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SUMMARY •

ANALlSYS OF INTERNAL STRUCTURE OF CANCER PATIENTS TREATED IN THE CLINIC OF HEMATOLOGY & ONCOLOGY DUR­ING 2001-2005 J. RAYNOV, ZH. MICHAYLOVA, I. NIKOLOV .......................................................................................................................................... 3

. MANAGEMENT OF SEVERE HEAD INJURY N.MLADENOV, M.SIMEONOVA-DOICHINOVA, N. PETROV ................................................................................................................ 6

CLINICAL AND LABORATORY FINDINGS IN THREE CASES OF 46,XX MALE SYNDROME V.IVANOV, L.MITEV, A.ANGELOV, A.TZVETANOVA, T.TOTOMIROVA, S.PASHKUNOVA, E.IVANOVA ................................................ 9

IMAGE-GUIDED CEREBRAL METASTASECTOMY T. EFTIMOV, A. PETKOV, I. STOEV, I. IVANOV ...................................................................................................................................... 11

PHARMACOLOGICAL CARDIOVERSION THROUGH QUICK INITIAL LOADING DOSE OF AMIODARONE IN CASE OF PAROXYS­MAL ATRIAL FIBRILLATION A. PAVLOV, Y. YONOV, B. DOTZEV, V. ILIEVA, K. PRINOVA ............................................................................................................... 15

TRAUMATIC AND GUNSHOTS LESIONS OF MAIN BLOOD VESSELS OF THE EXTREMITIES 0. ZLATEV, H. PESHEV, K. GUIROV, P. CHUKACHEV, B. MAGAEV .....................................................................•............................. 18

PATHOPHYSIOLOGY AND TREATMENT OF TRAUMAS OF MAIN BLOOD VESSELS OF THE EXTREMITIES H. PESHEV, Z. LAZAROV, G. KAZANDGIEV, l. GIAHOV, 1 B. MAGAEV, K. GIROV .....................................•....................................... 21

TRYCHOSTRONGILOIDOSIS IN A PATIENT WITH CHRONIC GASTROINTESTINAL SYMPTOMS A. GALEV, P. CHOBANOVA, Y. DIMOVA .............................................................................................................................................. 25

A CASE OF PERSONALITY DISORDER IN A MILITARY PILOT S. DOSHEV, L. ALEXIEV, E. CALUDIEV .............................................................................................................................................. 27

TERRORIST ATTACK "IN PEACE KEEPING OPERATION" IN KERBALA, IRAQ S. TONEV, K. KANEV, D. LEKOV .........................................................................................................................................•.............. 30

-· - - . PSYCHOLOGICAL CHALLENGES IN PEACEKEEPING OPERATIONS IN IRAQ S. TONEV, IL. MARINOV, K. KANEV, K. RAMSHEV, A. PETKOV ...................................................................................................•..... 33

MEDICAL SUPPORT FOR THE BULGARIAN CONTINGENT IN IRAQ BY THE COALITION FORCES K. KANEV, A. PETKOV ......................................................................................................................................................................... 36

ORGANISATION OF MEDICAL EVACUATION IN THE AREA OF RESPONSIBILITY OF MND-CS AND PARTNERSHIP OF BULGARIAN MILITARY MEDICAL SERVICE IN IT D. DONCHEV, K. KIREV ............................................................................... ., ....................................................................................... 40

PSYCHO-PHYSIOLOGICAL INVESTIGATION OF STRESS RESPONSE ASSOCIATED WITH PARTICIPATION IN PEACEKEEPING MISSIONS L. ALEKSIEV, R. NIKOLOVA, K. KANEV, H. LESSIDRENSKl, L. T ASKOV A ....................................................................................... 44

PEACEKEEPING MISSIONS A PSYCHOLOGICAL ASSESSMENT OF TRAUMA STRESS WiTH BULGARIAN MILITARY SERVICE PERSONNEL IN IRAQ . I. BONEV, Y. YORDANOV, Z. STOEVA ..................................................... ............... ............................................................................. 47

STANDARDIZE OF METHODS FOR MEASURING INTELECTUAL COEFFICIENT FOR MILITARY PSYCOLOGICAL NEEDS M. DIMITROVA, T. DONCHEV ............................................... ................................................................................................................ 51

TELEMEDICINE POSSIBILITIES AND DEVELOPMENT IN BULGARIA A. PETKOV, G. IANCHEV, V. VASSEVA, A. KRUSTEVA ............... ........................................................ .......... .................... ................. 53

FIRST STEPS OF MEDICAL EDUCATION IN THE THIRD BULGARIAN KINGDOM J. DOCHEV M. STOEVA, K. KANEV, G. VARBANOV, V. VASSEVA ..................................................................... ......... .................. .... 56

f\111! ETA RY M E 0 l C I r~::::: CANNOT BE HELD RESPONSIBLE FOR ERRORS OR FOR ANY CONSEQUENCES ARISING FROM THE USE OF THE INFORMATION CONTAINED IN THIS JOURNAL.

