplinary care of wounded active duty and veteran service members, and future research should determine whether multimorbidity denotes distinct post-blast injury syndromes.

ROLE OF THE UNHCR IN REPATRIATION OF AFGHAN REFUGEES FROM PAKISTAN: POST 9/11 ERA

The post 9/11-armed conflict in Afghanistan resulted in the displacement of millions of Afghans and many of these displaced persons entered Pakistan as refugees. Moreover, the involvement of Pakistan in the conflict as an ally to NATO claimed Pakistan an internal armed conflict that displaced waves and waves of internal displacements. Repatriation is considered as a durable solution of the refugee problem. It is the responsibility of the host state to plan for safe and voluntary return of refugees and the UNHCR plays a supportive role in complying with this responsibility. However, the principles of safety, voluntariness and dignity are preserved during repatriation. To comply with the legal framework for refugees regarding repatriation, Pakistan had been struggling a lot in the context of the ongoing armed conflict in both Afghanistan and Pakistan. UNHCR has been helping and assisting the government of Pakistan in planning and executing the safe and voluntary Afghan refugees. This cooperation between the UNHCR and Pakistan has remained effective in achieving the goal of repatriation of Afghan Refugees in the context of ongoing conflicts in both Afghanistan and Pakistan in the context of difficult circumstances This paper discusses the repatriation of the Afghan refugees from Pakistan, engineered by the UNHCR and Pakistan, under the legal framework applicable for safe and voluntary return of refugees, amid waves of repeated displacements due to the ongoing conflicts in Afghanistan and Pakistan.

Being Prepared for the Next Conflict Part II: Case Analysis of a Military Level 1 Trauma Center.

Combat-related injuries have declined substantially in recent years as we have transitioned to a low-volume combat casualty flow era. Surgeons must remain actively committed to training for the next engagement to maintain life and limb-saving skills. Soft tissue coverage procedures were imperative to the management of complex lower extremity trauma that occurred during recent conflicts. The purpose of this study was to evaluate advanced soft tissue coverage procedures performed on the lower extremity over the previous decade on military and civilian trauma patients at a Department of Defense Level 1 trauma center to provide data that can be used to guide future training efforts. The electronic surgical record system was searched for cases that utilized advanced soft tissue coverage (rotational and free flaps) to the lower extremity. The date of treatment, indication, procedure performed, and military/civilian patient designation were recorded. The data was categorized between military and civilian cases, rotational versus free flap, and indication and then charted over time. It was assessed as moving averages over a 12-month period. Statistically distinct periods were then identified. From January 2006 to March 2015, 132 advanced soft tissue coverage procedures were performed on the lower extremity (100 military, 32 civilian). Military soft tissue coverage data demonstrated peaks in 2007 and late 2011 to late 2012, averaging 6.5 (3.5-9.6) and 4.5 (3.2-5.8) per quarter, respectively. There were two low periods, from 2008 to mid-2010 and from mid-2012 to the end of the study, averaging 1.1 (0.6-1.6) and 1.8 (1.1-2.6) cases per quarter, respectively. Civilian procedures averaged 0.9 per quarter (0.5-1.2) throughout the study, but notably were equal to the number of military procedures by the last quarter of 2013 at 2.0 (1.2-2.8 civilian, 0.8-3.1 military). This data supports prior identified trends in military cases correlating increased number of procedures with increased combat activity related to the conflicts in Iraq and Afghanistan in 2007 and 2011, respectively. The data showed relative stability in the numbers of civilian procedures with a slight uptrend beginning in mid-2012. A comparison after mid-2012 shows military procedures declining and civilian procedures increasing to eventually become equivalent at the end of the data collection. These trends follow previously reported data on tibia fracture fixation procedures and lower extremity amputations for the same time periods. These data demonstrate the importance of the civilian trauma mission for maintaining surgical skills relevant to limb salvage, such as rotational and free flaps, during a low-volume combat casualty flow era.

