RESUMEN
PURPOSE: Thyroid autoimmunity has been associated with differentiated thyroid cancer although multiple potential biases might have influenced the results of previous studies. METHODS: We conducted a case-control study nested within the cohort of US active-duty personnel 1996-2014 to assess the association between thyroid autoimmunity, defined by serology, and thyroid cancer diagnosis. The primary exposure was thyroid peroxidase (TPO) antibody status 7-10 years before the thyroid cancer index date. We also assessed whether diagnosis of thyroid autoimmunity mediated any associations identified and if thyroid cancer features differed by autoimmunity status. RESULTS: Among 451 incident cases of papillary thyroid cancer and matched controls (median age 36 years, 61.4% men), TPO antibody positivity (v negative) 7-10 years prediagnosis was associated with thyroid cancer (odds ratio [OR] 1.90 [95% CI, 1.33 to 2.70]). Exploratory analyses suggested an increasing risk of thyroid cancer with higher TPO antibody titer (TPO antibody 550-1,399 IU/mL: OR 2.95 [95% CI, 1.37 to 6.36]; and ≥ 1,400 IU/mL: OR 3.91 [95% CI, 1.66 to 9.24]). Positive TPO antibody status remained associated with thyroid cancer after those with diagnosed autoimmunity were excluded, and the association was not mediated by diagnosis of thyroid autoimmunity. Among the cases with diagnosed autoimmunity, 58% thyroid cancers were ≤ 10 mm diameter. CONCLUSION: Longstanding prior thyroid autoimmunity up to 10 years before thyroid cancer diagnosis was associated with papillary thyroid cancer risk. The results could not be fully explained by diagnosis of thyroid autoimmunity although when autoimmunity had been identified, thyroid cancers were diagnosed at a very early stage.
Asunto(s)
Autoinmunidad , Neoplasias de la Tiroides , Adulto , Anticuerpos , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides/epidemiologíaRESUMEN
Aim: Our goal is to evaluate implications of cotinine cut points in subgroups of smokers and nonsmokers. Materials & methods: Data were assessed from 13,357 adult participants and collected over a period of 6 years by the National Health and Nutrition Examination Survey (2009-2014). Receiver operating characteristic curve analysis was used to identify optimal cut points. Rao-Scott χ2 tests measured associations between group characteristics. Results: The optimal serum cotinine cut point adult cigarette smokers was 3.63 ng/ml (sensitivity of 96.7%; specificity of 93.0%). This cut point differed by gender as well as race/ethnicity. Conclusion: There are notable differences in subgroup cut points compared with previous research. Use of gender or race/ethnicity specific cut points is more appropriate when feasible and may help clinician recommendations.
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Cotinina/sangre , Fumar/sangre , Adulto , Biomarcadores/sangre , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , No Fumadores , FumadoresRESUMEN
OBJECTIVE: Workers' compensation (WC) processes do not lead to maximal return-to-work or cost savings. The aim of this study is to assess barriers and facilitators to reporting and managing injuries and illnesses among civilian employees in the US Army. METHODS: We triangulated a review of policy and practice documents, stakeholder interviews, a descriptive analysis of WC data, and a literature review to inform recommendations of best practices for improving return-to-work and lowering WC costs. RESULTS: Federal WC costs are trending downward for civilian employees in the US Army; however, the approaches are not uniform or optimized, especially at the installation level. CONCLUSIONS: This mixed methods evaluation of the Department of Defense WC elucidates areas for improvement and potential best practices within the Federal WC system.