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PSYCHO-PHYSIOLOGICAL INVESTIGATION OF STRESS RESPONSE ASSOCIATED WITH PARTICIPATION IN PEACEKEEPING MISSIONS

L. Aleksiev\ R. Nikolova2, K. Kanev\ H. Lessidrenski\ L. Taskova1

1Center For Military Medical Expertise And Aviation Medicine 2National Center For Public Health Protection, Laboratory For Physiology, Psychology And Ergonomics - Military Medical Academy, Sofia

SUMMARY

One of the main tasks of military medical science is to implement health surveillance of military person­nel participating in Multinational Missions (MNM), in­cluding Peacekeeping Missions (PKM). PKM are dan­gerous and are characterized by conflicts , incidents, and challenges. Therefore the task of the military medi­cine, which considers the health status and the psy­chological and physical well-being of military person­nel as important indicators of operational effectiveness, is to control medical readiness (Capleton et al ., 2003). The medical readiness could be compromised during peacekeeping deployment phases when personnel are exposed to stress.

Key words: STRESS RESPONSE, PEACEKEEPING MISSIONS

INTRODUCTION

An extensive theoretical formulation and typology of peacekeeping stressors is given in military medical studies (Lamerson and Kelloway, 1996; Breakwell and Spacie, 1997; Litz et al. , 1997; Wright et al. , 2002). A specific requirement for military personnel participat­ing in PKM is the ability to maintain balance between combat readiness and the exercise of restraint (Wright et al. , 2002). Both parts of th is definition presuppose that participants are exposed to: the impact of poten­tial ly traumatic combat war-zone situations (combat attacks and incidents: dangerous patrols ; w itnessing death and injury; handling bodies j (Vvright et ai., 2002; Dirkzwager et al. , 2003); terrori st attacks (Bartone and Adler, 1998); social and psychological stressors (he I p­lessness, powerlessness, isol ation , boredom , mo­notony, separation from fami ly, role stressors , nation­al istic interests , non-recognition of human rights , state corruption, organized crime , drug and people traffick­ing, and provocations) (McDonald et a l. , 1998; Litz, 1996 ; Weisaeth et al. , 1996; Wright et a l. , 2002; Dirkzwager et al. , 2003).

Peacekeepers are exposed to different kinds of stressful experience that may put them , independently of their good health status and high level of psycho­logical and physical selection and training , at risk for development of medical and psychological problems

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screening is used to determine risk indicators and to predict morbid outcomes as a consequence of partici­pation in PKM (Castro et al. , 2000; Orsillo et al. , 1998; Brundage, 1998). Essential component of health sta­tus screening during peacekeeping deployment phases is the determ inat io n o f the effect of st ress on peacekeepers functional and psychological state.

The aim of our study was to determine the effect of stress on cardiac autonomic function and health risk of peacekeepers participating in PKM in Kosovo and Afghanistan .

METHODS

Two groups participated in the study: 36 male peacekeepers (mean age/SO; 28.3/7.1 yr) deployed on a six-month peacekeeping mission in Kosovo , ex­amined at the re-dep loyment phase ; 24 male peacekeepers (age, 29.7/8.3 yr) deployed on a six­month peacekeeping mission in Afghanistan , exam­ined at the re-deployment phase.

Peacekeepers were selected to be physically and psychologically healthy and suited for deployment ac­cording to NATO standards. Personal interview and inquiry in reference to physical load with fitness exer­cises at peacekeepers leisure time is performed at al l participants in PKM at the re-deployment phase. The purpose is to determine peacekeepers self-assessment manifesting in general comprehension for the system­atic and purposeful physical load or its absence.

1. Computerized diagnostic system for analysis of Heart Rate Variabil ity.

A computerized d iagnostic system was used to examine the functionai state of the cardiovascular sys­tem using measures of Heart Rate Variability (HRV) (Danev, 1989; Nikolova , 1993). HRV data were deter­mined from 1 0-min ECG recordings obtained between 9 a.m . and 11 a.m. in the supine position.

Time-domain and frequency-dom ain based HRV measures and HRV derived indices were analyzed :

1.1. Time-domain H RV measures : X (mean RR-~n­te:va!) (msec); Short-TerrTt Vari abili ty (STV) (msec);

1.2. Frequency-domain HRV measures: Spectra l power of cardiointerva ls in the Respiratory Si -

1.3. HRV-derived indices: Physical Stress (PS) (arb. un.) ; Mental Stress (MS) (arb. un. ); Health Risk (HR) (0/o).

2. Personal interviews and inquiries.

Personal interviews with peacekeepers were con­ducted to examine stressors. Results of interviews sho.wed that peacekeepers participating in PKM in Kosovo, and Afghanistan were exposed to the follow­ing general types of stress: social and psychological stress (permanent maintenance of alertness and at­tention; work on day/night duties ; deployment in new environment; provocations; consideration of the way of life , customs, and religion of the native population; separation from family ; limited access to civilian places); risk of terrorism ; potentially traumatic combat situations (incidents of combat attacks ; dangerous patrols; safeguarding of important objectives; and in­creased risk of escalating conflicts).

