Evaluation of mortality among Marines, Navy personnel, and civilian workers exposed to contaminated drinking water at USMC base Camp Lejeune: a cohort study.

BACKGROUND: Drinking water at U.S. Marine Corps Base (MCB) Camp Lejeune, North Carolina was contaminated with trichloroethylene and other industrial solvents from 1953 to 1985. METHODS: A cohort mortality study was conducted of Marines/Navy personnel who, between 1975 and 1985, began service and were stationed at Camp Lejeune (N = 159,128) or MCB Camp Pendleton, California (N = 168,406), and civilian workers employed at Camp Lejeune (N = 7,332) or Camp Pendleton (N = 6,677) between October 1972 and December 1985. Camp Pendleton's drinking water was not contaminated with industrial solvents. Mortality follow-up was between 1979 and 2018. Proportional hazards regression was used to calculate adjusted hazard ratios (aHRs) comparing mortality rates between Camp Lejeune and Camp Pendleton cohorts. The ratio of upper and lower 95% confidence interval (CI) limits, or CIR, was used to evaluate the precision of aHRs. The study focused on underlying causes of death with aHRs ≥ 1.20 and CIRs ≤ 3. RESULTS: Deaths among Camp Lejeune and Camp Pendleton Marines/Navy personnel totaled 19,250 and 21,134, respectively. Deaths among Camp Lejeune and Camp Pendleton civilian workers totaled 3,055 and 3,280, respectively. Compared to Camp Pendleton Marines/Navy personnel, Camp Lejeune had aHRs ≥ 1.20 with CIRs ≤ 3 for cancers of the kidney (aHR = 1.21, 95% CI: 0.95, 1.54), esophagus (aHR = 1.24, 95% CI: 1.00, 1.54) and female breast (aHR = 1.20, 95% CI: 0.73, 1.98). Causes of death with aHRs ≥ 1.20 and CIR > 3, included Parkinson disease, myelodysplastic syndrome and cancers of the testes, cervix and ovary. Compared to Camp Pendleton civilian workers, Camp Lejeune had aHRs ≥ 1.20 with CIRs ≤ 3 for chronic kidney disease (aHR = 1.88, 95% CI: 1.13, 3.11) and Parkinson disease (aHR = 1.21, 95% CI: 0.72, 2.04). Female breast cancer had an aHR of 1.19 (95% CI: 0.76, 1.88), and aHRs ≥ 1.20 with CIRs > 3 were observed for kidney and pharyngeal cancers, melanoma, Hodgkin lymphoma, and chronic myeloid leukemia. Quantitative bias analyses indicated that confounding due to smoking and alcohol consumption would not appreciably impact the findings. CONCLUSION: Marines/Navy personnel and civilian workers likely exposed to contaminated drinking water at Camp Lejeune had increased hazard ratios for several causes of death compared to Camp Pendleton.

How do navy escorts influence piracy risk in East Africa? A Bayesian network approach.

Navy escorts are considered crucial in countering illegal piracy attacks. In this paper, a novel approach is developed to investigate the effect of navy escorts on piracy incidents by models based on two enhanced Tree-Augmented Naïve (TAN) Bayesian networks. This approach offers a systematic investigation into the various factors that influence pirate activities, and helps to identify changes in piracy attack behaviors when confronted by navy escorts and assess the effectiveness of anti-piracy measures. An empirical study is conducted utilizing a unique data set compiled from multiple sources from 2000 to 2019. The empirical evidence shows that there was a gradual reduction in the incidence of piracy attacks in East Africa following the implementation of navy escorts in 2009, but with a surge in 2010 and 2011. The data set is, thus, divided into two time periods at the point of 2009 to facilitate a robust and comprehensive analysis, resulting in the development of two TAN models. Meanwhile, the geographical distribution of pirate attacks has shifted from international waters to port areas and territorial waters. We argue that the surge and geographical shift could be attributed to the calculating behavior of pirates when they encounter external pressures. Finally, a Shapely approach is introduced to evaluate the potential effectiveness of the implemented risk management strategies from a Game Theory perspective. This study offers new insights into the promotion of navy escorts and contributes to the development of a framework for assessing piracy risks in uncertain and dynamic anti-piracy environments.

Deployed at sea amidst the pandemic: Insights from 30 United States Navy nurses.

