Showing papers in "Military Medicine in 2003"

Geographic mobility, family, and maternal variables as related to the psychosocial adjustment of military children.

Abstract: The present study examined maternal and family factors and family mobility as related to mothers' and children's reports of the psychological adjustment of children in military families. Participants were 86 mother-child dyads in U.S. traditional military families. Children's reports of loneliness, peer relationships, fear of negative evaluations, and self-esteem were predicted by family cohesiveness, children's reports of their relationships with their mothers, and the length of time they had lived in their current residence, but not their rate of mobility (i.e., number of moves in the child's lifetime divided by the child's age). In contrast, maternal depressive symptoms predicted children's depressive and anxious behaviors, and both maternal depressive symptoms and children's perception of their relationship with their mothers predicted children's aggression and noncompliance. Results suggest that moving may not be as important as other aspects of maternal functioning and family relationships for the psychosocial adjustment of children in military families.

Effect of Static Stretching on Prevention of Injuries for Military Recruits

Abstract: This prospective study was designed to evaluate whether static stretching can prevent training-related injuries in Japan Ground Self-Defense Force military recruits. A total of 901 recruits between 1996 and 1998 were divided into two groups. Of which, 518 recruits were assigned to the stretching group and practiced static stretching before and after each physical training session. The control subjects (383 recruits in the nonstretching group) did not stretch statically prior to exercise. The static stretching consisted of 18 exercises. We collected injury data from medical records and assessed the incidence and the location of injury. The total injury rate was almost the same between two groups; however, the incidences of muscle/tendon injury and low back pain were significantly lower in the stretching group (p < 0.05). Static stretching decreased the incidence of muscle-related injuries but did not prevent bone or joint injuries.

Immune and hormonal changes following intense military training.

Abstract: This study was designed to determine whether the immune and hormonal systems were affected by a 5-day military course following 3 weeks of combat training in a population of 26 male soldiers (mean age, 21 +/- 2 years). The combination of continuous heavy physical activity and sleep deprivation led to energy deficiency. At the beginning of the training program and immediately after the combat course, saliva samples were assayed for secretory immunoglobulin A and plasma samples were assayed for interleukin-6, dehydroepiandrosterone sulfate, prolactin, catecholamines, glucocorticoids, and testosterone. Secretory immunoglobulin A was lower and circulating interleukin-6 was increased by the end of the course, which was attributed to sympathoadrenergic stimulation. Dehydroepiandrosterone sulfate, prolactin, and testosterone levels fell significantly. These results suggest that prolonged and repeated exercise such as that encountered in a military training program induces immune impairment via a decrease in mucosal immunity and a release of interleukin-6 into the circulation. The impaired secretion of dehydroepiandrosterone sulfate and prolactin, two immunomodulatory hormones, was thought to be a response to the chronic stressors. Lowered testosterone reflects a general decrease in steroid synthesis as a consequence of the physical and psychological strain.

Childhood obesity's relationship to time spent in sedentary behavior.

Abstract: Objective: The purpose of this study was to evaluate various types of sedentary behavior children participate in and to look for an association to childhood obesity. Methods: Questionnaires were used to gather data on physical and sedentary activity, dietary intake, demographics, and anthropometries of 9- to 12-year-old military dependents and their parents. Results: Using body mass index (BMI), 39.8% of children were obese. A significant relationship was found between childhood obesity and computer usage, television watching, total hours in sedentary behavior, and maternal BMI. An indirect significant relationship with childhood obesity was also shown if a parent was home when the child got home from school and if a father participated in exercise with their child. Caloric intake, total time in physical activity, demographic variables, and father's BMI showed no significant relationship with children's BMI. Conclusion: Interventions should be designed targeting total time spent on the computer, total time watching television, and maternal obesity in child obesity programs.

Depression in men with traumatic lower part amputation: a comparison to men with surgical lower part amputation.