Results of interviews showed also that peace­keepers participating in PKM in Afghanistan were ex­posed to the following specific stressors associated with peacekeeping deployment: high altitude stress exposure and adaptation, specific psychological and social stressors related to leisure time, deployment in confined space groups without an exit option, living at camps, lack of diversity and contact with different peo­ple.

3. Data analysis:

The following method was employed for data analy­sis: independent sample t-test. A p value <0.05 was considered statistically significant.

RESULTS

To examine the level of stress response of peacekeepers participating in different PKM ( 1 . Kosovo; 2. Afghanistan) , both groups were examined at there­deployment phase HRV indices were compared by t­test. The mean values of HRV indices in peacekeepers at the re-deployment phases are presented in Table 1.

Comparison of the peacekeepers re-deployment phases showed significant increase in mean heart rate, physical (PS) and mental stress (MS), and health risk (HR) , and significant decrease in mean values of X, STV, and P RSA in peacekeepers participating in PKM in Kosovo, as compared to peacekeepers participating

Tabie 1. V

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VARIABLES PKM PKM p-VALUE I KOSO V O - 1 AFGHAN 1ST AN - 2 1-2

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Heart Rat e (b/min ) 74 ,5±10,22 67 ,30± 9 .32 0 .01 - -

T ime-domain HRV mea sures ~ - - ---

X (msec) 812 .52± 111 . 1 3 903 .89±118_78 0 .01

STV (msec) 63.02±8.65 77 .8 0±9 .50 0 .03 - - -

Frequency-domain HRV measures - - - - -

2 PRsA (ms ) 9 79±1 35 15,58±1 .65 <0.0001

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HRV -derived ind1ces

HR ('%) 41 .4±6.36 . r) 1 Q 1 -1-4 7~ <O.OOOi . 4 f • • ...L- • ""'

--

P S (a rb. u n . ) 0 74±0.06 -0 43±0.0 3 0 _007

1 M S (a rb _ u n . ) 0 .79±0 08 I - 2 .39±0.01 I 0 .03

---- -·-- __ ....._ ---·--- --------~----

. ' . ' ..,.. . . ~ . . . . . ~ . . . - . . <

.. ,~ . . . ~ . . )

DISCUSSION

In peacekeepers participating in PKM in Kosovo com pared to peacekeepers participating in PKM in Af­ghanistan we found a deviation from the referent val­ues of the time-domain and frequency-domain HRV measures , and HRV-derived indices. The deviation from the referent values of the examined cardiovascu .. lar indices revealed a trend for development of dys­functional cardiac autonomic response, result of ex­posure to peacekeeping stressors in Kosovo .

Comparison of the re-deployment phases showed increases of the mean values of heart rate , physical and mental stress , and health risk in peacekeepers participating in PKM in Kosovo compared to peace­keepers participating in PKM in Afghanistan. We ob­served also decreases of the mean values of X, STV, and P RsA in peacekeepers in Kosovo. These results indicate that peacekeeping stress in Kosovo induces a reduction of parasympathetic function of heart rhythm .

Both groups~ peacekeepers participating ~n PKM in Kosovo and peacekeepers participating in PKM in Afghanistan were exposed to peacekeeping stress. However the relationship between exposure to peace­keeping stressors and mental stress might be moder­ated by the high level of physical fitness in peac­ekeepers participating in PKM in Afghanistan , who showed high levels of physical fitness and low levels of physical stress (PS). A six·month peacekeeping deployment in Afghanistan was associated with daily maintenance of physical exercise of the peacekeepers own choice, which contributed to their high level of physical training (low level of PS) .

Results of our study indicate that psychophysiologi­cal assessment of peacekeeper stress response at the re-deployment phases with functional indices contrib­utes to objective information about peacekeepers health status resulting from the impact of stress. The most likely mechanism for the observed changes in cardiac autonomic function is the cumulative effect of: risk of terrorist attacks, potentially traumatic combat stressors , and social and psychological stressors (Brundage J. , 1998; Litz B., 1996; Lamerson C. and Kelloway E. , 1996; Wright K., Huffman A. , Adler A. , Castro C. , 2002). The exposure to peacekeeping stressors induces functional changes in cardiac auto­nomic function. The assessment of health risk is an essential component of medical screening to determine risk indicators and to predict morbid outcomes as a consequence of participation in PKM . Health status screening during participation in PKM is requ ired to determine the effect of stress on peacekeepers func­tional state.

REFERENCES

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Occasional Paper Number 29 . Camberley UK: Strategic and Combat Studies Institute , 1997.

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