Anthropomorphic and Physical Fitness Characteristics of United States Air Force Basic Military Training: Special Warfare Versus Nonspecial Warfare Recruits, Fiscal Year 2019-2023.

INTRODUCTION: Each year, thousands of individuals enlist in the Department of the Air Force (DAF), with some seeking to become DAF Special Warfare (SW) candidates. This study aimed to compare the anthropomorphic and physical fitness characteristics between these groups during fiscal years (FYs) 2019-2023. METHODS:  The sample includes male candidates below the age of 30 who attended the DAF basic military training (BMT) from FY2019 to 2023 (N = 119,415). Initial physical fitness testing was conducted during week 1 of BMT. Physical fitness results, height, weight, and body mass index (BMI) were compared between the two cohorts. A two-way analysis of variance was performed to analyze the effects of group (SW and non-SW) and FY on mean anthropomorphic and physical fitness test variables. Dependent variables were evaluated for homogeneity of variance using Levene's test and for normality using the Shapiro-Wilk test. The Tukey-Kramer test was employed for post hoc analyses with a threshold for statistical significance of α < 0.05. RESULTS:  The cohort of SW recruits displayed superior physical fitness results across all FYs (p < 0.001) with the exception of FY2021. They were significantly taller and heavier, and had a higher BMI when compared to non-SW DAF BMT recruits (p < 0.001). Mean values for maximum push-ups and sit-ups for SW recruits were significantly lower in FY2021 (p < 0.001) and not significantly different from non-SW recruits. Additionally, run times for both SW- and non-SW-bound recruits during FY2022 and FY2023 were significantly slower than previous years. CONCLUSIONS:  These findings can be used to establish a baseline for anthropometric and physical fitness profiles of incoming SW and non-SW DAF BMT recruits that may inform clinicians, human performance professionals, and military training leaders with information necessary to guide future research and physical fitness policy.

Pneumonia in military trainees: a comparison study based on adenovirus serotype 14 infection.

BACKGROUND: Adenovirus serotype 14 (Ad-14) recently emerged as a respiratory pathogen in the United States, with studies suggesting higher morbidity and mortality. This study was conducted to determine whether Ad-14 is associated with clinical outcomes in otherwise healthy patients with pneumonia. METHODS: Medical records of military trainees hospitalized with pneumonia during an outbreak of Ad-14 infection were reviewed. Clinical, radiographic, and laboratory parameters were compared on the basis of Ad-14 infection. RESULTS: Two hundred thirty-four trainees received a diagnosis of pneumonia, and 83(35%) were hospitalized. Sixty-one percent of patients with pneumonia were Ad-14 positive; 43% of patients with Ad-14 pneumonia were hospitalized (83% of female patients and 40% of male patients; P = .04), compared with 40% of patients with Ad-14 negative cases. Ad-14 infection was associated with higher admission temperature (38.3°C [interquartile range, (IQR) 37.7, 39.4] vs 37.3°C [IQR (36.7, 38.5)]; P < .01) and lower white blood cell count (8.3 × 1000 cells/µL [IQR, 5.7, 12.4] vs 13 × 1000 cells/µL [IQR, 7.5, 12.9]; P = .01), neutrophil count (6.7 × 1000 cells/µL [IQR, 2.8, 9.7] vs 9.7 × 1000 cells/µL [IQR, 5.6, 12.1]; P = .02), lymphocyte count (0.9 × 1000 cells/µL [IQR, 0.8, 1.1] vs 1.3 × 1000 cells/µL [IQR, 1, 1.9]; P = .001), and platelet count (210 × 1000 cells/µL [IQR, 145, 285] vs 261 × 1000 cells/µL [IQR, 238, 343]; P < .01). Ad-14 pneumonia was not associated with specific radiographic findings, pneumonia severity score, intensive care unit admission, longer hospitalization, or 30-day mortality. CONCLUSIONS: During an outbreak of Ad-14 infection, Ad-14 infection was not associated with excess overall morbidity or mortality. Ad-14 infection was associated with specific laboratory and clinical parameters and higher hospitalization rates in female trainees. These data provide new insight to the epidemiology of Ad-14 infection.