BACKGROUND: Coronavirus disease 2019 (COVID-19) presented unique challenges to the United States Navy given that the major components of controlling an infectious disease outbreak are not easily achieved on ships. PURPOSE: To understand shipboard Navy nurses' activities during the COVID-19 pandemic. METHODS: Virtual semistructured interviews were conducted in 2021 with 30 Navy nurses who deployed to sea during the pandemic. Data were coded using directed content analyses whereby remarks were categorized according to 16 public health interventions (PHIs) of the Minnesota Department of Health Intervention Wheel. Data were also coded via conventional content analysis. DISCUSSION: Multiple PHIs were utilized to improve the public health of those on Navy ships during the height of the pandemic. Also, four themes were constructed via conventional content analysis. CONCLUSION: Shipboard Navy nurses overcame unprecedented challenges to protect the health of their crew, all the while preserving operational readiness during the COVID-19 pandemic.

Impact of army morale on suicidal ideation: The mediating role of grit and the moderating role of social support in a Chinese Navy population.

This study constructed a moderated mediation model to examine whether increased army morale could reduce suicidal ideation. The mediating role of grit and the moderating role of social support were also examined. A total of 1029 male navy cadets in China were recruited to complete the survey. The measures used in the study included the Army Morale Scale, Grit Scale, Social Support Scale, and Self-rated Idea of Suicide Scale. The results indicated that: increased army morale could significantly reduce suicidal ideation; the impact of army morale on suicidal ideation could be partially mediated by grit; and social support moderated the impact of army morale on suicidal ideation. Specifically, relatively higher levels of social support could reduce suicidal ideation among individuals with lower levels of army morale, but the effect is not significant when the morale is at a high level. The study revealed that increased army morale could reduce suicidal ideation. Moreover, the mediating role of grit and the moderating role of social support were also revealed.

Dispersion and mixing dynamics of complex oil-in-water emulsions in Taylor-Couette flows.

The seminal study by G. I. Taylor (1923) has inspired generations of work in exploring and characterizing Taylor-Couette (TC) flow instabilities and laid the foundation for research of complex fluid systems requiring a controlled hydrodynamic environment. Here, TC flow with radial fluid injection is used to study the mixing dynamics of complex oil-in-water emulsions. Concentrated emulsion simulating oily bilgewater is radially injected into the annulus between rotating inner and outer cylinders, and the emulsion is allowed to disperse through the flow field. The resultant mixing dynamics are investigated, and effective intermixing coefficients are calculated through measured changes in the intensity of light reflected by the emulsion droplets in fresh and salty water. The impacts of the flow field and mixing conditions on the emulsion stability are tracked via changes in droplet size distribution (DSD), and the use of emulsified droplets as tracer particles is discussed in terms of changes in the dispersive Péclet, Capillary and Weber numbers. For oily wastewater systems, the formation of larger droplets is known to yield better separation during a water treatment process, and the final DSD observed here is found to be tunable based on salt concentration, observation time and mixing flow state in the TC cell. This article is part of the theme issue 'Taylor-Couette and related flows on the centennial of Taylor's seminal Philosophical Transactions paper (Part 2)'.

The Smallpox Vaccine in Latin America: A New Approach (1801-1804).

The Royal Philanthropic Vaccine Expedition is considered in the history of medicine as the first international health expedition aimed at the global elimination of a contagious disease: smallpox. However, the initiatives carried out in this way before the arrival of the Balmis Expedition, by surgeons from the Spanish Navy, are less well known. Thus, the main objective of this research work is to offer an overview of the different anti-variolic vaccination initiatives prior to the campaign financed by the Spanish crown from these health facilities. Using the heuristic and hermeneutic method, our article is based on primary sources contrasted with specialised literature. The results obtained are presented in a narrative style from each of the surgeons identified as decisive in the implementation of the vaccine, thus providing a divergent and unpublished historiographic approach. As the facts described show, before the arrival of Balmis the vaccine substance was introduced in those countries thanks to the initiative of various surgeons: in Puerto Rico by Francisco Oller; in Cartagena and Santa Marta in Colombia by Ángel Hidalgo; in Venezuela by Alonso Ruiz; in Cuba by Tomás Romay and Bernardo de Cózar; in the Viceroyalty of New Granada (Colombia) by Lorenzo Vergés; in Guatemala by Miguel José Monzón and José María Ledesma; in the Viceroyalty of New Spain by Alejandro García Arboleya and Antonio Serrano; in Peru by Pedro Belomo; in Río de la Plata by Cristóbal Martín de Montúfar; in the Chilean region of Coquimbo by José María Gómez; and in the Philippines by Cristóbal Regidor. Finally, it should be noted that these surgeons and the approach presented are part of a historiography based on the personal actions of professionals trained, for the most part, at the Medical-Surgical School of Cadiz.

