Time to consider a targeted HPV vaccination programme for male military recruits.

Human papillomaviruses (HPV) are the most common type of sexually transmitted infection in men but also related to high-risk cancers. This article considers the epidemiology of HPV in the male military population, the UK vaccination programme and the current UK Joint Committee on Vaccination and Immunisation recommendations. Military men may not benefit from HPV herd immunity and may have a different risk profile; vaccination may in turn reduce the operational burden of HPV-related disease within this population. Military men may benefit from a targeted vaccination programme, and the paper calls for urgent consideration of approaches that could protect them from acquiring HPV.

Obstetric complications on deployed operations: a guide for the military surgeon.

Modern military general surgeons tend to train and then practice in 'conventional' surgical specialties in their home nation; however, the reality of deployed surgical practice, either in a combat zone or on a humanitarian mission, is that they are likely to have to manage patients with a broad range of ages, conditions and pathologies. Obstetric complications of war injury include injury to the uterus and fetus as well as the mother and both placental abruption and uterine rupture are complications that military surgeons may have little experience of recognising and managing. On humanitarian deployments, fetomaternal complications are a common reason for surgical intervention. We report a recent patient's story to highlight the obstetric training needs of military surgeons.

Sexual health provision in Defence Primary Health Care: a model for change?

INTRODUCTION: Defence Primary Health Care (DPHC) as an organisation has the responsibility for the provision of a basic level of sexual health service that every patient can access, regardless of their geographical location. The Military Advice and Sexual Health/HIV service (MASHH), based in Birmingham, provides nationally validated sexual health training and accreditation. Training was delivered to an isolated DPHC region to allow as many doctors and nurses to attend and minimised associated travel and accommodation costs. This training initiative enabled military personnel to access sexual health services within their own medical centres and reduced the number of potential referrals to local services. To assess compliance with the relevant standards, MASHH audited the DPHC region 2 months following completion of training. This was to ensure that the level 1 sexual health service provided by the DPHC region met with current British Association of Sexual Health and HIV (BASHH) Standards. METHODS: Provision of sexual health services in the four medical centres in the DPHC region were assessed for a 6-month period against the standards set by BASHH. RESULTS: Few of the audit standards were met; this was in part due to personnel undertaking sexual health consultations who had not been appropriately trained and partly due to unrecognised deficiencies in the DPHC computer coding systems. CONCLUSIONS: Overall, this programme demonstrates a potential model for the cost-effective roll-out of accredited sexual health training and resultant service provision for other DPHC regions, but some changes are needed to ensure national standards are met.

Survival of HIV-infected patients admitted to the intensive care unit in the era of highly active antiretroviral therapy.

We retrospectively studied outcomes for HIV-infected patients admitted to the intensive care unit (ICU) between January 1999 and June 2009. Patient demographics, receipt of highly active antiretroviral therapy (HAART), reason for ICU admission and survival to ICU and hospital discharge were recorded. Comparison was made against outcomes for general medical patients contemporaneously admitted to the same ICU. One hundred and ninety-two HIV-infected patients had 222 ICU admissions; 116 patients required mechanical ventilation (MV) and 43 required renal replacement therapy. ICU admission was due to an HIV-associated diagnosis in 113 patients; 37 had Pneumocystis pneumonia. Survival to ICU discharge and hospital discharge for HIV-infected patients was 78% and 70%, respectively, and was 75% and 68% among 2065 general medical patients with 2274 ICU admissions; P = 0.452 and P = 0.458, respectively. HIV infection was newly diagnosed in 42 patients; their ICU and hospital survival was 69% and 57%, respectively. From multivariable analysis, factors associated with ICU survival were patient's age (odds ratio [OR] = 0.74 [95% confidence interval (CI) = 0.53-1.02] per 10-year increase), albumin (OR = 1.05 [1.00-1.09] per 1 g/dL increase), Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 0.55 [0.35-0.87] per 10 unit increase), receipt of HAART (OR = 2.44 [1.01-4.94]) and need for MV (OR = 0.14 [0.06-0.36]). In the era of HAART, HIV-infected patients should be offered ICU admission if it is likely to be of benefit.