Sunscreens: UV filters to protect us: Part 2-Increasing awareness of UV filters and their potential toxicities to us and our environment.

BACKGROUND: Sunscreens are topical preparations containing one or more compounds that filter, block, reflect, scatter, or absorb ultraviolet (UV) light. Part 2 of this review focuses on the environmental, ecological effects and human toxicities that have been attributed to UV filters. METHODS: Literature review using NIH databases (eg, PubMed and Medline), FDA and EPA databases, Google Scholar, the Federal Register, and the Code of Federal Regulations (CFR). LIMITATIONS: This was a retrospective literature review that involved many different types of studies across a variety of species. Comparison between reports is limited by variations in methodology and criteria for toxicity. CONCLUSIONS: In vivo and in vitro studies on the environmental and biological effects of UV filters show a wide array of unanticipated adverse effects on the environment and exposed organisms. Coral bleaching receives considerable attention from the lay press, but the scientific literature identifies potential toxicities of endocrine, neurologic, neoplastic and developmental pathways. These effects harm a vast array of aquatic and marine biota, while almost no data supports human toxicity at currently used quantities (with the exception of contact allergy). Much of these data are from experimental studies or field observations; more controlled environmental studies and long-term human use data are limited. Several jurisdictions have prohibited specific UV filters, but this does not adequately address the dichotomy of the benefits of photoprotection vs lack of eco-friendly, safe, and FDA-approved alternatives.

The Risk of Chronic Gastrointestinal Disorders Following Acute Infection with Intestinal Parasites.

Background: Infectious gastroenteritis (IGE) is caused by numerous bacterial, viral, and parasitic pathogens. A history of IGE has been shown in previous studies to increase the risk of developing chronic gastrointestinal disorders and other chronic conditions. As bacteria and viruses represent the majority of pathogen-specific causes of IGE, post-infectious studies have primarily focused on these organisms. The objective of this study was to investigate an association between a history of parasite-associated IGE and the subsequent development of chronic post-infectious gastrointestinal and non-gastrointestinal disorders in a military population. Methods: International Classification of Diseases, 9th Revision Clinical Modification (ICD-9-CM) diagnostic coding data for primary exposures and outcomes were obtained for a retrospective cohort study of active component military personnel from 1998 to 2013. Exposed subjects consisted of individuals with documented infection with one of ten parasitic pathogens. Unexposed subjects were matched to exposed subjects on demographic and operational deployment history parameters. Adjusted odds ratios (aORs) were estimated using logistic regression for several chronic disorders previously shown to be associated with a history of IGE. Results: A total of 896 subjects with a parasitic exposure were matched to 3681 unexposed subjects for multivariate regression analysis. Individuals infected with Balantidium coli, Ascaris lumbricoides, Strongyloides stercoralis, Necator americanus/Ancylostoma duodenale, and Taenia spp. had higher aOR for development of several chronic gastrointestinal disorders when compared with unexposed subjects after controlling for various covariates. Conclusion: We found that parasite-associated enteric infection increases the risk of development of post-infectious chronic gastrointestinal disorders in a military population. These results require confirmation in similar populations and in the developing world where infection with these parasites is endemic. Further understanding of disease burden and causal mechanisms should direct primary prevention and potential disease interception strategies.

Duty Hour Compliance: A Survey of U.S. Military Medical Interns and Residents.

OBJECTIVE: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) modified its duty hour standards for interns and residents. This was done, in part, because of a belief that increased compliance with these standards was needed to positively impact resident fatigue, resident quality of life, and patient safety. However, several studies indicate that duty hour noncompliance and false reporting by interns and residents remains a significant concern for residency program directors. This study examined the compliance of interns and residents with ACGME duty hour standards at a large military graduate medical education (GME) training program. METHODS: We conducted a survey of 535 trainees assigned to 24 GME programs within the National Capital Consortium (NCC). Statistical analysis for descriptive parameters used a standard error of measure on the basis of sample and target population sizes to calculate two-sided 95% confidence intervals (CIs). A χ2 analysis was performed to compare response differences for particular survey questions. A Cronbach α coefficient was calculated to compare the internal consistency of responses for questions in which individual responses were expected to correlate. This study was reviewed by the Offices of Research at the Walter Reed National Military Medical Center and the Uniformed Services University and adjudicated as "Not Research." RESULTS: Overall, 41.3% (N = 221) of those contacted completed all survey questions. From the available responses, 31.6% (95% CI, 26.9-36.2) reported at least one occurrence of implicit pressure to alter duty hour reporting, and 32.0% (95% CI, 27.3-36.7) reported at least one occurrence of altering reported duty hours. In addition, 37.2 (95% CI, 32.5-41.9) reported being unable to always follow duty hour limits and 58.1% (95% CI, 53.1-63.1) felt time working at home on residency requirements should be included in reported duty hours. CONCLUSION: Our results indicate that a significant portion of interns and residents within the NCC were unable to consistently follow ACGME duty hour standards and various systemic barriers within the GME training environment may have contributed. To remove or mitigate these barriers, we recommend using an approach similar to those of "high-reliability organizations" in which organizational processes are systematically investigated to improve safety, quality, and efficiency. Additional surveys or cognitive interviewing within the NCC and at other military GME training sites could be used to help refine these barriers, discover other barriers, determine the scope of these issues within the entire military GME training system, and to measure the outcome of correction actions.

Post-refractive surgery complications and eye disease, active component, U.S. Armed Forces, 2005-2014.

Refractive surgery (RS) is a common procedure in the U.S. military population. This report provides an estimation of incident RS for vision correction purposes in the active component of the U.S. military from 1 January 2005 through 31 December 2014 and the prevalence of post-RS complications and eye disease in the 1-year period after RS. During the surveillance period, a total of 121,571 subjects without a diagnosis of eye disease other than hyperopia, myopia, or astigmatism in the previous year received a single incident RS procedure. In the 1-year period after RS, 5.3% of subjects with preoperative hyperopia or myopia had treatment-persistent (unresolved) hyperopia or myopia; 2.0% of subjects with preoperative astigmatism had treatment-persistent (unresolved) astigmatism; and 3.8% were diagnosed with tear film insufficiency. In general, most outcomes showed higher prevalences in Army and Air Force personnel versus Navy and Marine Corps personnel, in women versus men, in officer versus enlisted personnel, and in aviation and Special Forces personnel. A wide variation in outcome prevalences was noted by procedural military treatment facility.