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Enfermedades Profesionales , Traumatismos Ocupacionales , Indemnización para Trabajadores/economía , Ahorro de Costo , Empleo , Humanos , Entrevistas como Asunto , Investigación Cualitativa , Participación de los Interesados , Análisis de Sistemas , Estados UnidosRESUMEN
BACKGROUND: Musculoskeletal (MSK) injuries are a leading cause of morbidity among US Army soldiers, especially among women and the newly enlisted. While extremes of body mass index (BMI), low physical fitness and tobacco use have been identified as risk factors, no prior studies have determined the combined effects of these risk factors or tested for gender differences in the associations. METHODS: We conducted a retrospective cohort study utilising the Stanford Military Data Repository to study all enlisted soldier accessions to the US Army between January 2011 and January 2014, with follow-up through December 2014 (n=238 772). We used discrete-time logistic regression to test for associations between demographic, socioeconomic and health behaviour-related predictors and incident lower extremity injuries. We included interaction terms to test for gender differences. RESULTS: Among men, there were greater adjusted odds of injury among underweight (OR 1.27), overweight (OR 1.14) and obese soldiers (OR 1.54) (all p<0.001) relative to normal-weight soldiers. No statistically significant differences in the odds of injury on the basis of BMI were observed for female soldiers. Physical fitness was a significantly stronger predictor of injury for female as compared with male soldiers, while the association between tobacco use and injury was stronger for men (OR 1.47) than for women (OR 1.30) (p<0.001 for both). CONCLUSION: This is the largest known study to simultaneously assess important, modifiable musculoskeletal injury risk factors and to test for gender differences in these associations. These findings provide critical gender-related nuances for clinicians and leaders seeking to reduce the risk of these problems.
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Extremidad Inferior/lesiones , Personal Militar , Dolor Musculoesquelético/epidemiología , Aptitud Física/fisiología , Fumar Tabaco/epidemiología , Índice de Masa Corporal , Femenino , Humanos , Masculino , Personal Militar/estadística & datos numéricos , Oportunidad Relativa , Estudios Retrospectivos , Factores Sexuales , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Part 1 of this series reviewed the epidemiologic evidence for the association between cigarette smoking and injuries and possible biological and psychosocial mechanisms to account for this relationship. In the present article, nine criteria are explored to determine if smoking is a direct cause of injuries (i.e., a causal relationship). There is substantial evidence that individuals who smoked in the past have a higher subsequent risk of injury. A recent meta-analysis found that smokers in the military were 1.31 times more likely to be injured than nonsmokers and Servicemembers with low, medium, and high levels of smoking had 1.27, 1.37, and 1.71 times, respectively, the risk of injury compared with nonsmokers. The association between smoking and injuries has been reported in at least 18 US military studies and in 14 civilian studies in seven countries. The biological plausibility of the association was discussed extensively in part 1 of this series. A possible alternative explanation with sufficient data was that smokers may be risk takers and it is the risk-taking behavior that increases injury risk (not smoking per se). Once an individual no longer smokes, a decrease in injury risk has been reported for at least bone health and wound healing. The effects of smoking do not appear to be specific to one type of injury, possibly because of the numerous compounds in tobacco smoke that could affect tissues and physiological processes, with evidence provided for bones, tendons, and healing processes. The association was consistent with other knowledge, with some evidence provided from other types of medical problems and trends in smoking and injury-related mortality. In summary, the association between smoking and injuries appears to meet many of the criteria for a causal relationship.