Changes in alcohol use, PTSD hyperarousal symptoms, and intervention dropout following veterans’ use of VetChange

ObjectiveVeterans of Iraq and Afghanistan conflicts report high rates of drinking, PTSD, and low rates of treatment engagement. Web interventions may help address unmet treatment need; unfortunately, little is known regarding outcomes or adherence to these interventions. In this study, we examined VetChange treatment outcomes and downstream effects of alcohol reduction on PTSD symptoms and intervention dropout rates over six months. MethodParticipants included 222 veterans (77.5% men, 78.3% White) between 22 and 57 (mean age = 36.02, SD = 7.19). All VetChange users completed a brief alcohol assessment and received personal feedback, then received full access to intervention content including psychoeducation; motivational and cognitive-behavioral modules for relapse prevention, goal-setting, social support, stress, anger, and sleep management; and mood and drink tracking. Veterans completed self-report measures of alcohol use and PTSD symptoms at baseline, one, three, and six months. ResultsAlcohol use dropped by 43% over six months, p < .001, with the largest decrease occurring within the first month. Greater alcohol reduction in the first month predicted higher subsequent PTSD hyperarousal severity. Over half (52.3%) dropped out by month one, followed by 12.2% and 37.6% by months three and six. Hyperarousal symptoms, hypervigilance specifically, but not alcohol use predicted subsequent intervention dropout. ConclusionThese results highlight the importance of attending to the association between alcohol use and PTSD symptom change in web-based interventions for veterans. The fact that hyperarousal symptoms were associated with elevated risk for intervention dropout signifies the need for online intervention refinement aimed at tailoring content to time-varying symptom presentations.

Outpatient Pharmacy Prescriptions During the First Year Following Serious Combat Injury: A Retrospective Analysis.

Limited research has analyzed the full range of outpatient medication prescription activity following serious combat injury. The objectives of this study were to describe (1) outpatient medication prescriptions and refills during the first 12months after serious combat injury, (2) longitudinal changes in medication prescriptions during the first-year postinjury, and (3) patient characteristics associated with outpatient prescriptions. This was a retrospective analysis of existing health and pharmacy data for a random sample of U.S. service members who sustained serious combat injuries in the Iraq and Afghanistan conflicts, 2010-2013 (n=381). Serious injury was defined by an Injury Severity Score (ISS) of 9 or greater. These patients typically participate in military rehabilitation programs (eg, amputation care) where prescription medications are essential. Data sources were the Expeditionary Medical Encounter Database for injury-specific data, the Pharmacy Data Transaction Service for outpatient medication prescriptions and refills, and the Military Health System Data Repository for diagnostic codes of pain and psychological disorders. Military trauma nurses reviewed casualty records to identify types of injuries. Using the American Hospital Formulary Service Pharmacologic-Therapeutic Classification system, clinicians identified 13 categories of prescription medications (eg, opioid, psychotherapeutic, immunologic) for analysis. Multivariable negative binomial and logistic regression analyses evaluated significant associations between independent variables (eg, blast injury, traumatic brain injury [TBI], ISS, limb amputation, diagnoses of chronic pain, or psychological disorders) and prescription measures (ie, number or category of medication prescriptions). We also describe longitudinal changes in prescription activity postinjury across consecutive quarterly intervals (91days) during the first-year postinjury. During the first-year postinjury, patients averaged 61 outpatient prescriptions, including all initial prescriptions and refills. They averaged eight different categories of medications, primarily opioid, immunologic, gastrointestinal/genitourinary, central nervous system (CNS), nonopioid analgesic, and psychotherapeutic medications (representing 82% of prescriptions) during the first year. Prescription activity generally declined across quarters. There was still substantial prescription activity during the fourth quarter, as 79% of patients had at least one prescription. From 39 to 49% of patients had fourth-quarter prescriptions for opioid, CNS, or psychotherapeutic medications. Longitudinally, we found that 24-34% of patients had an opioid, CNS, or psychotherapeutic prescription during each of the final three quarters. In multivariable analysis, ISS, limb amputation (particularly bilateral amputation), and diagnoses of chronic pain and post-traumatic stress disorder (PTSD) were associated with significantly higher counts of individual and multiple medication prescriptions. TBI was associated with significantly lower numbers of prescriptions for certain medications. This is one of the first studies to provide a systematic analysis of outpatient medication prescriptions following serious combat injury. The results indicate substantial prescription activity from multiple medication categories throughout the first-year postinjury. Diagnoses of chronic pain, PTSD, and limb amputation and ISS were associated with significantly higher counts of prescriptions overall and more prescription medication categories. This study provides initial evidence to better understand medication prescription activity following serious combat injury. The results inform future research on medication prescription practices and planning for rehabilitation.