Musculoskeletal Injuries During U.S. Air Force Special Warfare Training Assessment and Selection, Fiscal Years 2019-2021.

From the inception of the Special Warfare Training Wing in fiscal year 2019 through 2021, 753 male, enlisted candidates attempted at least 1 Assessment and Selection and did not self-eliminate (i.e., quit). Candidates were on average 23 years of age. During candidates' first attempt, 356 (47.3%) individuals experienced a musculoskeletal (MSK) injury. Among the injuries, the most frequent type was nonspecific (n=334/356; 93.8%), and the most common anatomic region of injury was the lower extremity (n=255/356; 71.6%). When included in a multivariable model, older age, slower run times on initial fitness tests, and prior nonspecific injury were associated with both any injury and specifically lower extremity MSK injury.

The Use of Force Plate Vertical Jump Scans to Identify Special Warfare Trainees at Risk for Musculoskeletal Injury: A Large Cohort Study.

BACKGROUND: Vertical jump scans from commercially available force plate systems are increasingly used in military settings to screen for musculoskeletal injury (MSKI) risk. However, to date, no studies have determined the ability of these tools to identify tactical athletes at elevated risk for MSKI. PURPOSE: To (1) determine associations between scores from a force plate vertical jump test and the likelihood of experiencing an MSKI and to (2) establish the test-retest reliability of the output scores from the force plate system used. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 823 male Air Force Special Warfare trainees underwent force plate vertical jump screenings before entering an 8-week training course at US Air Force Special Warfare Training Wing. MSKI data were collected for the 8-week surveillance period for each trainee. Logistic regression analyses were used to identify associations between baseline force plate jump scores and the likelihood of MSKI (any region) or a lower extremity MSKI (significance level, P = .05). The test-retest portion of the study collected force plate output scores from 12 trainees performing 3 trials of the standard test procedures. The reliability of 5 output scores was assessed with intraclass correlation coefficients (ICCs) using a single rater. RESULTS: All force plate output scores demonstrated excellent test-retest reliability (ICC >0.90). Overall 308 (36.4%) trainees had an MSKI during the surveillance period. However, no significant associations were found between the proprietary force plate vertical jump scan output scores and the likelihood of experiencing either an MSKI or a lower extremity MSKI. CONCLUSION: Output scores from this commercially available force plate system did not identify Air Force Special Warfare trainees at elevated risk of experiencing an MSKI.

Association Between Markerless Motion Capture Screenings and Musculoskeletal Injury Risk for Military Trainees: A Large Cohort and Reliability Study.

BACKGROUND: Markerless motion capture (MMC) systems used to screen for musculoskeletal injury (MSKI) risk have become popular in military and collegiate athletic settings. However, little is known regarding the test-retest reliability or, more importantly, the ability of these systems to accurately identify individuals at risk for MSKI. PURPOSE: To determine the association between scores from a proprietary MMC movement screen test and the likelihood of suffering a subsequent MSKI and establish the test-retest reliability of the MMC system used. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Trainees for the Air Force Special Warfare program underwent MMC screenings immediately before entering the 8-week training course. MSKI data were extracted from a database for the surveillance period for each trainee. Logistic regression analyses were performed to identify associations between baseline MMC scores and the likelihood of suffering any MSKI or, specifically, a lower extremity MSKI. The test-retest portion of the study collected MMC scores from 10 separate participants performing 4 trials of the standard test procedures. Reliability was assessed using intraclass correlation coefficients by a single rater. RESULTS: Overall, 1570 trainees, of whom 800 (51%) suffered an MSKI, were included in the analysis. MMC scores poorly predicted the likelihood of any or a lower extremity MSKI (odds ratio, 1.01-1.02). Further, receiver operating characteristic curve analyses demonstrated poor sensitivity and specificity for prediction of MSKI with MMC scores (area under the curve = 0.53). Finally, intraclass correlation coefficients from the test-retest analysis of MMC scores ranged from 0.157 to 0.602. CONCLUSION: This MMC system displayed poor to moderate test-retest reliability and did not demonstrate the ability to discriminate between individuals who were and were not likely to suffer an MSKI.