Abstract: This study aimed at comparing the prevalence of depression among traumatic and surgical amputees and examining the relationship between depression and sociodemographic/clinical characteristics of amputees. Participants were 49 patients with traumatic lower part amputation and 35 patients with surgical lower part amputation. The diagnosis of depression in each participating patient was confirmed by means of the Structured Clinical Interview for DSM-IV, Turkish version. The level of depression was assessed by using the Hamilton Depression Rating Scale. The prevalence of depression was 34.7% in the traumatic amputee group and 51.4% in the surgical amputee group (p > 0.05). In the traumatic group, depression was associated with time since amputation but not with other variables. However, in the surgical group, depression was associated with age, education level, marital status, economic status, time since amputation, and whether the patient was treated with prosthesis. Our data indicated that depression is a common clinical condition among amputees. Clinicians may be advised to schedule periodic contacts with amputees over long periods to identify those in need of psychiatric intervention.

Women in the Gulf War: combat experience, exposures, and subsequent health care use.

Abstract: The expanding role of women in the military raises questions related to the military experiences of women serving in major conflicts. We assess the military experiences and postwar health care use of women who served during the Gulf War. Data from a population-based survey of military personnel serving between August 1990 and July 1991 assessing military preparedness, combat experience, occupational and other service-related exposures, and health care use were analyzed. Deployed women were more often in the Army, single, without children, college educated, and reported fewer vaccinations. Deployed men and women had similar military experiences; however, men more often participated in combat. Deployed women had more outpatient and inpatient health care use 5 years after deployment and more often received Department of Veterans Affairs compensation than men. If these important differences in exposures and health care use are confirmed in other studies, optimal training and deployment preparedness strategies should be reconsidered.

Suicidal admissions in the United States military.

Abstract: Suicide is currently the second leading cause of death in the U.S. military. Little recent research has been done on a well-defined cohort at high risk for death by suicide, which consist of military patients who attempt suicide or are admitted for suicidal ideation. As a pilot investigation based on a literature review of suicidal behavior in the U.S. military, 100 consecutive charts of suicidal patients at a tertiary military treatment facility were reviewed. The findings included the following: 94% were admitted with a depressed mood; 67% had a history of previous attempts or gestures; 49% had been treated with psychiatric medication prior to admission and 88% were treated with psychiatric medications while on the ward; 47% returned to a full duty status; 29% were recommended for administrative separation; and 18% were recommended for a medical board. Suggestions for future research are presented to help improve our suicide prevention programs.

Antibiotics in tactical combat casualty care 2002.

Abstract: Care of casualties in the tactical combat environment should include the use of prophylactic antibiotics for all open wounds. Cefoxitin was the antibiotic recommended in the 1996 article "Tactical Combat Casualty Care in Special Operations." The present authors recommend that oral gatifloxacin should be the antibiotic of choice because of its ease of carriage and administration, excellent spectrum of action, and relatively mild side effect profile. For those casualties unable to take oral antibiotics because of unconsciousness, penetrating abdominal trauma, or shock, cefotetan is recommended because of its longer duration of action than cefoxitin.

Does point-of-purchase nutrition labeling influence meal selections? A test in an Army cafeteria.

Abstract: Objective: This study assessed the effectiveness of nutrition labeling on sales of targeted entrees and measured the perceived influence that factors such as taste, quality, appearance, fat content, calorie content, and price had on meal selection behavior within an Army cafeteria. Methods: A quasi-experimental design was used to compare targeted entree sales between a 1-year baseline period and two 30-day postintervention periods, after the placement of entree nutrition labels. A brief questionnaire, distributed to 149 patrons, measured the perceived influence of the aforementioned factors on selections. Results: Analysis of variance detected no significant differences in sales between baseline and the two intervention periods; the factors of taste and quality were rated most influential to meal selection (p < 0.000). Conclusions: A marketing campaign focusing on the health attributes of targeted entree items was not successful in boosting sales. Sensory attributes (i.e., taste, quality, and appearance) appear to be more influential to meal selection.

Nutrition knowledge and supplement use among elite U.S. army soldiers.

Abstract: : A U.S. Army Special Forces (SF) unit was studied to determine the characteristics of those who were dietary supplement users, assess their nutrition knowledge, and identify the nutrition information sources they use. SF-qualified (n=119) and non-SF, support soldiers (n=38) participated in the study. Results show that most soldiers (87%) reported current supplement use with more SF (90%) than non-SF, support soldiers (76%) using supplements (p

Upper body fatiguing exercise and shooting performance.