Changes in sleep quality among Chinese active service personnel: A cross-temporal meta-analysis, 2003-2019.

Military personnel live in operating environments in which poor sleep is common. In this cross-temporal meta-analysis (CTMA), 100 studies (144 data sets, N = 75,998) were identified to examine changes in sleep quality among Chinese active service personnel from 2003 to 2019. Participants were divided into three groups: the navy, the non-navy, and the unknown service. The Pittsburgh Sleep Quality Index (PSQI) was used as the measure of sleep quality; it contains a global score and seven component scores, with higher scores indicative of poorer sleep. Among all active military personnel, the PSQI global and seven component scores decreased from 2003 to 2019. In examining the results by military type, the PSQI global and seven component scores increased in the navy group. Conversely, both the non-navy and unknown-service groups showed decreased PSQI global scores over time. Similarly, all PSQI component scores decreased over time for both the non-navy and unknown service groups, except for the use of sleeping medication (USM), which increased in the non-navy group. In conclusion, the sleep quality of Chinese active service personnel showed a positive trend. Further research should focus on improving the navy's sleep quality.

Unintended Pregnancy and Abortion in the US Navy, 2016.

BACKGROUND: The unintended pregnancy rate in the US military is higher than among civilians. While 42% of unintended pregnancies end in abortion among civilian women, there are no data on the prevalence of abortion in the military overall or by service branch. OBJECTIVE: This analysis was conducted to estimate unintended pregnancy rates and the percentage of unintended pregnancies that resulted in abortion among active-duty US Navy members aged 44 years or younger reporting female gender in 2016. DESIGN: Cross-sectional survey data from the 2016 Navy Pregnancy and Parenthood Survey, collected from August to November 2016. PARTICIPANTS: Our sample included 3,423 active-duty US Navy members aged 44 years or younger reporting female gender, generated from a stratified random sample of 38% of all active-duty Navy women in pay grades E2-E9 and O1-O5 in 2016; the survey had a 20% response rate for females. MAIN MEASURES: We calculated pregnancy and unintended pregnancy rates, the percentage of pregnancies that were unintended, and the percentage of unintended pregnancies resulting in birth and abortion in the prior fiscal year. KEY RESULTS: Overall, the self-reported unintended pregnancy rate was 52 per 1,000 participants and 38.1% of pregnancies were unintended. The adjusted unintended pregnancy rate accounting for abortion underreporting was 68 per 1,000 participants. Unintended pregnancy rates were highest among individuals who were younger (aged 18-24) and in enlisted pay grades, compared to their counterparts. Six percent reported their unintended pregnancy resulted in abortion. Six respondents reported becoming pregnant while deployed; none of these pregnancies resulted in abortion. CONCLUSIONS: In this first study to report on abortion prevalence among US servicemembers, we found the proportion of unintended pregnancies resulting in abortion among a sample of US Navy members in 2016 was much lower than civilians, yet unintended pregnancy rates were higher.

[The French Armed Forces Biomedical Research Institute (IRBA) and wastewater-based epidemiology: Applicability and relevance in armed forces]. / L'Institut de recherche biomédicale des armées (IRBA) et l'épidémiologie des eaux usées : intérêt pour les forces armées.

The French Armed Forces Biomedical Research Institute (IRBA) deeply involved in research on SARS-COV-2, participated in the creation of the Obépine sentinel network in charge of detecting, qualifying and quantifying the virus genome in wastewater in France. During this pandemic, wastewater-based epidemiology has proven to be a first class public health tool for assessing viral dynamics in populations and environment. Obépine has also conducted research demonstrating the low infectivity of faeces and wastewater and allowed for early detection of epidemic waves linked to new variants. The IRBA has adapted this powerful tool to the monitoring of viral infections on board the aircraft carrier Charles-de-Gaulle in order to get an operational system for anticipation after the first local outbreak in 2020. The presence of this surveillance and anticipation tool has allowed a better management of SARS-CoV-2 contingent introductions on board during stopovers or crewmembers entries. The combination of a mandatory vaccination protocol and the surveillance of viral circulation in black waters has made it possible to identify and locate cases, and thus to continue the operational mission in the COVID-19 environment while limiting the spread and preserving the health of the crew. This innovative tool can easily be redirected to the search for any other pathogens in blackwater or even, in the long term, to ensure health surveillance of any military establishment, at sea or on land, in France or on overseas bases.

