Cause-Specific Mortality Among Norwegian Veterans Deployed to Afghanistan Between 2001 and 2019.

INTRODUCTION: Norwegian military forces participated in the military campaign Operation Enduring Freedom in Afghanistan starting in 2001. Military personnel often show a "healthy soldier effect" in terms of lowered all-cause mortality when compared to the general population. However, military service in conflict areas is associated with an increased risk of death from external causes such as transport accidents and suicide after discharge. We aimed to investigate cause-specific mortality in a cohort of 9,192 Norwegian (7.5% women) veterans deployed to Afghanistan between 2001 and 2019. MATERIALS AND METHODS: We followed cohort members from their first day of service in Afghanistan through 2019. We computed standardized mortality ratios (SMRs) with 95% CIs by comparing the observed number of deaths in our cohort with the expected number of deaths in the general population. Standardized mortality ratios were calculated for the full follow-up period among men and women separately, and among men only for two time periods: during deployment and after discharge from service in Afghanistan. RESULTS: We observed 77 deaths (3 women and 74 men), 10 of which occurred during deployment (war casualties, 1 woman and 9 men); all others occurred after discharge. All-cause mortality in women did not differ from that in the general population (SMR = 0.52, 95% CI 0.11-1.53). For men, the observed all-cause mortality was lower than the expected rate for the full follow-up period (SMR = 0.55, 95% CI 0.43-0.69), during deployment, and after discharge, while deaths because of transport accidents after discharge (13 cases) were more than twice as high as expected rates (SMR = 2.36, 95% CI 1.26-4.04). The 11 observed suicides gave a nonstatistically significant, lower suicide risk compared to the expected rates (SMR = 0.66, 95% CI 0.33-1.18). CONCLUSION: In accordance with the "healthy soldier effect," military service in Afghanistan was generally associated with a lower than expected risk of death both during deployment and after discharge. The risk of death from transport accidents was higher than expected after discharge, while the observed incidence of suicide did not differ from the expected rate in the general population.

Yersinia enterocolitica: A Follow-up of the Outbreak in the Norwegian Armed Forces in 2014.

INTRODUCTION: In the spring of 2014, there was an outbreak of Yersinia enterocolitica (YE) gastroenteritis in four Norwegian military camps-the largest outbreak ever reported in Norway. YE is usually transmitted via food, and the gastrointestinal disease caused by the bacterium is considered a public health problem in several countries. Common symptoms of YE gastroenteritis are abdominal pain, diarrhea, fever, nausea, and vomiting. Post-infectious complications can occur after YE gastroenteritis, the most common of which are erythema nodosum and reactive arthritis. Based on self-reported data, we describe the duration of illness, the duration of any absence from service, and the incidence of symptoms of post-infectious complications in two groups of servicepeople: one diagnosed with YE gastroenteritis and the other with an unspecified acute infectious gastroenteritis. MATERIALS AND METHODS: The Norwegian Armed Forces Health Register (NAFHR) is a central health register that contains data from conscripts and from military and civilian personnel in the Norwegian Armed Forces. In this study, we identified all individuals with a diagnosis of YE gastroenteritis in the NAFHR in the period from January 1 to June 30, 2014 (n = 128) as well as all those with a diagnosis of an unspecified acute infectious gastroenteritis in the same period (n = 323) to participate as controls. In October 2018, a link to an internet-based questionnaire was distributed by e-mail to all identified individuals. The questionnaires collected data on the duration of illness, the duration of absence from service, and the incidence of symptoms of post-infectious complications. RESULTS: Of all those who received the questionnaire, 72 (59%) were included in the YE group and 117 people (36%) were included in the control group. Half of those in the YE group were ill for more than 13 days, while almost all (90%) of those in the control group recovered after 1 week. There were no differences between the groups in the incidence of symptoms of post-infectious complications during the 6 weeks after recovery. There was a significantly larger proportion of officers than conscripts in the YE group who reported symptoms of post-infectious complications. None of the respondents reported symptoms of post-infectious complications in the 6 months after the termination of military service. CONCLUSION: One strength of this study is that we were able to investigate a large outbreak of YE gastroenteritis in a group of individuals with good underlying health. Weaknesses are the low response rate, especially in the control group, and the fact that we sent out the questionnaire >4 years after the acute gastroenteritis occurred. YE gastroenteritis among personnel in the Norwegian Armed Forces was associated with a significantly longer duration of illness and a longer duration of absence from service than that resulting from an unspecified acute infectious gastroenteritis. However, YE gastroenteritis was not associated with more symptoms of post-infectious complications.