Outcomes of Embedded Athletic Training Services Within United States Air Force Basic Military Training.

CONTEXT: Musculoskeletal injury is the leading cause of attrition from military training. OBJECTIVE: To assess the effect of an embedded athletic training musculoskeletal care model within a basic military training unit. DESIGN: Cluster randomized trial. SETTING: United States Air Force Basic Military Training, Joint Base San Antonio-Lackland. PATIENTS OR OTHER PARTICIPANTS: Military recruits randomly assigned to 1 of 3 training squadrons, 2 control and 1 experimental, between January 2016 and December 2018. INTERVENTION(S): A sports medicine care model was established in 1 squadron by embedding 2 certified athletic trainers overseen by a sports medicine fellowship-trained physician. The athletic trainers diagnosed and coordinated rehabilitation as the primary point of contact for recruits and developed interventions with medical and military leadership based on injury trends. MAIN OUTCOME MEASURE(S): Recruit attrition from basic training due to a musculoskeletal injury. Secondary outcomes were all-cause attrition, on-time graduation, rates of lower extremity injury and stress fracture, rates of specialty care appointments, and fiscal costs. RESULTS: Recruits in the athletic training musculoskeletal care arm experienced 25% lower musculoskeletal-related attrition (risk ratio = 0.75 [95% CI = 0.64, 0.89]) and 15% lower all-cause attrition (risk ratio = 0.85 [95% CI = 0.80, 0.91]), translating to a net saving of more than $10 million. The intervention reduced the incidence of lower extremity stress fracture by 16% (rate ratio = 0.84 [95% CI = 0.73, 0.97]). CONCLUSIONS: An embedded athletic training musculoskeletal care model outperformed usual care across operational, medical, and fiscal outcomes.

Adenovirus serotype 14 pneumonia at a basic military training site in the United States, spring 2007: a case series.

Adenovirus, a frequent cause of mild respiratory disease in military trainees, can result in severe manifestations when outbreaks are caused by novel viral strains for which there is little pre-existing immunity. Twenty-five basic military trainees (BMTs) were hospitalized with adenovirus pneumonia from April 1, 2007 through June 21, 2007. Clinical findings for 9 of these patients with PCR-confirmed adenovirus serotype 14 were studied retrospectively. The clinical picture was characterized by cough (88.9%) and sputum production (77.8%). All trainees were febrile. Laboratory results showed 88.9% had normal white blood cell (WBC) counts, 66.7% with high monocytes, and 55.6% with low lymphocytes on differential. All had lobar pneumonia radiographically. One patient required the intensive care unit (ICU) and later expired. In conclusion, among hospitalized patients with the combination of fever, productive cough, normal WBC, a differential showing high monocytes and low lymphocytes in an immunocompetent young adult with lobar pneumonia warrants a high level of suspicion for adenovirus 14 pneumonia.

Hydration status of Air Force military basic trainees after implementation of the back-mounted hydration system.

The Air Force makes an extraordinary effort to prevent heat-related illnesses associated with basic military training (BMT) in south Texas. However, inadequate hydration can still contribute to lost training time and qualified trainees leaving military service without completing BMT. The purpose of the present study was to determine whether equipping BMTs with back-mounted hydration systems (BM) is better than the standard-issue (SI) canteens with respect to hydration status. Male BMTs were randomly assigned to either BM (n = 40) or SI (n = 38) groups. Baseline values were assessed at week 0 before any physical readiness training (PRT). Subsequent data collection took place in the a.m. before PRT and in the p.m. before dinner the first 3 weeks, and during the 5 weeks of training. BMT total body water (TBW) and body composition were assessed by bioelectrical impedance. Saliva osmolality and total protein concentration were also determined. Hydration status increased daily in BM and SI and was well maintained over the duration of BMT. A significant hydration effect (p < 0.05) was observed for average daily increases in TBW and body weight with BM gaining more compared to SI. Average a.m. TBW was 0.3-0.8 L greater in SI versus BM (p < 0.05). Our findings demonstrate that adequate hydration status is maintained during Air Force BMT in a hot environment using either hydration mode and therefore do not support widespread issuance of the BM system on the premise of improved hydration during USAF BMT military training.

