doi: 10.7205/MILMED.171.10.xipmid: N/A
This content is only available as a PDF. Reprint & Copyright © by Association of Military Surgeons of U.S.
doi: 10.7205/MILMED.171.10.ivpmid: N/A
This content is only available as a PDF. Reprint & Copyright © by Association of Military Surgeons of U.S.
doi: 10.7205/MILMED.171.10.925pmid: 17076440
ABSTRACT Over the last 50 years, members of the U.S. military have faced the threat of malaria in diverse geographical locations and operational situations, resulting in considerable morbidity and mortality. However, because malaria may be transported out of endemic areas and into areas that are free of malaria, the threat does not end with redeployment. Since the Korean Conflict, outbreaks of imported malaria have followed every major deployment of U.S. military forces to malaria endemic areas. By examining unique aspects of these outbreaks through the years, many similarities can be drawn. Repeated observations demonstrate that preventive efforts are only effective at reducing the impact of imported malaria when commanders are informed about the risks of malaria. Commanders must also understand the preventive resources that are available while deployed, and the potential for morbidity and mortality from malaria. Reprint & Copyright © by Association of Military Surgeons of U.S.
MPH, Andréa Snyder,;USA, James Mancuso, MC;USA, Wade Aldous, MC
doi: 10.7205/MILMED.171.10.929pmid: 17076441
ABSTRACT Influenza and other respiratory infections, the most common cause of acute infectious disease in U.S adults, are also the leading cause of outpatient illness and a major cause of infectious disease hospitalization in U.S. military personnel. Although respiratory disease control is improved, epidemics continue to occur, and respiratory disease in military trainees continues to exceed that in U.S. civilian adults. Overall, Department of Defense utilization of the trivalent inactivated vaccine was much lower than anticipated during the 2004–2005 season. The slow start to the 2004–2005 influenza season resulted in a low demand for influenza immunization by the medically high-risk beneficiary population of the Department of Defense. Surveillance for influenza during the 2004–2005 season in U.S. Army Europe reached unprecedented heights, testing and confirming more cases than in any previous year. Reprint & Copyright © by Association of Military Surgeons of U.S.
USA, Clinton K. Murray, MC;USA, Joel C. Reynolds, MC;DO, Douglas A. Boyer,;USA, Maureen K. Koops, MC;Van de Car, MC USA, David A.;USA, Thomas B. Zanders, MC;USA, Duane R. Hospenthal, MC
doi: 10.7205/MILMED.171.10.933pmid: 17076442
ABSTRACT Graduates of military internal medicine residency programs are required to have the necessary knowledge and skills to function as internists, military physicians, and military medical leaders. The global war on terrorism has increased the role internists are playing in combat theaters as they fill multiple different military medical positions including battalion, brigade, and division surgeons as well as physicians in echelon I, II, and III medical facilities. Along with general internists, internal medicine subspecialists, pediatricians, and family physicians also fill these roles. Although internal medicine training provides a broad-based knowledge to care for adults, it does not provide significant training in combat casualty care, detainee health care, or environmental health. To overcome many of these perceived shortfalls, we developed the 3-day deployment course for graduating internal medicine residents outlined in this article. Through a combination of didactic and hands-on training, militarily relevant medical knowledge and skills necessary to function at echelon I and II levels of care were provided. Residents uniformly accepted the course with measurable increase in their fund of knowledge at the completion of the course. Reprint & Copyright © by Association of Military Surgeons of U.S.
MD, John F. Brundage,;MS, Karen E. Johnson,;PhD, Jeffrey L. Lange,;USA, Mark V. Rubertone, MC
doi: 10.7205/MILMED.171.10.937pmid: 17076443
ABSTRACT Prevention activities are designed and resourced based on perceptions of the relative population health impacts of various conditions. We examined the nature and variability of rankings of “conditions” based on how they are defined and how their population health impacts are measured. The first listed diagnosis from all hospitalizations and ambulatory visits of U.S. service members during 2002 was used to rank conditions (as defined by two standard classification systems) using five different measures of population health impacts. Less than 10% of all conditions accounted for more than one-half of total population health impact, regardless of how conditions were defined or impacts measured. However, specific conditions with the largest impacts varied depending on the classification system and impact measure. Four groups of related conditions—acute musculoskeletal injuries, pregnancy-related conditions, respiratory infections, and mental disorders (including substance abuse)—accounted for disproportionately large impacts regardless of the measure. The identification of conditions with the largest population health impacts depends on the nature and degree of aggregation in defining conditions and the measure of impact. The findings are relevant to prevention planning and resourcing. Reprint & Copyright © by Association of Military Surgeons of U.S.