Abstract: This study assessed the effect of upper extremity muscle fatigue on shooting performance while in a standing, unsupported firing position. Nine male and three female soldiers fired at targets before and after performing upper extremity exercise to fatigue using both (1) an upper body ergometer and (2) a Military Operations in Urban Terrain obstacle course. Shooting accuracy, assessed by the number of hits, misses, and shot group size, was significantly decreased (p < 0.05) immediately following both types of exercise and recovered to pre-exercise values within 5 minutes for all measures except the number of misses, which returned to pre-exercise values by 10 minutes. There was no relationship between fitness measures and shooting performance, although muscle endurance was a factor in the duration of exercise prior to fatigue. We conclude that shooting accuracy recovers rapidly in fit soldiers following fatiguing lifting, climbing, and pulling activity.

Chemical warfare and the Gulf War: a review of the impact on Gulf veterans' health.

Abstract: It is unlikely that Gulf War veterans are suffering chronic effects from illnesses caused by chemical warfare nerve agent exposure. Extensive investigation and review by several expert panels have determined that no evidence exists that chemical warfare nerve agents were used during the Gulf War. At no time before, during, or after the war was there confirmation of symptoms among anyone, military or civilian, caused by chemical warfare nerve agent exposure. However, studies of Gulf War veterans have found belief that chemical weapons were used, significantly associated with both severe and mild-moderate illnesses. The psychological impact of a chemical warfare attack, either actual or perceived, can result in immediate and long-term health consequences. The deployment or war-related health impact from life-threatening experiences of the Gulf War, including the perceived exposure to chemical warfare agents, should be considered as an important cause of morbidity among Gulf War veterans.

Quetiapine for treatment of refractory symptoms of combat-related post-traumatic stress disorder.

Abstract: To assess the effects of adjunctive quetiapine for treatment of refractory symptoms of combat-related post-traumatic stress disorder (PTSD), charts of Vietnam veterans with war-connected PTSD who had been prescribed quetiapine were reviewed. Only patients with symptoms that had not responded to adequate therapy with two or more psychotropic medications prior to quetiapine treatment were analyzed. Addition of quetiapine to ongoing therapy resulted in further symptomatic improvements in DSM-IV PTSD criterion B (re-experiencing) for 35%, criterion C (avoidance/numbing) for 28%, and criterion D (arousal) for 65% of study subjects. Low doses of quetiapine (mean = 155 +/- 130 mg) were associated with minimal side effects. These results, although retrospective, suggest that augmentative quetiapine may benefit some refractory symptoms of PTSD in combat veterans.

Health-related quality of life of U.S. military personnel: a population-based study.

Abstract: Objective: This study evaluated the association between military service and health-related quality of life (HRQOL), using a large, population-based sample of U.S. adults. Methods: Participants in the 2000 Behavioral Risk Factor Surveillance System were characterized as active duty personnel (N = 1,163), reserves (N = 1,055), veterans (N = 22,558), or no military service (N = 141,620). HRQOL was described by sex and military status. Logistic regression was used to calculate sex-specific adjusted odds ratios. Results: Active duty men were more likely than men without military service to report 14 or more days of activity limitation, pain, and not enough rest in the past 30 days. Reserve personnel reported better overall HRQOL than nonmilitary participants, and no difference in HRQOL was observed between veterans and persons with no military service. Conclusions: Recommendations are made to monitor HRQOL of active duty and reserve personnel over time and to include HRQOL measures in military-based surveys of active duty troops.

Sentinel cases of community-acquired methicillin-resistant Staphylococcus aureus onboard a naval ship.

Abstract: Methicillin-resistant Staphylococcus aureus (MRSA) is emerging as a community-acquired organism. A number of recent reports have documented its involvement in a variety of infections in which no risk factors for nosocomial transmission are present. This report presents the initial cases of a MRSA outbreak on a U.S. Navy ship. Each patient failed traditional antibiotic therapy and one required hospitalization. Their presentations evolved simultaneously and proved to be sentinel cases of an outbreak of cutaneous MRSA infections. The events of this outbreak emphasize the growing need to consider the prevalence of resistant organisms in outpatient settings, as well as the impact that infections from resistant organisms might have on the combat readiness of a military unit. Recommendations addressing infection-control guidelines for MRSA within close-quarter environments of healthy adults, such as military units, need to be developed and existing infection-control measures need to be regularly emphasized.