Description and Rate of Musculoskeletal Injuries in Air Force Basic Military Trainees, 2012-2014.

CONTEXT: Musculoskeletal injuries are common in military trainees and have significant medical and operational effects. OBJECTIVE: To provide current musculoskeletal injury epidemiology data for US Air Force basic military trainees. DESIGN: Descriptive epidemiologic study with cross-sectional features. SETTING: US Air Force Basic Military Training, Joint Base San Antonio-Lackland, Texas. PATIENTS OR OTHER PARTICIPANTS: All recruits who entered training between July 1, 2012, and June 30, 2014. MAIN OUTCOME MEASURE(S): Incidence density rate of all musculoskeletal injuries (stratified by body region and type) and factors and costs associated with injuries. RESULTS: Of the 67 525 trainees, 12.5% sustained 1 or more musculoskeletal injuries. The overall incidence density rate was 18.3 injuries per 1000 person-weeks (15.1 for men and 29.4 for women). The most common diagnosis (n = 2984) was Pain in joint, lower leg, as described in the International Classification of Diseases, Ninth Revision, Clinical Modification, code 719.46. Injuries were more common among those with lower levels of baseline aerobic and muscular fitness. Injured trainees were 3.01 times (95% confidence interval = 2.85, 3.18) as likely to be discharged, and injured trainees who did graduate were 2.88 times (95% confidence interval = 2.72, 3.04) as likely to graduate late. During the surveillance period, injuries resulted in more than $43.7 million in medical ($8.7 million) and nonmedical ($35 million) costs. CONCLUSIONS: Musculoskeletal injuries, predominantly of the lower extremities, have significant fiscal and operational effects on Air Force Basic Military Training. Further research into prevention and early rehabilitation of these injuries in military trainees is warranted.

Sexually transmitted infections in U.S. Air Force recruits in basic military training.

This study reports the counts, prevalence, and trends of five common sexually transmitted infections (STIs) among U.S. Air Force recruits during 2012-2014. Chlamydia and genital herpes simplex virus (HSV) were the most commonly identified STIs in females, with a prevalence of 4,841.2 and 432.3 per 100,000, respectively. Genital HSV was the most commonly identified STI in males at 133.4 per 100,000. There were 13 cases of chlamydia and gonorrhea co-infection among females and none among males. STI prevalence was lower than in a similarly aged U.S. civilian population.

Exercise-induced cardiac arrest in a sickle cell trait-positive Air Force recruit: a case report.

In October 2011, a sickle cell trait (SCT)-positive Air Force recruit collapsed and died immediately following his physical fitness test. The cause of death was reported to be a cardiac dysrhythmia secondary to an acute sickling crisis. Although it is well known that SCT-positive individuals have a significant risk of exercise-related death (ERD), this case is notable in that none of the commonly cited risk factors were present, including exertional heat injury, dehydration, training at altitude, and rhabdomyolysis. Our findings challenge the commonly held assertion exertional heat illness is the fundamental underlying etiology in these cases, and that the current Department of Defense's policy on SCT screening is ineffective at mitigating the risk of ERD in SCT-positive recruits. Furthermore, we argue that without a clearer understanding of the precise risk factors for ERD in this population, screening programs may actually shift excessive health risks onto those without SCT.

The effects of prenatal vitamin supplementation on operationally significant health outcomes in female air force trainees.

OBJECTIVES: A prenatal vitamin supplementation program for female basic military trainees at Joint Base San Antonio-Lackland was initiated in June 2012 with the goals of decreasing attrition and improving performance. This project examined whether supplementation influences attrition rates, incidence of stress fractures and iron deficiency anemia, and physical performance. METHODS: This was a cohort-based pilot study with an historical control group. Primary outcome measures included all-cause attrition, medical attrition, stress fractures, and iron deficiency anemia. RESULTS: Incidence rates of all-cause attrition, medical attrition, stress fractures, and anemia were similar in both groups, although the lower medical attrition in the supplementation group approached statistical significance (risk ratio, 0.74; 95% confidence interval, 0.54-1.01). CONCLUSION: Although this study found no statistical benefit, the operationally significant reduction in medical attrition of 26% suggests that providing prenatal vitamin supplementation to female basic trainees in the Air Force may be worthwhile.

