Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom: Early findings from the Trauma Outcomes and Urogenital Health (TOUGH) project.

BACKGROUND: In Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), genitourinary (GU) wounds have occurred in unprecedented numbers. Severe concomitant injuries, including extremity amputations, are common. The epidemiology of GU injury and extremity amputation in OEF/OIF has not been described. MATERIALS AND METHODS: The Department of Defense Trauma Registry was queried from October 2001 through August 2013 to identify all surviving US male service members with GU injuries sustained in OEF/OIF. Genitourinary injury was defined as sustaining one or more injuries to any organ or structure within the genitourinary and/or reproductive system(s) based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Injury severity was quantified based on Abbreviated Injury Scale scores and overall Injury Severity Scores. The incidence, nature, and severity of GU injuries and extremity amputations are described. RESULTS: Of the 1,367 service members with GU injury included in this analysis, 433 (31.7%) had one or more extremity amputations. Most GU injuries were to the external genitalia [scrotum (55.6%), testes (33.0%), penis (31.0%), and urethra (9.1%)] vs. the kidneys (21.1%). Those with amputation(s) had greater GU injury severity (Abbreviated Injury Scale score ≥ 3) than those without amputations (50.1% vs. 30.5%, respectively; p < 0.0001). Approximately 3.4% of male service members with GU injury had an upper extremity amputation only, 8.9% had both lower and upper extremity amputation(s), and 19.4% had lower extremity amputation(s) only. Of the 387 patients with GU injury and lower extremity amputations, 87 (22.5%) had amputations below the knee and 300 (77.5%) had amputation(s) at/above the knee. CONCLUSION: In OEF/OIF, concomitant GU injury and extremity amputation are common and have serious implications for health and quality of life. This wounding pattern presents new challenges to the military medical and research and development communities to prevent, mitigate, and treat these battlefield injuries. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III.

Self-reported and accelerometer-derived physical activity levels and coronary artery calcification progression in older women: results from the Healthy Women Study.

OBJECTIVE: Despite the well-supported biological link between physical activity (PA) and atherosclerosis, most previous studies have reported a null association between PA and coronary artery calcification (CAC). The aim of this study was to examine the relationship between PA and CAC progression in 148 Healthy Women Study (HWS) participants over 28 years of observation. METHODS: The HWS was designed to examine cardiovascular risk factor changes from premenopause to postmenopause. Based on CAC scores collected on two follow-up visits (electron beam tomography [EBT] 1 and EBT4) scheduled 12 years apart, participants were classified into one of three groups: (1) no-detectable CAC group (n = 37; 0 CAC on both visits); (2) incident CAC group (n = 46; 0 CAC on the first visit and >0 CAC on the last visit); or (3) prevalent CAC group (n = 65; >0 CAC on both visits). PA data were collected regularly throughout the study using self-report questionnaires and accelerometers on EBT4. RESULTS: The percentage of HWS participants with no detectable CAC decreased from 56.1% on EBT1 to 25.0% on EBT4. Times spent per day in accumulated moderate- to vigorous-intensity PA (MVPA) and bouts of MVPA were each significantly higher in the no-detectable CAC group when compared with the prevalent CAC group (both P ≤ 0.01). After covariate adjustment, these differences remained statistically significant (both P < 0.05). Although self-reported summary estimates collected throughout the study were significantly associated with accelerometer data on EBT4, there were no significant differences in self-reported PA levels by CAC group after covariate adjustment. CONCLUSIONS: Study findings suggest that low levels of accelerometer-derived MVPA may be indicative of subclinical disease in older women.