Pilonidal Sinus Disease: A 10-Year Review Reveals Occupational Risk Factors and the Superiority of the Minimal Surgery Trephine Technique.

OBJECTIVES: To identify military occupational risk factors for pilonidal sinus disease (PSD) and to compare an Army Clinic minimal surgery with techniques used at public hospitals. METHODS: Review of a historical cohort of soldiers (3,407 with PSD) to determine PSD risk factors in military personnel and comparison of postoperative sick leave days between surgical techniques. RESULTS: Male and female officers had a lower PSD incidence, whereas male combatants and female drivers were at higher risk compared to administrative personnel. The minimal surgery technique used at the Army Clinic was associated with an average 13 less postoperative sick leave days per patient, as compared to the surgical techniques including wide excision used at public hospitals. Compared to healthy soldiers, the relative risk for PSD recurrence was 7.87 in all males and 9.54 in male combatants. CONCLUSIONS: Male combatants and female drivers are at higher risk for PSD, whereas officers and administrative personnel are at lower risk. Compared with surgical techniques used at public hospitals, the Army Clinic exclusive use of the Gips minimal surgery technique is associated with fewer sick leave days. Prior surgery for PSD is a positive predictor of recurrence, and these patients warrant secondary prevention.

Early pregnancy confirmation--the role of urine pregnancy test in military primary care clinics.

Pregnancy detection is a common procedure in primary care and can be challenging in the setting of military primary care clinics. The objective of this study was to determine whether the introduction of urine pregnancy tests to military primary care clinics is associated with earlier pregnancy detection. We conducted a cross-sectional study using data from female soldiers, aged 18 to 20 years. Pregnancy was diagnosed using urine pregnancy tests. Ultrasonographic gestational age at presentation was compared between pregnant soldiers diagnosed in primary care clinics and pregnant soldiers diagnosed in gynecology secondary care clinics. A total of 150 female soldiers performed urine pregnancy tests in 5 different primary care clinics, from which 28 (19%) were pregnant. Mean gestational age at diagnosis was significantly lower among patients diagnosed in primary care clinics as compared with patients diagnosed in gynecology secondary care clinics (41.07 days (SD, 6.72) vs. 48.42 days (SD, 21.94), p < 0.001). In conclusion, the availability of urine pregnancy tests in the setting of military primary care clinics was strongly associated with early pregnancy detection at a time point in which presentation for both antenatal care and abortion services potentially improve maternal and neonatal health.