Epidemiology, microbiology, and antibiotic susceptibility patterns of skin and soft tissue infections, Joint Base San Antonio-Lackland, Texas, 2012-2014.

Skin and soft tissue infections (SSTIs), including those caused by methicillin-resistant Staphylococcus aureus (MRSA), are common in military training environments. In 2014, the healthcare providers for trainees at Joint Base San Antonio (JBSA)-Lackland, TX, notified the surveillance unit of increased antibiotic resistance reported on wound cultures of purulent SSTIs. To provide updated clinical guidance to local providers, the surveillance unit conducted a review of all SSTIs diagnosed among trainees at JBSA-Lackland between 1 October 2012 and 31 December 2014. SSTI cumulative incidence during the surveillance period was 0.81%, with similar rates between males (0.80%) and females (0.84%) and between basic (0.82%) and technical (0.79%) trainees. Of 772 total cases, 254 were cultured; 196 resulted in growth of one or more pathogens: MRSA (n=110); methicillin-sensitive S. aureus (n=68); other gram-positive cocci (n=5); and gram-negative rods (n=18). In vitro activity of commonly used antibiotics against S. aureus isolates dropped slightly from the previous surveillance period. In addition to novel antibiotic research and development, these trends warrant enhanced local preventive efforts and close adherence to evidence-based treatment algorithms.

Concurrent bilateral femoral neck stress fractures in a military recruit: a case report.

BACKGROUND: Stress fractures are overuse injuries that historically afflict a large number of military recruits, likely because of the sudden increase of high-intensity activity, such as running and marching. CASE: A 23-year-old male U.S. Air Force recruit presented with hip pain during his second week of basic training and was diagnosed with bilateral femoral neck stress fractures, grade 4 on the right and grade 3 on the left. This is the first known case of concurrent bilateral femoral neck stress fractures in a U.S. military recruit reported in the medical literature. CONCLUSION: This report describes a severe case of stress fracture in an individual with no readily identifiable risk factors.

Bilateral lower extremity inflammatory lymphedema in Air Force basic trainees: clinical and epidemiologic study of a new disease entity.

IMPORTANCE: This observational study characterizes a new clinical condition identified in 55 military trainees. OBJECTIVE: To determine the incidence and underlying cause of bilateral lower extremity inflammatory lymphedema in Air Force basic trainees. DESIGN, SETTING, AND PARTICIPANTS: An observational study was conducted at Lackland Air Force Base in San Antonio, Texas. Participants included 14 243 Air Force basic trainees who entered training between September 2011 and January 2012 and the 55 trainees (0.4%) who developed bilateral lower extremity inflammatory lymphedema that occurred during the 8½-week basic training course. Two modifiable risk factors were evaluated: vaccine reaction and newly issued military footwear (combat boots and boot socks). INTERVENTIONS: During November 2011, all new trainees wore only white socks and running shoes rather than the issued military footwear. During December 2011 and January 2012, the scheduled administration of tetanus/diphtheria/acellular pertussis and meningococcal vaccines, respectively, was delayed by 1 week for all new trainees. A full medical record review was conducted for every confirmed case of bilateral lower extremity inflammatory lymphedema. MAIN OUTCOMES AND MEASURES: Identification of incident cases, symptom onset, antimicrobial treatment, immunization reaction, laboratory studies, specialty referral, and biopsy. RESULTS: Fifty-four of the 55 incident cases (98%) of bilateral lower extremity inflammatory lymphedema occurred during the first 120 hours of training. Alterations in the timing of the military footwear used and selected vaccine administration had no effect on the incidence of new cases. Two participants (4%) experienced symptom onset before receipt of the vaccines. Oral antimicrobial medications were not found to speed symptom resolution compared with conservative treatment measures (P = .34). One incident case was diagnosed as leukocytoclastic vasculitis by tissue examination. CONCLUSIONS AND RELEVANCE: Multiple training-related risk factors were ruled out as sources of bilateral lower extremity inflammatory lymphedema. Cases are likely secondary to prolonged standing with resultant gravity-dependent venous congestion and inflammatory vasculitis. The potential roles of undiagnosed venous reflux disease and the military physical training environment in these cases remain to be elucidated.