Comparison of physicochemical and mechanical properties of edible films made from navy bean and corn starches.

BACKGROUND: Recently, there has been a great interest in developing new applications of edible dry beans (Phaseolus vulgaris L.). The utilization of starch, comprising the major component of dry bean seeds, for the preparation of edible films has just emerged. RESULTS: In the present study, we chose navy bean as a model dry bean source, isolated its starch component, prepared edible films with different formulations (35 and 40 g L-1 ), and compared these with the films made using isolated and commercial corn starches. Sunflower oil at 10 g L-1 was dispersed into film-forming solution to design composite films. The water vapor barrier property, mechanical properties and microstructure of starch films from navy bean and corn were studied to evaluate their potential for use in food packaging. All of the films had smooth and uniform surface and were transparent. CONCLUSION: Navy bean starch film showed physicochemical and mechanical properties comparable to corn starch films, and the addition of sunflower oil could further improve the water vapor barrier and mechanical properties of films. The findings obtained in the present study demonstrate the potential of using navy bean starch to prepare edible films. © 2020 Society of Chemical Industry.

Raising Boys for the Navy: Health, Welfare, and the British Sea Services, 1870-1905.

Efforts to improve the quality and quantity of seafarers in the Royal Navy and merchant service became a particular concern amidst the degeneration debates of late-Victorian Britain. Maritime reformers not only promoted fitness in adult sailors, but also particularly sought to improve health and physique of boy recruits in order to rear a new generation of healthy sailors. This article shows how both services experimented with tighter admission criteria and dietary and exercise reforms, and became early advocates of using metrical standards to exclude all but the fittest, healthiest boys from training opportunities. While the physical monitoring of boy recruits undoubtedly showed the value of early lifestyle interventions in fostering healthy development, the rising physical standards of British seafarers in this period was just as much the result of restrictive medical examinations as a commitment to welfare initiatives.

Co-occurrence of beaked whale strandings and naval sonar in the Mariana Islands, Western Pacific.

Mid-frequency active sonar (MFAS), used for antisubmarine warfare (ASW), has been associated with multiple beaked whale (BW) mass stranding events. Multinational naval ASW exercises have used MFAS offshore of the Mariana Archipelago semi-annually since 2006. We report BW and MFAS acoustic activity near the islands of Saipan and Tinian from March 2010 to November 2014. Signals from Cuvier's (Ziphius cavirostris) and Blainville's beaked whales (Mesoplodon densirostris), and a third unidentified BW species, were detected throughout the recording period. Both recorders documented MFAS on 21 August 2011 before two Cuvier's beaked whales stranded on 22-23 August 2011. We compared the history of known naval operations and BW strandings from the Mariana Archipelago to consider potential threats to BW populations. Eight BW stranding events between June 2006 and January 2019 each included one to three animals. Half of these strandings occurred during or within 6 days after naval activities, and this co-occurrence is highly significant. We highlight strandings of individual BWs can be associated with ASW, and emphasize the value of ongoing passive acoustic monitoring, especially for beaked whales that are difficult to visually detect at sea. We strongly recommend more visual monitoring efforts, at sea and along coastlines, for stranded cetaceans before, during and after naval exercises.

Job Opportunities in the Navy (JOIN).

This article describes the author's efforts to build a combined job-preference/job-preview measure as an alternative to conventional interest inventories for use in U.S. Navy recruiting, as most applicants have no previous exposure to Navy-specific jobs. Criteria for building a successful instrument (i.e., JOIN) that can identify the best match between the Sailor and his/her assigned job are presented. The resulting taxonomy (i.e., JOIN's classification of Navy jobs based on Community (e.g., aviation), Work Styles/Environments (e.g., outdoor), and specific Work Activity process-content pairs (e.g., maintain mechanical equipment)), is described. Psychometric properties of JOIN are presented based on data from 6,988 U.S. Navy Sailors, as well as gender differences and factor structure. Preliminary evidence of JOIN's predictive validity with five service-related outcome measures is presented, with modest yet significant findings. Although the development of JOIN may be considered non-traditional, JOIN promises to have a direct impact on training, promotion, and retention.