Pelvic injury patterns in blast: Morbidity and mortality.

Pelvic trauma has emerged as one of the most severe injuries to be sustained by the victim of a blast insult. The incidence and mortality due to blast-related pelvic trauma is not known, and no data exist to assess the relative risk of clinical or radiological indicators of mortality. The UK Joint Theater Trauma Registry was interrogated to identify those sustaining blast-mediated pelvic fractures during the conflicts in Iraq and Afghanistan, from 2003 to 2014, with subsequent computed tomography image analysis. Casualties that sustained more severe injuries remote to the pelvis were excluded. One hundred fifty-nine casualties with a 36% overall mortality rate were identified. Pelvic vascular injury, unstable pelvic fracture patterns, traumatic amputation, and perineal injury were higher in the dismounted fatality group (p < 0.05). All fatalities sustained a pelvic vascular injury. Pelvic vascular injury had the highest relative risk of death for any individual injury and an associated mortality of 56%. Dismounted casualties that sustained unstable pelvic fracture patterns, traumatic amputation, and perineal injury were at three times greater risk (relative risk, 3.00; 95% confidence interval, 1.27-7.09) to have sustained a pelvic vascular injury than those that did not sustain these associated injuries. Opening of the pubic symphysis and at least one sacroiliac joint was significantly associated with pelvic vascular injury (p < 0.001), and the lateral displacement of the sacroiliac joints was identified as a fair predictor of pelvic vascular injury (area under the receiver operating characteristic curve, 0.73). Dismounted blast casualties with pelvic fracture are at significant risk of a noncompressible pelvic vascular injury. Initial management of these patients should focus upon controlling noncompressible pelvic bleeding. Clinical and radiological predictors of vascular injury and mortality suggest that mitigation strategies aiming to attenuate lateral displacement of the pelvis following blast are likely to result in fewer fatalities and a reduced injury burden. Prognostic, level III.

Cancer care in times of conflict: cross border care in Pakistan of patients from Afghanistan.

Armed conflict in Afghanistan has continued for close to 40 years and has devastated its health infrastructure. The lack of a cancer care infrastructure has meant that many Afghans seek cancer care in neighbouring countries, like Pakistan. There remains a significant lack of empirical data on the new therapeutic geographies of cancer in contemporary conflicts.This retrospective single centre study explores the therapeutic and clinical geographies of Afghan cancer patients who were treated at the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) in Lahore, Pakistan over a 22-year-period (1995 to 2017) covering major periods of conflict and relative peace.Data was available for 3,489 Afghan patients who received treatment at SKMCH&RC. The mean age at presentation was 42.7 years, and 60% were men. 30.2% came from Kabul and Nangarhar districts of Afghanistan, which have relatively short travel times to Pakistan, but patients from all parts of Afghanistan migrated to SKMCH&RC for treatment. Overall, 34.1% were diagnosed with upper gastrointestinal malignancies and 55.7% presented with late stage III/IV cancer. A wide range of treatments were provided, with 25.4% of patients receiving a combination of chemotherapy and radiation treatment. 52.7% of all patients were lost to follow-up. Outcomes were more favourable for children with cancer, 42% of whom had a complete response to therapy.Complex migration patterns, mixed political economies (refugees, forced and unforced migrants) and models of care that must be adapted to the realities of the patients rather than notional international standards all reflect the new therapeutic geographies that long-term conflict creates. This requires significant new domestic and international (e.g., United Nations High Commissioner for Refugees) policy and practises for providing cancer care in today’s contemporary conflict ecosystems that frequently cross national borders.

Remembering World War I in AmericaA Shadow on Our Hearts: Soldier-Poetry, Morality, and the American War in VietnamThe Hell of War Comes Home: Imaginative Texts from the Conflicts in Afghanistan and IraqBodies at War: Genealogies of Militarism in Chicana Literature and Culture

Remembering World War I in AmericaA Shadow on Our Hearts: Soldier-Poetry, Morality, and the American War in VietnamThe Hell of War Comes Home: Imaginative Texts from the Conflicts in Afghanistan and IraqBodies at War: Genealogies of Militarism in Chicana Literature and Culture

Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts

IntroductionTraumatic brain injury (TBI) is the most common cause of death on the modern battlefield. In recent conflicts in Iraq and Afghanistan, the US typically deployed neurosurgeons to medical treatment...