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Fumar Cigarrillos , Personal Militar , Heridas y Lesiones , Fumar Cigarrillos/epidemiología , Humanos , Medicina Militar , Factores de Riesgo , Heridas y Lesiones/complicaciones , Heridas y Lesiones/epidemiologíaRESUMEN
Surveys indicated that 24% of military personnel are current cigarette smokers. Smoking is well known to increase the risk of cancers, cardiovascular and respiratory diseases, reproductive problems, and other medical maladies, but one of the little known effects of smoking is that on injuries. There is considerable evidence from a variety of sources that (1) smoking increases overall injury risk, (2) the greater the amount of smoking, the higher is the injury risk, and (3) smoking is an independent injury risk factor. Smoking not only affects the overall injury risk but also impairs healing processes following fractures (e.g., longer healing times, more nonunions, more complications), ligament injury (e.g., lower subjective function scores, greater joint laxity, lower subsequent physical activity, more infections), and wounding (e.g., delayed healing, more complications, less satisfying cosmetic results). Smoking may elicit effects on fractures through low bone mineral density (BMD), lower dietary intake of calcium and vitamin D, altered calcium metabolism, and effects on osteogenesis and sex hormones. Effects on wound healing may be mediated through altered neutrophils and monocytes functions resulting in reduced ability to fight infections and remove damaged tissue, reduced gene expression of cytokines important for tissue healing, and altered fibroblast function leading to lower density and amount of new tissue formation. Limited data suggest smoking cessation has favorable effects on various aspects of bone health over periods of 1 to 30 years. Favorable effects on neutrophil and monocyte functions may occur as early as 4 weeks, but fibroblast function and collagen metabolism (important for wound remodeling) appear to take considerably longer and may be dependent on the amount of prior smoking. Part 2 of this series will use this information to explore the possibility of a causal relationship between smoking and injuries.
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Fumar Cigarrillos/epidemiología , Personal Militar/estadística & datos numéricos , Heridas y Lesiones/epidemiología , Fumar Cigarrillos/fisiopatología , Fracturas Óseas/epidemiología , Humanos , Músculo Esquelético/lesiones , Factores de Riesgo , Asunción de Riesgos , Cese del Hábito de Fumar , Estados Unidos/epidemiología , Cicatrización de HeridasRESUMEN
PURPOSE: Tobacco use is common among military personnel, as is musculoskeletal injury during training. In a review of the literature on musculoskeletal injuries, there was mixed evidence on the role of smoking as a risk factor. The purpose of this study is to review and analyze the literature on the impact of cigarette smoking on lower-extremity overuse injuries in military training. METHODS: We performed a literature search on articles published through October 2016. Search terms focused on lower-extremity overuse musculoskeletal injuries and cigarette smoking in military populations. We conducted a meta-analysis overall and by sex, including smoking intensity. RESULTS: We identified 129 potential studies and selected 18 based on quality. The overall rate ratio for smoking was 1.31, 1.31 for men, and 1.23 for women. Overall and for each sex, rate ratios were significantly greater than 1.0 for each intensity level of smoking. CONCLUSIONS: Smoking is a moderate risk factor for musculoskeletal injury and may account for a meaningful proportion of injuries among men and women due to the high prevalence of smoking and injury in this population. Although enlistees are not allowed to smoke during basic training, their risk of injury remains high, indicating that smokers may remain at increased risk for medium- to long-term duration.
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Fumar Cigarrillos/epidemiología , Trastornos de Traumas Acumulados/epidemiología , Extremidad Inferior/lesiones , Personal Militar/estadística & datos numéricos , Sistema Musculoesquelético/lesiones , Acondicionamiento Físico Humano/efectos adversos , Femenino , Humanos , Masculino , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To evaluate the association of pre-accession physical fitness, as measured by a five-minute step test, with incidence of overuse injuries and outpatient healthcare utilization among male United States (US) Army recruits. PARTICIPANTS: US Army male trainees who met weight standards and took a pre-accession fitness test. METHODS: In this prospective cohort study, incidence and outpatient healthcare visits for overuse injuries during the first 90 days of military service were compared between recruits who failed the pre-accession step test with those who passed. RESULTS: The hazard rate ratio for injury among recruits who failed the fitness test compared to those who passed the test was 1.31 (95% C.I = 1.20-1.44). Among the subset of recruits with at least one medical encounter for an overuse injury, the utilization rate ratio for subjects who failed the fitness test versus those who passed was 1.15 (95% C.I = 1.09-1.22). Other factors associated with increased risk of injury or healthcare utilization include age, body mass index, and smoking history. CONCLUSIONS: Risk of injury and utilization were associated with fitness test results. These findings may have implications for military accession and training policy as well as for other physically demanding training programs such as police, fire fighters and athletes.