Prediction of performance by non-cognitive traits.

Project A clearly demonstrated that performance is multidimensional and that some aspects are better predicted by noncognitive measures. Substantial research and development in the ensuing years has focused on personality and vocational interests. The articles in this special issue convincingly demonstrate that at least one personality measure developed by military researchers, the Tailored Adaptive Personality Assessment System (TAPAS), is resistant to faking, which was an important concern about earlier single statement instruments. Moreover, several articles report showing that TAPAS predicts retention and important aspects of "will do" performance. On the other hand, these papers show that TAPAS adds little or no incremental validity to "can do" aspects of performance over and above the Armed Services Vocational Aptitude Battery (ASVAB). Three measures of vocational interest are described in articles in this special issue and research has been positive about their ability to predict attrition, rates of promotion and reenlistment, and job satisfaction. A number of topics for further research are noted.

[Research progress on the occurrence and prevention of low back pain in naval officers and soldiers].

Low back pain (LBP) is a common occupational disease among naval officers and soldiers. This article reviewed the incidence of LBP in naval personnel in different positions in recent years, and analyzed the causes combined with the operating environment and occupational characteristics of personnel in different positions in order to clarify the causes of LBP in naval officers and soldiers in different positions and improve their awareness of the disease. Moreover, this study aims to help naval officers and soldiers to take protective measures in training life to reduce the incidence of LBP.

Characteristics of traumatic brain injury during Operation Enduring Freedom-Afghanistan: a retrospective case series.

Traumatic brain injury (TBI) is a significant cause of morbidity and mortality, especially among members of the armed services. Injuries sustained in the battlefield are subject to different mechanisms than those sustained in civilian life, particularly blast and high-velocity injury. Due to the unique nature of these injuries and the challenges associated with battlefield medicine, surgical interventions play a key role in acute management of TBI. However, the burden of chronic disease posed by TBI is poorly understood and difficult to investigate, especially in the military setting. The authors report the case logs of a United States Navy neurosurgeon, detailing the acute management and outcomes of 156 patients sustaining TBI between November 2010 and May 2011 during the war in Afghanistan. By demographics, more than half of the patients treated were local nationals. By mechanism of injury, blunt trauma (40.4%) and explosive injury (37.2%) were the most common contributors to TBI. Decompressive craniectomies (24.0%) and clot evacuations (14.7%) were the procedures most commonly performed. Nearly one-quarter of patients were transferred to receive further care, yet only 3 patients were referred for rehabilitative services. Furthermore, the data suggest that patients sustaining comorbid injuries in addition to TBI may be predisposed to worse outcomes. Improvements in documentation of military patients may improve knowledge of TBI and further identify potential variables or treatments that may affect prognosis. The increased survivability from TBI also highlights the need for additional research expenditure in the field of neurorehabilitation specifically.

[The nurse at the heart of combat rescue in the navy]. / L'infirmier au cœur du sauvetage au combat en milieu maritime.

Based on lessons learned from the the war in Afghanistan, combat rescue, taught to all army soldiers, equips troops with techniques for saving lives in the most critical conditions. Combat rescue in the maritime environment is the equivalent for the French navy. There are specificities inherent to this form of rescue due to the particular place of practice, like the place of the on-board nurse.

Analysis and determinants of Chinese navy personnel health status: a cross-sectional study.

BACKGROUND: There have been very few studies analyzing the relationship of physical and mental health status with health behaviors and deployment status in Chinese navy personnel. Thus, we undertook this survey to assess this relationship and identify specific factors affecting the physical and mental health status. METHODS: The subjects enrolled in this study were selected from four units of the active-duty navy personnel in China, based on a cluster random sampling design. A total of 1200 Chinese navy personnel participated and completed the questionnaire survey that included veteran SF-36 form and a self-designed questionnaire regarding their sociodemographic characteristics, deployment status, self-rated health status and health behaviors. Totally 1200 questionnaires were distributed to different participants, while 1083 valid questionnaires were included in the final analysis. All data were analyzed using SPSS18.0 software. RESULTS: Based on the information provided by navy personnel, 17.82, 35.09 and 23.08% rated their health as excellent, very good and good, respectively. The mean score of physical component summary (PCS) and mental component summary (MCS) was 50.53 and 41.39, respectively. Length of service, binge drinking, regular drinking and BMI appeared to be associated with PCS score, while household income, binge drinking and BMI affected MCS score. Deployment status and smoking exhibited no significant association with PCS and MCS scores. CONCLUSIONS: Our study suggested that the sociodemographic factors like length of service and household income, along with behavioral risk factors like binge drinking, regular drinking and body mass index (BMI), seem to affect the physical and mental health status of Chinese navy personnel. However, additional data collection and more detailed analysis would still be required to develop a systematic, comprehensive and corresponding health education program to promote overall health status.