PhD, Xian Liu,;USA, Charles Engel, Jr.,;DrPH, Han Kang,;PhD, David W. Armstrong,
doi: 10.7205/MILMED.171.10.943pmid: 17076444
ABSTRACT Objectives: This research examines the relationship of veteran status with functional status transitions in older Americans. Methods: Data for this study come from the Survey of Asset and Health Dynamics among the Oldest Old. We use a structural multinomial logit model to decompose the effect of older veterans into the direct effect and the indirect effects via physical health conditions and mental disorders on functional status transitions. Results: Although there is no distinct association among those functionally independent at baseline, veteran status significantly impacts age-dependent transitions from functional dependence to other statuses. At age 85, the excess mortality and the lower level of functional resolution among functionally dependent veterans are considerable. Conclusions: Physical health is more important than mental health in transmitting the effect of veteran status on functional status transitions in functionally dependent persons. Footnotes 1 Presented at the 2004 Annual Meeting of the Population Association of America, April 1–3, 2004, Boston, MA. Reprint & Copyright © by Association of Military Surgeons of U.S.
PhD, Jane L. Meza,;PhD, Li-Wu Chen,;(Ret.), Thomas V. Williams, USA;BA, Fred Ullrich,;PhD, Keith J. Mueller,
doi: 10.7205/MILMED.171.10.950pmid: 17076445
ABSTRACT Objectives: We examined differences in health care ratings and reported health care experiences for active duty uniform services personnel using health care plans other than military treatment facilities. Methods: We used a cross-sectional mail survey of a stratified sample of 3,871 beneficiaries enrolled in TRICARE Prime (TP) and TRICARE Prime Remote (TPR). The adjusted plan mean composite and global ratings were compared between TP and TPR participants. Results: There were few significant differences between the two groups. Patient satisfaction was higher when patients chose their providers (TPR), and use of some preventive services was higher in managed-care plans (TP). Respondents in metropolitan locations differed significantly from those in nonmetropolitan locations in ratings of plans, quality of health care received, and access to services. Conclusions: The military health system is achieving some success in delivering uniform benefits but faces challenges in delivering high-quality uniform benefits in rural communities. Reprint & Copyright © by Association of Military Surgeons of U.S.
MHSc, Jean L. Wilson,;FRCPC, Maureen T. Carew, MD,;MSc, Barbara A. Strauss, RN,
doi: 10.7205/MILMED.171.10.955pmid: 17076446
ABSTRACT The Canadian Forces (CF) adopted the EPINATO surveillance system in 1996 to monitor disease and injury morbidity in deployed settings. The Directorate of Force Health Protection, CF Health Services Group initiated an evaluation of EPINATO in Task Force Bosnia-Herzegovina in August 2003. Two methods were used to assess coding reliability: a chart audit and Sick Parade Register review. Stakeholder interviews were conducted evaluating data flow, reporting structure, and key system attributes. Reliability (κ, 95% confidence interval) was good in 4 of 24 categories—sexually transmitted diseases, κ = 0.75 (0.50, 1.00); eye disorders, κ = 0.51 (0.15, 0.88); ears/nose/throat, κ = 0.51 (0.33, 0.69); lower respiratory infections, κ = 0.49 (95% confidence interval 0.34, 0.65)—but otherwise was poor. EPINATO is not an effective, reliable tool for CF deployment health surveillance. An improved health surveillance system is required to ensure disease and injury aberrations are detected and optimal preventive programs and policies are in place for deployed CF military members. Footnotes 1 Presented at NATO Medical Surveillance and Response: Research and Technology Opportunities and Options, April 19–21, 2004, Budapest, Hungary, and at the Committee of the Chiefs of Military Medical Services in NATO (Preventive Medicine Working Group) Meeting, April 22, 2004, Budapest, Hungary. Reprint & Copyright © by Association of Military Surgeons of U.S.
doi: 10.7205/MILMED.171.10.962pmid: 17076447
ABSTRACT Current policies governing the Departments of Defense and Veterans Affairs physical examination programs are out of step with current evidence-based medical practice. Replacing periodic and other routine physical examination types with annual preventive health assessments would afford our service members additional health benefit at reduced cost. Additionally, the Departments of Defense and Veterans Affairs repeat the physical examination process at separation and have been unable to reconcile their respective disability evaluation systems to reduce duplication and waste. A clear, coherent, and coordinated strategy to improve the relevance and utility of our physical examination programs is long overdue. This article discusses existing physical examination programs and proposes a model for a new integrative physical examination program based on need, science, and common sense. Reprint & Copyright © by Association of Military Surgeons of U.S.
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