Publications

While the onset of mechanical hyperalgesia induced by endothelin-1 was delayed in female rats, compared to males, the duration was much longer. Given that the repeated test stimulus used to assess nociceptive threshold enhances hyperalgesia, a phenomenon we have referred to as stimulus-induced enhancement of hyperalgesia, we also evaluated for sexual dimorphism in the impact of repeated application of the mechanical test stimulus on endothelin-1 hyperalgesia. In male and female rats, endothelin-1 induced hyperalgesia is already maximal at 30 min. At this time stimulus-induced enhancement of hyperalgesia, which is observed only in male rats, persisted for 3-4h. In contrast, in females, it develops only after a very long (15 day) delay, and is still present, without attenuation, at 45 days. Ovariectomy eliminated these differences between male and female rats. These findings suggest marked, ovarian-dependent sexual dimorphism in endothelin-1 induced mechanical hyperalgesia and its enhancement by repeated mechanical stimulation.

PURPOSE OF REVIEW

Traumatic injury continues to be a significant cause of morbidity and mortality in the year 2011. In addition, the healthcare expenditures and lost years of productivity represent significant economic cost to the affected individuals and their communities. Helicopters have been used to transport trauma patients for the past 40 years, but there are conflicting data on the benefits of helicopter emergency medical service (HEMS) in civilian trauma systems. Debate persists regarding the mortality benefit, cost-effectiveness, and safety of helicopter usage, largely because the studies to date vary widely in design and generalizability to trauma systems serving heterogeneous populations and geography. Strict criteria should be established to determine when HEMS transport is warranted and most likely to positively affect patient outcomes. Individual trauma systems should conduct an assessment of their resources and needs in order to most effectively incorporate helicopter transport into their triage model.

RECENT FINDINGS

Research suggests that HEMS improves mortality in certain subgroups of trauma patients, both after transport from the scene of injury and following interfacility transport. Studies examining the cost-effectiveness of HEMS had mixed results, but the majority found that it is a cost-effective tool. Safety remains an issue of contention with HEMS transport, as helicopters are associated with significant safety risk to the crew and patient. However, this risk may be justified provided there is a substantial mortality benefit to be gained.

SUMMARY

Recent studies suggest that strict criteria should be established to determine when helicopter transport is warranted and most likely to positively affect patient outcomes. Individual trauma systems should conduct an assessment of their resources and needs in order to most effectively incorporate HEMS into their triage model. This will enable regional hospitals to determine if the costs and safety risks associated with HEMS are worthwhile given the potential benefits to patient morbidity and mortality.

The number of women of childbearing age who are active-duty service members or veterans of the US military is increasing. These women may seek reproductive health care at medical facilities operated by the military, in the civilian sector, or through the Department of Veterans Affairs. This article reviews the current data on unintended pregnancy and prevalence of and barriers to contraceptive use among active-duty and veteran women. Active-duty servicewomen have high rates of unintended pregnancy and low contraceptive use, which may be due to official prohibition of sexual activity in the military, logistic difficulties faced by deployed women, and limited patient and provider knowledge of available contraceptives. In comparison, little is known about rates of unintended pregnancy and contraceptive use among women veterans. Based on this review, research recommendations to address these issues are provided.