Tuberculosis outbreak investigation of a U.S. navy amphibious ship crew and the Marine expeditionary unit aboard, 1998

Abstract: A Marine deployed aboard a U.S. Navy amphibious ship had smear-positive, cavitary pulmonary tuberculosis (TB). Contact investigation ultimately found 21 active cases of TB among sailors and Marines who were aboard the affected ship. Approximately 3 months lapsed between onset of the source patient's illness and appropriate diagnosis and treatment. During the contact investigation, 3,338 persons received tuberculin skin tests and 712 were identified as new latent tuberculosis infection cases. Four persons diagnosed with latent tuberculosis infection developed active TB because of poor compliance with treatment. After personnel disembarked from the ship, persistent efforts to identify persons with active disease and latent infections were successful in controlling further spread of tuberculosis in military units and local communities. The Mycobacterium tuberculosis bacteria isolated from the source patient and 16 of the other active cases were susceptible to all drugs commonly used to treat TB.

Overweight, obesity, and associated disease burden in the Veterans Affairs ambulatory care population.

Abstract: Background: This report describes the prevalence of overweight and obesity and estimates the disease burden associated with excess weight in ambulatory Veterans Affairs (VA) patients. Methods: Height and weight were measured, and self-reported age and self-reported morbidities were obtained for 1,731 patients. Prevalence odds ratios explain the association of self-reported disease on increasing weight status category using body mass index. Results: Seventy-five percent of the participants were overweight or obese. Obesity was significantly higher in the younger patients. Graded increases in odds ratios were observed with increasing severity of overweight and obesity for all morbidities, except heart disease. Conclusion: Overweight, obesity, and associated disease burden are prevalent in the VA health care system, particularly in younger VA patients, which may contribute to the higher prevalence of certain morbidities observed in VA populations compared with private sector outpatients. Department of Veterans Affairs should emphasize obesity prevention and treatment during the design and implementation of ambulatory care services.

Exertional heatstroke in an infantry soldier taking ephedra: Containing dietary supplements

Abstract: This is a case report of a highly trained, heat-acclimatized infantry soldier who suffered from exertional heatstroke during a 12-mile road march shortly after taking an ephedra-based supplement. Heatstroke is associated with systemic complications and a high mortality rate if not recognized early. Control of risk factors is key to the prevention of heatstroke. Since there are no clear ergogenic benefits in using ephedra alone, clinicians and military commanders should strongly discourage the use of ephedra-containing substances in active duty soldiers undergoing strenuous exercise.

The physiological and psychological effects of combat ration feeding during a 12-day training exercise in the tropics.

Abstract: The health and psychological effects of combat ration pack (CRP) feeding during 12 days of military training in a tropical environment were investigated. Three groups of air defence guards (ADGs) received either: freshly prepared foods (fresh group, 15 mega joule (MJ), 3,600 kcal, N=13), full CRP (15 MJ, 3,600 kcal, N=10), or one-half CRP (7.5 MJ, 1,800 kcal, N=10). Underconsumption by the full CRP group resulted in CRP groups experiencing similar weight loss, protein catabolism, and immune suppression (both cell-mediated and humoral), whereas the fresh group maintained their weight and protein balance and cell-mediated immune status. CRP groups reported greater fatigue than the fresh group. All ADGs experienced poor sleep quality and declining folate and iron status. ADGs drank insufficient water to prevent dehydration. In the medium term, ADGs were able to adapt to restricted food consumption and poor sleep quality with no decrement in physical fitness or cognition.

Primary squamous cell carcinoma of the thyroid gland.

Abstract: A case of primary squamous cell carcinoma of the thyroid is presented. Squamous epithelium is normally not present in the thyroid gland, and this tumor is exceedingly rare. Proper workup is described, including the differentiation from metastatic disease. The case reported is of a 64-year-old woman who presented with an asymptomatic nodule and underwent thyroidectomy. The final pathologic diagnosis, confirmed using immunohistochemistry for cytokeratin and transmission electron microscopy, revealed the unusual tumor. Squamous cell carcinoma of the thyroid is highly aggressive and behaves clinically like anaplastic thyroid carcinoma; the prognosis is poor. The patient described developed local recurrence and expired 7 months after resection from local invasion and airway obstruction. Unfortunately, this is the typical outcome. Chemoradiotherapy is generally not helpful, and complete resection remains the best chance for cure.