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Mal Uso de los Servicios de Salud/estadística & datos numéricos , Personal Militar , Selección de Personal , Aptitud Física/fisiología , Heridas y Lesiones/epidemiología , Adolescente , Índice de Masa Corporal , Estudios de Cohortes , Humanos , Masculino , Personal Militar/psicología , Personal Militar/estadística & datos numéricos , Educación y Entrenamiento Físico , Estudios Prospectivos , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Heridas y Lesiones/etiología , Adulto JovenRESUMEN
BACKGROUND: Stress fractures and other musculoskeletal injuries are major sources of morbidity among female military trainees. Several risk factors have been postulated, particularly pre-existing fitness, usually assessed with post-entry run time for ≥ 1.0 mile. PURPOSE: Physical fitness is not formally evaluated prior to Army entry. If a valid and simple test that identified women at increased risk of stress fracture were available and could be applied prior to entry, it would facilitate cost-benefit studies of deferral or interventions. These analyses were undertaken to determine if a 5-minute step test conducted before entry identified women at increased risk. METHODS: A prospective study was conducted of weight-qualified women entering the Army in 2005-2006, with analyses completed in 2011. At the pre-entry examination, information was collected on age, BMI, smoking, race, and activity level. Everyone took the step test. All outpatient medical encounters were captured, and stress fractures and other musculoskeletal injuries identified. Women with stress fractures and those with other musculoskeletal injuries were evaluated separately. RESULTS: 1568 women were included in the study; 109 developed stress fractures and 803 other musculoskeletal injury. Women who failed the step test had a 76% higher stress fracture incidence and a 35% higher incidence of other musculoskeletal injuries. There was effect modification between age and test failure for stress fracture. CONCLUSIONS: A step test that can be administered before military entry identifies women with increased incidence of stress fracture and other musculoskeletal injury. This test could be used pre-entry to defer or target high-risk recruits for tailored fitness training before or after military entrance.
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Fracturas por Estrés/epidemiología , Personal Militar , Análisis y Desempeño de Tareas , Adolescente , Adulto , Prueba de Esfuerzo , Femenino , Humanos , Estudios Prospectivos , Medición de Riesgo , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: To date, there has been no study correlating the American College of Preventive Medicine (ACPM) in-service exam (ISE) with the American Board of Preventive Medicine (ABPM) certification exam. PURPOSE: To validate the ACPM ISE as a predictor of success on the ABPM certification exam. METHODS: ISE and ABPM certification exam scores were standardized by year using z-scores. The correlation between practicum year ISE scores and certification exam scores for military preventive medicine residencies in the National Capital and Washington State areas (core component only) was analyzed. A multivariable linear regression model included adjustments for age, gender, Master of Public Health grade point average (GPA), prior specialty board certification, and board deferral ≥1 year after graduation. Data were collected in 2010 and analyzed in 2011. RESULTS: Performance on the ISE was correlated with performance on the ABPM certification core exam (r=0.61, p<0.001). Performance on the ISE was still significant after adjusting for relevant demographic and educational variables (p<0.001). Other significant covariates included GPA (p=0.001) and board deferral (p=0.04) in the linear regression model. CONCLUSIONS: Performance on the ISE is moderately correlated with performance on the board certification core exam, and this correlation remained significant after adjustment in the linear regression model. These results serve to validate the ISE as a means for program directors to identify residents at academic risk and as encouragement for residents to take the certification exam as soon as possible after graduation.
