The Impact of Environment and Occupation on the Health and Safety of Active Duty Air Force Members: Database Development and De-Identification.

Preparing data for medical research can be challenging, detail oriented, and time consuming. Transcription errors, missing or nonsensical data, and records not applicable to the study population may hamper progress and, if unaddressed, can lead to erroneous conclusions. In addition, study data may be housed in multiple disparate databases and complex formats. Merging methods may be incomplete to obtain temporally synchronized data elements. We created a comprehensive database to explore the general hypothesis that environmental and occupational factors influence health outcomes and risk-taking behavior among active duty Air Force personnel. Several databases containing demographics, medical records, health survey responses, and safety incident reports were cleaned, validated, and linked to form a comprehensive, relational database. The final step involved removing and transforming personally identifiable information to form a Health Insurance Portability and Accountability Act compliant limited database. Initial data consisted of over 62.8 million records containing 221 variables. When completed, approximately 23.9 million clean and valid records with 214 variables remained. With a clean, robust database, future analysis aims to identify high-risk career fields for targeted interventions or uncover potential protective factors in low-risk career fields.

Review of non-battle injuries in Air Force personnel deployed in support of Operation Enduring Freedom and Operation Iraqi Freedom.

This study examines non-battle injuries among U.S. Air Force members deployed during Operations Iraqi and Enduring Freedom. A cohort of 275,843 Active Duty, Guard, and Reserve members were identified for the period September 11, 2001 through October 31, 2006. Data on injuries were obtained from electronic medical records and deployment time was obtained from manpower records. Poisson regression was used to estimate adjusted incidence rate ratios (IRRs). The most common non-battle injuries were sprains and strains (53%) followed by open wounds (27%). Guard and Reserve members tended to have a lower rate of orthopedic non-battle injuries than Active Duty members in crude analyses and after adjustment for age, previous deployment, sex, race/ethnicity, and occupation (IRR = 0.95; 95% CI = 0.89-1.02 and IRR = 0.85; 95% CI = 0.77-0.93). Results from this study are intended to facilitate further research of potential differences between Air Force components to reduce non-battle injuries in a deployed environment.

Outbreak of varicella at a day-care center despite vaccination.

BACKGROUND: In seven studies of the effectiveness of the varicella vaccine conducted since it was licensed, the effectiveness was 71 to 100 percent against disease of any severity and 95 to 100 percent against moderate and severe disease. We investigated an outbreak of varicella in a population of children with a high proportion of vaccinees who were attending a day-care center in a small community in New Hampshire. METHODS: Using standardized questionnaires, we collected information about the children's medical and vaccination history from parents and health care providers. The analysis of the effectiveness of the vaccine and of risk factors for vaccine failure was restricted to children who were enrolled in the day-care center continuously during the outbreak and attended for one week or more and who were cared for in the building that represented the epicenter of the outbreak, since transmission was not documented in a second building. RESULTS: Varicella developed in 25 of 88 children (28.4 percent) between December 1, 2000, and January 11, 2001. The index case occurred in a healthy child who had been vaccinated three years previously and who infected more than 50 percent of his classmates who had no history of varicella. The effectiveness of the vaccine was 44.0 percent (95 percent confidence interval, 6.9 to 66.3 percent) against disease of any severity and 86.0 percent (95 percent confidence interval, 38.7 to 96.8 percent) against moderate or severe disease. Children who had been vaccinated three years or more before the outbreak were at greater risk for vaccine failure than those who had been vaccinated more recently (relative risk, 2.6 [95 percent confidence interval, 1.3 to 5.3]). CONCLUSIONS: In this outbreak, vaccination provided poor protection against varicella, although there was good protection against moderate or severe disease. A longer interval since vaccination was associated with an increased risk of vaccine failure. Breakthrough infections in vaccinated, healthy persons can be as infectious as varicella in unvaccinated persons.