Physician assistants in the Canadian Forces.

Abstract: Canada is struggling with burgeoning health care access problems. At the same time, this nation may be overlooking an available resource to help address specific physician shortages. The services of more than 130 physician assistants in the Canadian Department of National Defense are used to off-set and amplify physician services. Their extensive education and training, along with their international experience in war-torn areas, dealing with wounded and ill military personnel, refugees, civilians, epidemics, and other health care problems make them particularly valuable assets. Yet, upon discharge from military service and reentry into the civilian sector, they are left without the legislation and formal recognition as a health care provider that would enable them to use these skills to help improve medical care access. This study provides the first description of the training and activity of Canadian physician assistants.

Does deployment impact the health care use of military families stationed in Okinawa, Japan?

Abstract: Military families are placed under a great deal of stress while serving in the armed forces. In Okinawa, Japan, marines deploy regularly at 3-month intervals throughout the year, leaving behind 7,924 dependents in a single-parent home environment. The purpose of this study was to investigate the health care needs of families in a deployed and nondeployed status in Okinawa, Japan. Families enrolled were studied over a 6-month period for levels of self-reliance, coherence, social support, well-being, adaptation, coping, anxiety, and health care visits. The tools that were used included the Family Index of Regenerativity and Adaptation-Military tools and the State Trait Anxiety Inventory. There were 299 families enrolled, of which 80% were marine spouses. A total of 28% of those surveyed were regarded as "high risk" based on the responses received on the surveys. Of these 85 families, 35% (n = 30) were nondeployed (ND), and 65% (n = 55) were from the deployed group (p = 0.03). After phone intervention, 40% of the deployed group and 17% of the ND were classified as stable; however, psychiatric consults were accepted by 29% of deployed group spouses compared with 23% of ND spouses who were identified as high-risk families. Typology change over time identified family dysfunction at 1% in the ND group alone. This study sheds new light on the stressors and subsequent health care needs of both deployed and nondeployed families in an isolated overseas duty location.

Psychosocial and health correlates of types of traumatic event exposures among U.S. military personnel.

Abstract: The prevalence of lifetime exposure to violence, natural disaster, or major accidents involving injuries or fatalities was examined in the largest population-based epidemiologic survey of U.S. military personnel to date. The psychosocial and health effects of types of exposure experience (witness only, victim/survivor, relief worker), gender differences, and social support were also evaluated. Over 15,000 active duty U.S. military personnel from stratified random samples of active duty U.S. personnel from all services responded to either mail questionnaires and/or worksite surveys. The lifetime exposure to one or more traumatic events was 65%; the most prevalent trauma for men was witnessing a major accident, and for women, witnessing a natural disaster. Victims of any traumatic event were at twice the risk of having two or more physical and mental health problems than nonexposed controls. Health outcomes of trauma exposure vary by type of traumatic event: type of exposure experience, rank, and gender.

Use of the stages of change model in improving nutrition and exercise habits in enlisted Air Force men.

Abstract: Thirty-nine U.S. Air Force enlisted men participated in a randomized controlled study that evaluated an experimental program designed to enhance fitness. Subjects were assigned to either a treatment (access to the program) or control (no access to program) group for 6 months. To improve treatment group fitness (as measured by VO2, subjects received individually tailored information (based on a behavior change model) via the Internet to encourage adoption of positive diet and exercise behaviors. Results showed no significant effect in improving fitness in treatment. However, significant effects were observed for secondary outcomes such as weight (controls, +1.0 kg vs. treatment, -2.2 kg, p < 0.05), body mass index (+0.3 kg/m2 vs. -0.7 kg/m2, p < 0.05), and percent body fat (+0.6% vs. -1.5%, p < 0.001). The data suggest that the individually tailored exercise information was not effective in encouraging sufficient exercise intensity to impact fitness. However, the dietary tailored information appears to have encouraged the adoption of more positive nutritional practices as demonstrated by the beneficial effects reflected in secondary outcomes.