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Certificación , Evaluación Educacional , Medicina Preventiva/educación , Adulto , Estudios de Cohortes , Recolección de Datos , Femenino , Predicción , Humanos , Masculino , Maryland , Persona de Mediana Edad , WashingtónRESUMEN
The Assessment of Recruit Motivation and Strength (ARMS) study evaluated a physical fitness screening test for Army applicants before basic training. This report examines applicants' self-reported physical activity as a predictor of objective fitness measured by ARMS. In 2006, the ARMS study administered a fitness test and physical activity survey to Army applicants during their medical evaluation, using multiple logistic regression for comparison. Among both men and women, "qualified" and "exceeds-body-fat" subjects who met American College of Sports Medicine adult physical activity guidelines were more likely to pass the fitness test. Overall, subjects who met physical activity recommendations, watched less television, and played on sports teams had a higher odds of passing the ARMS test after adjustment for age, race, and smoking status. This study demonstrates that self-reported physical activity was associated with physical fitness and may be used to identify those at risk of failing a preaccession fitness test.
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Personal Militar , Actividad Motora , Selección de Personal/métodos , Aptitud Física , Adolescente , Adulto , Composición Corporal , Femenino , Humanos , Masculino , Selección de Personal/organización & administración , Encuestas y Cuestionarios , Estados Unidos , Adulto JovenRESUMEN
Selective accession waivers for medically disqualifying conditions like spinal curvature are one way the military meets its manpower needs. We evaluated retention patterns during the first 2 years of service of a cohort of military recruits with waivers for pathological curvature of the spine (spinal curvature). Recruits waived for spinal curvature (n = 417), who accessed from 1998 to 2005 were identified and matched with 3 qualified recruits. Kaplan-Meier survival analysis and Cox proportional hazards model were used to compare survival patterns and adjusted attrition hazard estimates. Waived recruits experienced significantly increased risk of "all cause" discharge (relative risk = 1.3; 95% confidence interval: 1.1, 1.5) and "existing prior to service" discharge (relative risk = 2.4; confidence interval: 1.6, 3.5). Despite the increased risk of discharge, current waiver criteria allowed a majority with spinal curvature to complete at least 2 years of service. Policy makers must consider risks and benefits before modifying the current accession standard for spinal curvature.
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Personal Militar , Selección de Personal , Curvaturas de la Columna Vertebral/epidemiología , Adolescente , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Modelos de Riesgos Proporcionales , Curvaturas de la Columna Vertebral/patología , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: There are limited data describing the epidemiology of adult-onset schizophrenic disorders in the United States. Although the military is not proportionately comparable in all demographic characteristics to the civilian population, it is drawn from all racial/ethnic subgroups, and members range in age from 17 to >60 years. We describe the incidence of hospitalization for new onset schizophrenic disorders among military members by sex, race, and age. METHODS: Using military inpatient data, we evaluated patterns of initial hospitalizations for schizophrenic disorders among military personnel for 2000-2009, focusing on sex, race, and age. No individual-level data were available. RESULTS: From 2000-2009, 1976 military personnel had a first schizophrenic disorder hospitalization, with an overall incidence rate of 0.14/1000 person-years. There were no consistent changes in rates over time. While overall incidence rates were similar for men and women (incidence rate ratio (IRR)=1.10), rates were higher among men than women below age 25; after 25-30 rates were higher among women. Incidence was higher among blacks and other racial groups, with IRR=2.0 and 1.3, respectively. CONCLUSION: Medical screening of military applicants prevents persons with overt or a reported history of psychosis, and most with serious behavior problems, from enlisting; therefore, first hospitalization is likely to reflect new illness. No pre-military socioeconomic data were available, however, essentially all study subjects were high school graduates; unmeasured differences in socioeconomic status were unlikely to explain the observed results. This report may provide lower bound estimates of the schizophrenic disorder incidence in the United States.