A novel mouse model of mild traumatic brain injury using laser-induced shock waves

Blast-induced mild traumatic brain injury (mild bTBI) has been a frequent battlefield injury in soldiers during the conflicts in Iraq and Afghanistan. Understanding the pathophysiology and determining effective treatments for mild bTBI has become an international problem in the field of neurotrauma research. Contributing to this problem is a lack of an experimental model that accurately mimics the characteristics of mild bTBI. To date, the “mild’’ versions of common experimental models of TBI have simply been less severe degrees of traumatic injury; these animals do not necessarily exhibit the clinical characteristics of mild bTBI seen in humans. Therefore, our first objective was to develop a highly controlled mouse model of bTBI using laser-induced shockwaves (LISWs). We established the parameters necessary to cause a reproducible injury of very mild severity, the most important feature seen in clinical practice. We defined very mild bTBI as having no traumatic change on the head visible to the naked eye after the insult was applied using very mild shockwaves to the heads of mice. Our very mild bTBI mouse model exhibited neurobehavioral changes in the chronic phase, such as cognitive impairment and depression-like behavior. We also observed an increase in 5-bromo-2′-deoxyuridine-positive, proliferating cells in the dentate gyrus during the acute phase and a subsequent decrease during the chronic phase. This model appears to be an accurate representation of the damage occurring in actual mild bTBI patients. We also found that an increase in cell proliferation in the dentate gyrus during the acute phase is the most prominent feature after a TBI.

Lost in translation: anthropologists and Marines in Iraq and Afghanistan

ABSTRACTDrawing upon ethnographic data gathered over a six year period, this paper illustrates how the contrasting worldviews of US Marines and anthropologists frequently led to misunderstandings, frustrations, and garbled interpretations as the two struggled to work together to help resolve conflicts in Iraq and Afghanistan. I examine three key military domains where cultural experts and Marines attempted to work together to understand the cultural factors at play in both Iraq and Afghanistan: first as interpreters or experts in pre-deployment language and culture training programs; secondly in theater on the Human Terrain Teams; and third as cultural SMEs (experts) in military planning rooms. As the case studies and interviews illustrate, while both sides thought they were working together to understand the foreign cultures where they were operating, the real cross-cultural misunderstanding was ironically between the cultural experts and Marines.

Balanced Coverage in Practice: News Reporting of Conflict and Peace in Afghanistan

The application of the concept of balance in news is considered to be the cornerstone of professional journalism; however, the realization of balance when covering issues of conflict raises a number of serious questions. Based on interviews and textual analysis, we seek to understand how the concept of balance is perceived by journalists working with non-governmental/private broadcast media in Afghanistan. The findings of this research show that differences exist in the way balance is perceived and applied. There are also a number of constraints in applying the concept. Furthermore, the practical application of the concept of balance reduces the complexity of the conflict by presenting only two opposing sides. Nonetheless, we argue that balance has uses for journalists in Afghanistan. The authors recommend increasing the number of sources in news stories, inclusion of non-violent groups/parties as sources, and encouraging creative ways of reporting and presenting issues of conflict and peace.

Peace in Afghanistan:

The year-2019, marked the 40 years of instability and chaos in Afghanistan, ever since it was invaded by former Soviet Union in December 1979. In the last forty years, the Afghan instability and conflict has been so transmissible that any peace plan, initiated even with sincerity got entombed into viscid domestic ambiguities, undesired regional rivalries and geopolitical interests of great powers. Owing to internal instability and frequent foreign invasions, there could not develop a cohesive national character within Afghanistan. Besides, there has been no institutional build-up and development which could have provided a strong base for the establishment of good governance system. In the absence of domestic peace and a unanimously acceptable leadership, the invaders and regional players have been exploiting Afghan geopolitics and its diverse societal makeup. Above all, the poor economic system, lack of needed resource base and massive unemployment constrained the flexibility, the Kabul regimes could have utilized for the minimum economic management at the domestic level. Furthermore, the post 2014 drawdown of US and NATO forces did not provide conducive environment where Afghans could have taken independent decisions to determine their future course of action for the larger national interest of the state and masses. The paper takes a critical analysis of the above-mentioned factors, which impeded peace process from taking firm roots in Afghanistan. The paper also puts into debate the US strategic interests in and around Afghanistan and diverging interests of regional countries which further impede peace process in Afghanistan.