Measles, Mumps, and Rubella Titers in Air Force Recruits: Below Herd Immunity Thresholds?

INTRODUCTION: Preventable diseases like measles and mumps are occurring with increasing frequency in the U.S. despite the availability of an effective vaccine. Given concern that an outbreak may occur among military recruits, we compared serologic evidence of immunity to measles, mumps, and rubella among military recruits with known herd immunity thresholds and determined whether the current Department of Defense policy of presuming mumps immunity based on measles and rubella titers is reliable. METHODS: Serum antibody levels for measles, mumps, and rubella were obtained from all new recruits upon arrival at Joint Base San Antonio-Lackland, Texas, from 25 April 2013 through 24 April 2014. Seroprevalence of each disease was assessed by age and sex, and concordance between mumps titers and measles and rubella titers was calculated. Data analysis was performed in 2014-2015. RESULTS: Among 32,502 recruits, seroprevalences for measles, mumps, and rubella antibodies were 81.6%, 80.3%, and 82.1%, respectively. Of the 22,878 recruits seropositive for both measles and rubella antibodies, 87.7% were also seropositive for mumps. CONCLUSIONS: Seroprevalences for measles, mumps, and rubella antibodies among a large cohort of recruits entering U.S. Air Force basic training were generally lower than levels required to maintain herd immunity. In order to reduce the incidence of mumps infections, the Department of Defense should consider obtaining antibody titers for measles, mumps, and rubella and vaccinating all individuals susceptible to one or more of the viruses.

Prevalence and Impact of Anemia on Basic Trainees in the US Air Force.

BACKGROUND: Anemia has been implicated in adverse health outcomes of athletes and military trainees, ranging from overuse injuries to degraded physical and cognitive performance. The purpose of this study was to investigate prevalence of anemia among US Air Force (USAF) basic trainees, to compare physical performance and discharge rates between anemic and non-anemic trainees, and to determine the risks and relative risks of being discharged for anemic versus non-anemic women and men. METHODS: All USAF basic trainees were screened for anemia between July 2013 and January 2014, during an 8-week basic training course at Joint Base San Antonio-Lackland, TX. Age, sex, screening hemoglobin, anthropometric measurements, initial/final physical fitness assessment scores, and discharge data were collected from trainees. Those identified as anemic (hemoglobin <13.5 g/dL for males and <12.0 g/dL for females) received additional labwork, nutritional counseling, and oral iron-replacement, if indicated. Mean percent improvement was calculated for all performance parameters from beginning to end of training. Anemic trainees were compared to non-anemic trainees by t test with Welch modification. Results were stratified by sex and anemia severity with post-hoc Bonferroni correction. RESULTS: Prevalence of anemia was 12.6 % (N = 18,827). Respective prevalence of borderline, moderate, and severe anemia was 12.6, 10.9, and 1.9 % for females and 4.8, 3.8, and 0.3 % for males. Mean 1.5-mile run-time, push-up and sit-up counts improved from beginning to end of training for both anemic and non-anemic trainees (p < 0.001 both). Non-anemic trainees had slightly greater run-time improvements than borderline and moderate anemics (female: 17.7 vs. 15.2, and 15.1 % improvement, p < 0.05 both; male: 14.9 vs. 13.2, and 13.5 % improvement, p < 0.05 both). One-way ANOVA demonstrated statistically significant differences between initial and final fitness data for all measures and both genders (p < 0.001) with the exception of final sit-up counts for male trainees (p = 0.082). Discharge rate for anemic trainees was 9.0 % (20 % for severely anemic trainees) as compared to 5.7 % for non-anemics. CONCLUSIONS: Anemia was prevalent among USAF basic trainees. Identification and treatment of anemia may optimize physical performance and decrease the rate of medical discharge.

Injury-reduction effectiveness of prescribing running shoes on the basis of foot arch height: summary of military investigations.