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Personal Militar , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiología , Factores de Edad , Intervalos de Confianza , Etnicidad/psicología , Femenino , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Personal Militar/psicología , Personal Militar/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: The high prevalence of overweight and obesity in military recruits and in the US population as a whole necessitates understanding the health effects of body composition and associated morbidity. OBJECTIVE: In this study, we examined the effect of body mass index (BMI; in kg/m(2)) and medical status on premature discharge from the US Army in a large cohort of first-time-enlisted, active-duty soldiers. DESIGN: We determined the odds ratios (ORs) associated with BMI and medical status at enlistment by using a retrospective cohort of first-time, active-duty army recruits. RESULTS: ORs for BMI, calculated by using 24-24.9 as a reference, exhibited a U-shaped pattern. Soldiers with a BMI >34 had the highest ORs for all-cause (OR: 1.47; 95% CI: 1.32, 1.64) and medical (OR: 1.68; 95% CI: 1.46, 1.93) discharges. A BMI <17 was 1.35 times as likely (95% CI: 1.02, 1.80) to result in an all-cause discharge and 1.45 times as likely (95% CI: 1.01, 2.08) to result in a medical discharge. ORs for soldiers who required a medical reexamination did not vary when all-cause discharge (OR: 1.10; 95% CI: 1.06, 1.14) and medical discharge (OR: 1.10; 95% CI: 1.05, 1.15) were compared. The medical discharge OR for soldiers who required a medical waiver to enter the army (OR: 1.56; 95% CI: 1.48, 1.64) was higher than the OR for all-cause discharge (OR: 1.27; 95% CI: 1.22, 1.32). CONCLUSION: Enlistment BMI and medical qualification status play an important role in early discharge and may provide a valuable tool in the development of fitness, nutrition, and injury-prevention interventions in higher-risk groups.
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Índice de Masa Corporal , Política de Salud , Estado de Salud , Personal Militar , Adulto , Composición Corporal , Personas con Discapacidad , Femenino , Humanos , Masculino , Personal Militar/estadística & datos numéricos , Sobrepeso , Aptitud Física , Estudios Retrospectivos , Factores de Riesgo , Delgadez , Estados Unidos , Heridas y Lesiones/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Anti-malarial drug resistance in Kenya prompted two drug policy changes within a decade: sulphadoxine-pyrimethamine (SP) replaced chloroquine (CQ) as the first-line anti-malarial in 1998 and artemether-lumefantrine (AL) replaced SP in 2004. Two cross-sectional studies were conducted to monitor changes in the prevalence of molecular markers of drug resistance over the period in which SP was used as the first-line anti-malarial. The baseline study was carried out from 1999-2000, shortly after implementation of SP, and the follow-up study occurred from 2003-2005, during the transition to AL. MATERIALS AND METHODS: Blood was collected from malaria smear-positive, symptomatic patients presenting to outpatient centers in Kisumu, Kenya, during the baseline and follow-up studies. Isolates were genotyped at codons associated with SP and CQ resistance. In vitro IC50 values for antifolates and quinolones were determined for isolates from the follow-up study. RESULTS: The prevalence of isolates containing the pfdhfr N51I/C59R/S108N/pfdhps A437G/K540E quintuple mutant associated with SP-resistance rose from 21% in the baseline study to 53% in the follow-up study (p < 0.001). Isolates containing the pfdhfr I164L mutation were absent from both studies. The pfdhps mutations A581G and A613S/T were absent from the baseline study but were present in 85% and 61%, respectively, of isolates from the follow-up study. At follow-up, parasites with mutations at five pfdhps codons, 436, 437, 540, 581, and 613, accounted for 39% of isolates. The CQ resistance-associated mutations pfcrt K76T and pfmdr1 N86Y rose from 82% to 97% (p = 0.001) and 44% to 76% (p < 0.001), respectively, from baseline to follow-up. CONCLUSIONS: During the period in which SP was the first-line anti-malarial in Kenya, highly SP-resistant parasites emerged, including isolates harboring pfdhps mutations not previously observed there. SP continues to be widely used in Kenya; however, given the highly resistant genotypes observed in this study, its use as a first-line anti-malarial should be discouraged, particularly for populations without acquired immunity to malaria. The increase in the pfcrt K76T prevalence, despite efforts to reduce CQ use, suggests that either these efforts are not adequate to alleviate CQ pressure in Kisumu, or that drug pressure is derived from another source, such as the second-line anti-malarial amodiaquine.