Exploring Disparities in Awarding VA Service-Connected Disability for Post-Traumatic Stress Disorder for Active Duty Military Service Members from Recent Conflicts in Iraq and Afghanistan

We explore disparities in awarding post-traumatic stress disorder (PTSD) service-connected disability benefits (SCDB) to veterans based on gender, race/ethnicity, and misconduct separation. Department of Defense data on service members who separated from October 1, 2001 to May 2017 were linked to Veterans Administration (VA) administrative data. Using adjusted logistic regression models, we determined the odds of receiving a PTSD SCDB conditional on a VA diagnosis of PTSD. A total of 1,558,449 (79% of separating service members) had at least one encounter in VA during the study period (12% female, 4.5% misconduct separations). Females (OR 0.72) and Blacks (OR 0.93) were less likely to receive a PTSD award and were nearly equally likely to receive a PTSD diagnosis (OR 0.97, 1.01). Other racial/ethnic minorities were more likely to receive an award and diagnosis, as were those with misconduct separations (award OR 1.3, diagnosis 2.17). Despite being diagnosed with PTSD at similar rates to their referent categories, females and Black veterans are less likely to receive PTSD disability awards. Other racial/ethnic minorities and those with misconduct separations were more likely to receive PTSD diagnoses and awards. Further study is merited to explore variation in awarding SCDB.

Analysis of Casualties That Underwent Airway Management Before Reaching Role 2 Facilities in the Afghanistan Conflict 2008-2014.

Airway compromise is the second leading cause of potentially survivable death on the battlefield. The purpose of this study was to better understand wartime prehospital airway patients. The Role 2 Database (R2D) was retrospectively reviewed for adult patients injured in Afghanistan between February 2008 and September 2014. Of primary interest were prehospital airway interventions and mortality. Prehospital combat mortality index (CMI-PH), hemodynamic interventions, injury mechanism, and demographic data were also included in various statistical analyses. A total of 12,780 trauma patients were recorded in the R2D of whom 890 (7.0%) received prehospital airway intervention. Airway intervention was more common in patients who ultimately died (25.3% vs. 5.6%); however, no statistical association was found in a multivariable logistic regression model (OR 1.28, 95% CI 0.98-1.68). Compared with U.S. military personnel, other military patients were more likely to receive airway intervention after adjusting for CMI-PH (OR 1.33, 95% CI 1.07-1.64). In the R2D, airway intervention was associated with increased odds of mortality, although this was not statistically significant. Other patients had higher odds of undergoing an airway intervention than U.S. military. Awareness of these findings will facilitate training and equipment for future management of prehospital/prolonged field care airway interventions.

Tactical Combat Casualty Care in Operation Freedom's Sentinel.

Over the course of nearly 19 years of conflict, Tactical Combat Casualty Care (TCCC) guidelines and their implementation have evolved to incorporate the latest advances in trauma research, casualty care, and transport, playing a large role in generating the lowest incidence of preventable deaths in the history of modern warfare. During the conflicts in Afghanistan and Iraq, the adoption and implementation of TCCC principles by conventional forces have been extrapolated to have been responsible for saving the lives of more than 1,000 US Servicemembers. As the intensity and nature of the military conflicts in Afghanistan and Iraq change, and a growing potential for a near peer conflict rises, it remains important that the lessons of TCCC continue to be instilled in our formations in garrison, before deployment, and while in theater. This article reviews the use of TCCC principles by an assault helicopter battalion, in combination with a variety of other factors, in the successful management of a mass casualty event during Operation Freedom's Sentinel 2019 in Afghanistan.