STUDY DESIGN: Secondary analysis of 3 randomized controlled trials. Objective Analysis of studies that examined whether prescribing running shoes on the basis of foot arch height influenced injury risk during military basic training. BACKGROUND: Prior to 2007, running magazines and running-shoe companies suggested that imprints of the bottom of the feet (plantar shape) could be used as an indication of foot arch height and that this could be used to select individually appropriate types of running shoes. METHODS: Similar studies were conducted in US Army (2168 men, 951 women), Air Force (1955 men, 718 women), and Marine Corps (840 men, 571 women) basic training. After foot examinations, recruits were randomized to either an experimental or a control group. Recruits in the experimental group selected or were assigned motion-control, stability, or cushioned shoes to match their plantar shape, which represented a low, medium, or high foot arch, respectively. The control group received a stability shoe regardless of plantar shape. Injuries during basic training were assessed from outpatient medical records. RESULTS: Meta-analyses that pooled results of the 3 investigations showed little difference between the experimental and control groups in the injury rate (injuries per 1000 person-days) for either men (summary rate ratio = 0.97; 95% confidence interval [CI]: 0.88, 1.06) or women (summary rate ratio = 0.97; 95% CI: 0.85, 1.08). When injury rates for specific types of running shoes were compared, there were no differences. CONCLUSION: Selecting running shoes based on arch height had little influence on injury risk in military basic training. LEVEL OF EVIDENCE: Prevention, level 1b.

Staphylococcus aureus and other skin and soft tissue infections among basic military trainees, Lackland Air Force Base, Texas, 2008-2012.

Military training environments have been identified as high-risk settings for acquisition of skin and soft tissue infections (SSTIs), including those caused by methicillin-resistant Staphylococcus aureus (MRSA). Among the 148,355 basic military trainees at Lackland Air Force Base, Texas, between 1 October 2008 and 30 September 2012, there were 289 SSTIs, including 48 cases of culture-confirmed MRSA and 48 cases of possible MRSA-defined as SSTIs treated with both incision and drainage and MRSA drug coverage (i.e., trimethoprim-sulfamethoxazole, clindamycin, a tetracycline, or linezolid). The period prevalence rates of all SSTIs and MRSA SSTIs increased annually since fiscal year 2010. Of the 87 SSTIs cultured during the surveillance period, 74 were positive: MRSA (n=48); methicillin-sensitive Staphylococcus aureus (n=24); Haemophilus parainfluenzae (n=1); and viridans Streptococcus (n=1). Among MRSA positive cultures, three were resistant to clindamycin, one to tetracycline, and one to both clindamycin and tetracycline; none was resistant to trimethoprim-sulfamethoxazole. An algorithmic clinical approach and heightened public health measures may reduce rates of future SSTIs among basic trainees at Lackland Air Force Base.

Effect on injuries of assigning shoes based on foot shape in air force basic training.

BACKGROUND: This study examined whether assigning running shoes based on the shape of the bottom of the foot (plantar surface) influenced injury risk in Air Force Basic Military Training (BMT) and examined risk factors for injury in BMT. METHODS: Data were collected from BMT recruits during 2007; analysis took place during 2008. After foot examinations, recruits were randomly consigned to either an experimental group (E, n=1042 men, 375 women) or a control group (C, n=913 men, 346 women). Experimental group recruits were assigned motion control, stability, or cushioned shoes for plantar shapes indicative of low, medium, or high arches, respectively. Control group recruits received a stability shoe regardless of plantar shape. Injuries during BMT were determined from outpatient visits provided from the Defense Medical Surveillance System. Other injury risk factors (fitness, smoking, physical activity, prior injury, menstrual history, and demographics) were obtained from a questionnaire, existing databases, or BMT units. RESULTS: Multivariate Cox regression controlling for other risk factors showed little difference in injury risk between the groups among men (hazard ratio [E/C]=1.11, 95% CI=0.89-1.38) or women (hazard ratio [E/C]=1.20, 95% CI= 0.90-1.60). Independent injury risk factors among both men and women included low aerobic fitness and cigarette smoking. CONCLUSIONS: This prospective study demonstrated that assigning running shoes based on the shape of the plantar surface had little influence on injury risk in BMT even after controlling for other injury risk factors.