Medical Management Principles for Radiation Accidents

Abstract: The medical management of radiation accidents requires intensive planning and action. This article looks at the medical management of recent radiation accidents to derive principles for structuring and organizing the treatment of patients who may have radiation-induced health impairments. Although the radiation accidents in Tokai-mura, Japan and Lilo, Georgia were small-scale accidents, they illustrate important and characteristic symptoms and clinical developments. There are lessons to be learned and conclusions to be drawn for the military medical officers concerned with problems of medical management after radiation accidents.

Military women's risk factors for and symptoms of genitourinary infections during deployment.

Abstract: Symptoms of vaginitis and urinary tract infections are miserable, distracting, and significantly affect women's quality of life. Among civilian women, these symptoms account for 10.5 million office visits per year. To examine the scope of the problem for military women during deployment situations, surveys were sent to randomly selected Army and Navy units. Of 841 women who completed the anonymous survey and had been deployed, vaginal infections were experienced by 30.1% and urinary tract infections by 18.4% of them during deployment. Vaginal symptoms were consistent with symptoms associated with the three most common vaginal infections (candida, bacterial, and trichomonas vaginitis). A variety of risk factors, both behavioral and situational, significantly differentiated women with and without infections. Urinary tract infections and vaginal infections are common during deployment situations where resources for self-care and appropriate primary health care for women are scarce or unavailable. One solution is a self-diagnosis and treatment kit for deployed military women.

Exertional heat illness in Air Force basic military trainees.

Abstract: Objective Exertional heat illnesses (heat stroke, heat exhaustion, and heat cramps) are a serious problem in military operations. Air Force basic military training at Lackland Air Force Base is a prime example of where exertional heat illnesses can occur. This project was conducted to evaluate the problem o exertional heat illnesses during basic military training a Lackland Air Force Base. Methods Data were obtained from the Ambulatory Data System, the Air Force Reportable Event Surveillance System, and a published report in the December 1999 issue of Military Medicine (Drehner, Neuhauser, Neuhauser, and Blackwood). Results In 1999, there were 51 cases of heat illness (not necessarily exertional) among basic trainees at Lackland Air Force Base, for a rate of 1.3 per 1,000 trainees. Many of the cases (21) had the nonspecific diagnosis of "heat effect," 4 were diagnosed as heat syncope, 22 as heat exhaustion, and 5 as heat stroke. From 1956 to 1999, there were seven deaths among trainees at Lackland Air Force Base due to heat stroke. Conclusion After reviewing Air Force basic military training, it is apparent that the heat stress incident rates are low. Heat injury rates are low despite being located in an area that has extremely hot temperatures. However, there are some areas, such as tracking and reporting heat illness that need improvement.

Premature labor and birth: Influence of rank and perception of fatigue in active duty military women

Abstract: The purpose of this study was to determine whether stress, sleep disturbance, or fatigue at 22 to 26 weeks of gestation is related to the incidence of preterm labor and birth in military women. Data were collected prospectively by questionnaires measuring factors contributing to preterm labor and birth. Hours worked per week were ascertained by telephone until the participants delivered. Postpartum medical records were reviewed for pregnancy outcomes. There was a trend for preterm labor to be associated with lower perceived fatigue severity, low sleep disturbance, and more negative life events. Officer rank was related to both preterm labor and delivery. Findings indicate that the perception of fatigue may be protective against preterm birth and that military officer rank is a risk factor for preterm labor and birth.

Survey of personal protection measures against mosquitoes among Australian defense force personnel deployed to East Timor.

Abstract: A questionnaire was completed by 955 Australian Defense Force soldiers from two battalion groups to determine their usage of mosquito repellents and bed nets during peacekeeping duties in East Timor. The survey showed that most soldiers (84%) used repellents, but only 19% used them daily. The soldiers used a number of repellent formulations; however, few soldiers used the Australian Defense Force deet (diethyl methylbenzamide) formulation containing 35% deet in a gel. Most soldiers preferred several commercial formulations, which contained 7 to 80% deet. The occurrence of mosquito-borne disease in soldiers was not affected by repellent usage, as the use of repellents was comparable between infected and noninfected individuals. The overall frequency of bed net usage differed in the two battalion groups. The occurrence of malaria in soldiers from one battalion group who did not sleep under a bed net every night of their deployment was significantly (p = 0.007) higher than those who did.