Weighing in on type 2 diabetes in the military: characteristics of U.S. military personnel at entry who develop type 2 diabetes.

OBJECTIVES: Current incidence trends in type 2 diabetes portend a significant public health burden and have largely been attributed to similar trends in overweight and physical inactivity. Medical surveillance of the U.S. military indicates that the incidence of all types of diabetes is similar to that in the civilian population (1.9 vs. 1.6 cases per 1,000 person-years) despite weight and fitness standards. Differences in the common determinants of diabetes have not been studied in the military population, which may provide novel clues to the increasing incidence of diabetes in the U.S. RESEARCH DESIGN AND METHODS: A case-control study, 4-to-1 matched for age, sex, entry date, time in service, and service component (e.g., Army, Navy), was used to describe the association of race/ethnicity, socioeconomic status, and BMI and blood pressure at entry into military service with the subsequent development of type 2 diabetes. RESULTS: Increased BMI (adjusted odds ratio, 3.0 for the > or =30 kg/m(2) vs. < or =20 kg/m(2) categories and 2.0 for the 25.0-29.9 kg/m(2) category, compared with the reference category), African-American (adjusted odds ratio, 2.0) and Hispanic origin (adjusted odds ratio, 1.6) compared with white race and rank (adjusted odds ratio for junior enlisted versus officers, 4.1) were all associated with type 2 diabetes. CONCLUSIONS: Individuals with type 2 diabetes in the U.S. military have risk factors similar to the general U.S. population. Because diabetes is a preventable disease, it is of concern that it is occurring in this population of younger and presumably more fit individuals. This has significant implications for the prevention of diabetes in both military and civilian populations.

Non-battle injury casualties during the Persian Gulf War and other deployments.

OBJECTIVE: To review injury occurrence and to evaluate various injury surveillance systems used on recent deployments of U.S. military personnel. BACKGROUND: Injuries that occur in a deployed military force are more likely to have an immediate and detrimental effect on the military mission than those in garrison or training. These injuries have a direct impact on deployed personnel and unit readiness and consume limited field medical resources. METHODS: Data collected during four recent deployments were evaluated. Administrative databases established for the routine collection of death and hospital admissions were used to characterize mortality and morbidity in the Persian Gulf War. Surveillance teams deployed to Haiti, Somalia, and Egypt provided inpatient and outpatient data for those missions. RESULTS: Data collected by these surveillance systems are presented. Unintentional trauma accounted for 81% of deaths during the Persian Gulf War and 25% of hospital admissions. During operations in Somalia and Haiti, 2.5% to 3.5% of about 20,000 troops in each deployment sought medical treatment for an injury or orthopedic problem each week. In Egypt, injuries accounted for about 25% of all outpatient visits to medical treatment facilities. CONCLUSIONS: Injuries were the leading cause of death and a leading cause of morbidity during recent deployments of U.S. troops. Comprehensive injury surveillance systems are needed during deployments to provide complete and accurate information to commanders responsible for the safety of the force. Recommendations for establishing such systems are made in this article.

Cost-effectiveness analysis of targeted and sequential screening strategies for latent tuberculosis.

SETTING: No cost-effectiveness studies of testing for latent tuberculosis infection have incorporated both targeted testing and the use of interferon-gamma release assays (IGRAs) in heterogeneous populations. OBJECTIVE: To examine the cost-effectiveness of universal vs. targeted and sequential testing strategies and the use of tuberculin skin testing (TST) vs. IGRAs. DESIGN: Using a decision-analytic model, incremental cost-effectiveness ratios were calculated in 2009 among nine potential strategies for screening recruits. A societal perspective was taken over a 20-year analytic horizon, discounting future costs at 3% annually. Sensitivity analyses were conducted to determine how changes in assumptions affected the estimates. RESULTS: Targeted strategies cost over US$250 000 per case prevented, whereas universal testing strategies cost over US$700 000 per incremental case prevented in base case and most sensitivity analyses. CONCLUSION: Targeted testing offered the best value in this population, although it was still relatively expensive compared to no testing. Sequential testing with both TST and IGRAs provided a poor incremental value compared to targeted and universal testing strategies. Targeted testing using TST was slightly more cost-effective than targeted testing using either QuantiFERON®-TB Gold In-Tube or T-SPOT®.TB, but these estimates were very sensitive to changes in model assumptions.

The effects of inadvertent exposure of mefloquine chemoprophylaxis on pregnancy outcomes and infants of US Army servicewomen.

During US military operations in Somalia, mefloquine, a drug for malaria chemoprophylaxis, was not approved for use in pregnant women. Some female soldiers inadvertently used mefloquine before becoming aware of their pregnancy. A registry was established to follow the outcomes of these pregnancies. Questionnaires were administered at the time the pregnancy was diagnosed, after termination or delivery, and at 1 year after birth. Seventy-two soldiers were eligible for the registry. There were 17 elective abortions, 12 spontaneous abortions, 1 molar pregnancy, and 23 live births. The outcome for 19 soldiers was unknown. An unexpected high rate of spontaneous abortions was observed. All infants were healthy at birth, with no major congenital malformations. One infant died at 4 months of viral pneumonitis. At 1 year of age, 13 infants were reported to be healthy, with normal cognitive and motor development. This study provides additional postmarketing data that mefloquine does not cause gross congenital malformations.