Self-reported health behaviors, including sleep, correlate with doctor-informed medical conditions: data from the 2011 Health Related Behaviors Survey of U.S. Active Duty Military Personnel.

BACKGROUND: Health behaviors and cardiometabolic disease risk factors may differ between military and civilian populations; therefore, in U.S. active duty military personnel, we assessed relationships between demographic characteristics, self-reported health behaviors, and doctor-informed medical conditions. METHODS: Data were self-reported by 27,034 active duty military and Coast Guard personnel who responded to the 2011 Department of Defense Health Related Behaviors Survey. Multivariate linear and logistic regressions were used to estimate cross-sectional associations between (1) demographic characteristics (age, sex, service branch, marital status, children, race/ethnicity, pay grade) and self-reported behaviors (exercise, diet, smoking, alcohol, sleep); (2) demographic characteristics and doctor-informed medical conditions (hypertension, hypercholesterolemia, low high density lipoprotein (HDL) cholesterol, hyperglycemia) and overweight/obesity; and (3) behaviors and doctor-informed medical conditions. RESULTS: Among respondents (age 29.9 ± 0.1 years, 14.7% female), females reported higher intake than men of fruit, vegetables, and dairy; those with higher education reported higher intakes of whole grains; those currently married and/or residing with children reported higher intake of starches. Older age and female sex were associated with higher odds (ORs 1.25 to 12.54 versus the youngest age group) of overweight/obesity. Older age and female sex were also associated with lower odds (ORs 0.29 to 0.65 versus male sex) of doctor-informed medical conditions, except for blood glucose, for which females had higher odds. Those currently married had higher odds of high cholesterol and overweight/obesity, and separated/divorced/widowed respondents had higher odds of high blood pressure and high cholesterol. Short sleep duration (< 5 versus 7-8 h/night) was associated with higher odds (ORs 1.36to 2.22) of any given doctor-informed medical condition. Strength training was associated with lower probability of high cholesterol, high triglycerides, and low HDL, and higher probability of overweight/obesity. Dietary factors were variably associated with doctor-informed medical conditions and overweight/obesity. CONCLUSIONS: This study observed pronounced associations between health behaviors-especially sleep-and medical conditions, thus adding to evidence that sleep is a critical, potentially modifiable behavior within this population. When possible, adequate sleep should continue to be promoted as an important part of overall health and wellness throughout the military community.

Analysis of factors related to failure in the pressure test: a six-year experience in Taiwan.

INTRODUCTION: The Republic of China Navy instituted the pressure test as one of the selection tools for diving troops and submarine crews. We analyzed factors associated with failure in the pressure test. METHODS: This was a retrospective cohort study designed to investigate pressure test failure in Navy recruits between January 2010 and August 2015. The recruits received pressurization in a hyperbaric chamber to a simulated depth of 112 feet of seawater (fsw) at a rate of 25 fsw/minute. Data describing trainee demographics, disease history, causes and depth of failure, as well as type of injury, were extracted from case notes and facility databases for statistical analysis. RESULTS: Of 3,608 trial cohorts, there were 435 failures, with an overall failure rate of 12.06%. About 95% of these failure trials were within a simulated depth of 60 fsw. Fifty-seven (57) failures did not record causes of failure. Among the other 378 failures, the most commonly identified causes were ear barotrauma (365 trials, 96.56%) and sinus barotrauma (10 trials, 2.65%). Statistical analysis revealed that recent upper respiratory tract infection, allergic rhinitis, and cigarette smoking were all significantly associated with higher incidence of middle ear barotrauma. CONCLUSIONS: Our results suggest that pressure testing to a depth of 60 fsw is effective in disqualifying personnel entering diving and submarine service. Recent infection of the upper respiratory tract, allergic rhinitis and cigarette smoking are risk factors for middle ear barotrauma, resulting in failure of the pressure test.