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Antimaláricos/farmacología , Dihidropteroato Sintasa/genética , Resistencia a Medicamentos , Malaria/parasitología , Mutación Missense , Plasmodium/genética , Tetrahidrofolato Deshidrogenasa/genética , Combinación Arteméter y Lumefantrina , Artemisininas/farmacología , Artemisininas/uso terapéutico , Cloroquina/farmacología , Cloroquina/uso terapéutico , Codón , Estudios Transversales , Combinación de Medicamentos , Etanolaminas/farmacología , Etanolaminas/uso terapéutico , Fluorenos/farmacología , Fluorenos/uso terapéutico , Antagonistas del Ácido Fólico/farmacología , Genotipo , Humanos , Concentración 50 Inhibidora , Kenia , Malaria/tratamiento farmacológico , Pruebas de Sensibilidad Parasitaria , Plasmodium/efectos de los fármacos , Plasmodium/aislamiento & purificación , Prevalencia , Proteínas Protozoarias/genética , Pirimetamina/farmacología , Pirimetamina/uso terapéutico , Quinolonas/farmacología , Sulfadoxina/farmacología , Sulfadoxina/uso terapéuticoRESUMEN
Psychiatric disorders in military members require substantial medical, administrative, and financial resources, and are among the leading causes of hospitalization and early discharge. We reviewed available data to better understand the incidence of bipolar I disorder among military personnel. Defense Medical Epidemiology Database inpatient data were used. Descriptive and comparative statistics were performed. From 1997-2006 there were 3,317 first hospitalizations for bipolar I disorder with a mean of 1.2 hospitalizations per case. The rate of first occurrence among this adult population was 0.24 per 1,000 person-years. The incidence increased over time for depressed and mixed episode types among both genders. High risk groups include women, younger individuals, and whites. This population provides insight into adult onset bipolar I disorder incidence and demographic patterns not available elsewhere and offers potential opportunities to improve its understanding.
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Trastorno Bipolar/epidemiología , Personal Militar/estadística & datos numéricos , Adulto , Negro o Afroamericano/estadística & datos numéricos , Trastorno Bipolar/etnología , Femenino , Humanos , Incidencia , Masculino , Personal Militar/psicología , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricos , Adulto JovenRESUMEN
The ongoing obesity epidemic has made recruiting qualified Army applicants increasingly difficult. A cohort of 10,213 Army enlisted subjects was enrolled in the Assessment of Recruit Motivation and Strength (ARMS) study from February 2005 through September 2006. Overweight recruits obtained a waiver for enlistment (n = 990) if they passed a screening physical fitness test. Recruits were evaluated for enrollment into the Army Weight Control Program (AWCP) and discharged during the 15 months following enlistment. Enrollment was higher among overweight recruits than recruits who met entrance standards (men: adjusted OR = 13.3 [95% CI: 10.3, 17.2]; women: adjusted OR = 3.6 [3.3, 3.9]). Although the discharge frequency was higher in the waiver group than in those who met standards (25.4% versus 19.9%, p < 0.001), there were only 10 (0.5% of total) discharges directly attributed to weight. Granting overweight waivers through the ARMS program increases enrollment to the AWCP but has little effect on weight-related attrition.