Opium poppy in Afghanistan: The determinants of cultivation

In this article we examine increasing opium poppy cultivation in Afghanistan since 2001. First, we discuss the historical background for the emergence and spread of opium production in Afghanistan in the 20th century and its current spatial distribution. Then we proceed with our statistical analysis. Our results show that the intensity of violent conflict (which we proxy by the number of military casualties in a calendar year) and the farm gate price of opium are positively correlated with the increase in opium cultivation. We find that a 1% increase in conflict intensity leads to 0,2% increase in the land under opium poppy cultivation the following season. Given the magnitude of the increase in the intensity of conflict in Afghanistan in 2010s these effects seem to be very significant. Our findings are in line with existing research on the topic. Higher conflict intensity and the expansion of the conflict zone may create conditions, where opium cultivation is a low-risk activity and may be preferable to the production of other agricultural goods, with southern regions of Afghanistan being particularly affected both by higher conflict intensity and opium production. However, we note that our analysis is constrained by data quality and availability and should be viewed as capturing some of the interconnection between the variables of our choice, but not strictly causal.

Сучасний стан діагностики та лікування військовослужбовців із вогнепальними проникаючими пораненнями великих суглобів. Огляд літератури

SummaryGunshot wounds of the joints are classified as severe injuries, primarily because thecomplexity of their anatomical structure, deep placement in tissues, in particular the hipjoint, favorable conditions for the development of infection, and a large percentage ofinjured persons who are disabled. According to the analysis carried out, penetratinggunshot wounds of large joints differ in number and this depends on the scale of thearmed military conflict. In particular, during the Second World War, gunshot wounds oflarge joints were found in 5.71% of the total structure of gunshot wounds of theextremities.During the war in the former Yugoslavia, gunshot wounds of the joints occurred in18.2%. During the war in eastern Ukraine, the proportion of penetrating gunshotwounds of large joints was 17.1%. The increase in the proportion of injuries of largejoints in military conflicts after the Second World War is due to the lack of personalprotective equipment and the purposeful work of snipers, which is aimed at deliberatelydisabling the wounded. During the armed conflict in Afghanistan, injuries of theshoulder joint were observed in 18.9%, elbow joint – 17.6%, hip joint – 21.6%, kneejoint – 32.6%, and ankle joint – 9.5%. Injuries of the knee and elbow joints were mostoften observed, 46.6% and 20.1%, respectively. In the structure of gunshot injuries ofthe upper limb at the level of the shoulder – elbow joint, the proportion of polystructuralpenetrating wounds of the elbow joint is 24.4%, most of which were accompanied by theformation of tissue defects.All penetrating gunshot wounds of the joints are polystructural injuries that requirea clear understanding of the anatomical and functional features of the damaged area.Fulfillment of the basic rules of primary surgical treatment, the earliest possiblereposition of intra-articular bone fragments, adequate debridement of the joint, stablefixation of the main fragments and early restoration of movement and support in case ofdamage to the lower extremities are the main elements in the provision of medical careto this category of patients.

Афганский вооруженный конфликт в 1980-е годы и позиция некоторых государств Латинской Америки

The article reviews the policy of some Latin American states regarding the Afghan armed conflict of 1979–1989 with the participation of Soviet troops. The objective of the study is to find out the degree of support by Latin American states for both Soviet policy in Afghanistan and the Afghan government itself of that period. To achieve the objective of the study, the author resorts to studying documents, including collections of foreign policy documents of the Soviet Union and UN documentation. The author separately considered the Cuban policy in this matter, separately – the policy of the Latin American socialist-oriented states (Nicaragua and Grenada), the author also refers to the policy regarding the Afghan conflict of states that took an intermediate position of support for conflict (for example, Argentina and Mexico). The author pays the main attention to the diplomatic position of the above-mentioned states. The author comes to the following conclusions: on the Latin American continent, fewer states supported the Soviet policy in Afghanistan compared with the number of states condemning it or holding a neutral position – but nonetheless, the number of these supporters throughout the 1980s remained stable. A key supporter of the «Afghan» policy of the USSR in Latin America in the 1980s was Cuba, while Cuba supported not so much the policy of the USSR in Afghanistan, expressed in maintaining the Soviet military presence there, but the line aimed at a political settlement of the Afghan conflict; Nicaragua and Grenada’s position was more restrained than Cuban’s, and after the October events of 1983, the USSR lost the Grenadian support for its «Afghan» policy; and some states of the continent took an intermediate position – they did not provide the USSR with direct diplo-matic support, but carried it out indirectly.