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Peso Corporal/fisiología , Prueba de Esfuerzo/métodos , Capacitación en Servicio/métodos , Medicina Militar/métodos , Personal Militar , Selección de Personal/métodos , Pérdida de Peso/fisiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Fuerza Muscular , Obesidad/epidemiología , Obesidad/prevención & control , Resistencia Física/fisiología , Aptitud Física , Estudios Prospectivos , Factores de Tiempo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
INTRODUCTION: Heat illness has not declined in the U.S. military despite preventive measures. The increase in overweight recruits entering the U.S. military may lead to an increase in heat-related events. This study compares the risk of heat illness among U.S. Army recruits who exceeded body fat standards at accession to those who met standards. METHODS: Recruits with excess body fat and qualified applicants to the Army were required to take a preaccession fitness test during the study period (February 2005 through September 2006). The test included a 5-min step test and 1-min push-up challenge, scored as pass or fail. Incidence and outpatient usage for heat illness (any heat illness, heat stroke, heat exhaustion, and other heat illness) at 90 d of service were compared in 9667 male recruits of whom 826 had excess body fat and 8841 were qualified. There were too few heat events among women for analysis. RESULTS: The incidence odds ratio among male recruits with excess body fat compared to qualified male recruits was 3.63 (95% CI: 1.92, 6.85). Men with excess body fat had an increased incidence of heat illness with a rate ratio of 7.25 (95% CI: 4.17, 12.61). DISCUSSION: Although there were few heat illness events, the results indicate a significantly increased risk of heat illness and outpatient utilization among male recruits with excess body fat. It was estimated that approximately 70% of the relative risk for heat illnesses in men with excess body fat during basic training was associated with exceeding body fat standards. These findings may have implications for military accession and training.
Asunto(s)
Trastornos de Estrés por Calor/epidemiología , Personal Militar , Sobrepeso/epidemiología , Adolescente , Adulto , Humanos , Masculino , Aptitud Física , Factores de Riesgo , Estados Unidos , Adulto JovenRESUMEN
The Assessment of Recruit Motivation and Strength (ARMS) project evaluated whether active duty Army enlistees who exceeded weight and body-fat standards but were able to pass the ARMS physical fitness test were at elevated risk of early attrition relative to the traditional recruit population. Attrition among 1146 overweight and overbody-fat (OBF) recruits who passed ARMS was compared to 10,514 fully qualified (FQ) recruits who began service in February 2005 through September 2006. The ARMS test includes a 5-minute step test and a 1-minute pushup test. There were no significant differences in attrition between OBF and FQ at 180 days: adjusted hazard ratios were 1.17 (95% CI: 0.83, 1.65) among females and 1.23 (95% CI: 0.95, 1.58) among males. This study indicates that physically fit recruits who exceeded weight/body-fat standards were equally capable of serving at least 180 days compared to those who met standards.
Asunto(s)
Personal Militar , Reorganización del Personal , Aptitud Física , Adiposidad , Adolescente , Adulto , Composición Corporal , Índice de Masa Corporal , Intervalos de Confianza , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Análisis Multivariante , Obesidad , Sobrepeso , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Riesgo , Factores de Tiempo , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: Minimal influenza surveillance has been carried out in sub-Saharan Africa to provide information on circulating influenza subtypes for the purpose of vaccine production and monitoring trends in virus spread and mutations. OBJECTIVE: The aim of this study was to investigate a surveillance program in Kenya to isolate and characterize influenza viruses. RESULTS: In the 2006-2007 influenza season, nine influenza A viruses were isolated. All were of H3N2 subtype with key amino acid (aa) changes indicating that they were more closely related to recent World Health Organization recommended vaccine strains than to older vaccine strains, and mirroring the evolution of circulating influenza A globally. Hemagglutination inhibition data showed that the 2006 Kenya isolates had titers identical to the 2005-2006 H3N2 vaccine strain but two- to threefold lower titers to the 2006-2007 vaccine strain, suggesting that the isolates were antigenic variants of the 2006-2007 vaccine strains. Analysis of aa substitutions of hemagglutinin-1 (HA1) protein of the 2006 Kenyan viruses revealed unique genetic variations with several aa substitutions located at immunodominant epitopes of the HA1 protein. These mutations included the V112I change at site E, the K 173 E substitution at site D and N 278 K change at site C, mutations that may result in conformational change on the HA molecule to expose novel epitopes thus abrogating binding of pre-existing antibodies at these sites. CONCLUSION: Characterization of these important genetic variations in influenza A viruses isolated from Kenya highlights the importance of continuing surveillance and characterization of emerging influenza drift variants in sub-Saharan Africa.