Fit for fight - self-reported health in military women: a cross-sectional study.

BACKGROUND: Substantial research has found that women assess their health as poor relative to men, but the reasons for this are not fully understood. Military women are characterised by good health and the ability to work in an archetypically male culture. Thus, studies on the gender pattern of self-reported health in military personnel could generate hypotheses for future research on the possible associations between gender and health. However, such studies are rare and limited to a few countries. The aim of this study was to examine self-reported physical and mental health in Norwegian military women. METHODS: We compared responses on self-reported health of 1068 active duty military women in Norway to those of active duty military men (n = 8100). Further, we compared the military women to civilian women working in the Norwegian Armed Forces (n = 1081). Participants were stratified into three age groups: 20-29; 30-39; and 40-60 years. We used Pearson Chi-square tests, Students t-tests and regression models to assess differences between the groups. RESULTS: The military women in our study reported physical illness and injuries equal to those of military men, but more military women used pain relieving and psychotropic drugs. More military women aged 20-29 and 30-39 years reported mental health issues than military men of the same age. In the age group 30-39 years, twice as many military women assessed their health as poor compared to military men. In the age group 40-60 years, more military women than men reported musculoskeletal pain. Military women used less smokeless tobacco than military men, but there were few differences in alcohol consumption and smoking. Military women appeared to be more physically healthy than civilian women, but we found few differences in mental health between these two groups. CONCLUSION: Most military women reported physical symptoms equal to those of military men, but there were differences between the genders in mental health and drug use. More favourable health compared to civilian women was most evident in the youngest age group and did not apply to mental health.

Introduction of a new instrument to measure motivation for gaming: the electronic gaming motives questionnaire.

AIMS: To adapt the four-dimensional Gambling Motives Questionnaire-Revised (GMQ-R) to measure the motivation for engaging in electronic gaming, and to validate the internal structure and investigate the criterion validity of the new Electronic Gaming Motives Questionnaire (EGMQ). DESIGN AND SETTING: The GMQ-R was adapted to measure motivation for playing video games and the new instrument was tested on a sample of Norwegian conscripts selected randomly from the pool of conscripts who started their military service between 2013 and 2015. PARTICIPANTS: The questionnaire was administered to all those who had played video games during the last 6 months and consisted of 853 gamers (86.8% men, mean age = 19.4 years). MEASUREMENTS: All participants completed the EGMQ, as well as other measures of gaming behaviour, gaming problems, boredom, loneliness and depression. FINDINGS: The confirmatory factor analyses showed that the proposed EGMQ (measuring enhancement, coping, social and self-gratification motives) displayed satisfactory fit and internal consistency. Hierarchical regression analyses showed that gender emerged as a significant predictor (P < 0.001) of all the dependent variables (variety, hours weekly gaming, loss of control and gaming problems) and the first step explained between 1 and 6.1% of the variance in the gaming behaviours. In the second step the four motivational dimensions explained an additional 5.8-38.8% of the variance. Coping and self-gratification predicted gaming problems (P < 0.001) and coping alone predicted loss of control (P < 0.001). The four motivational dimensions were also predicted differentially by indicators of psychosocial wellbeing, indicating divergent validity of the four motives. CONCLUSIONS: The four-dimensional Electronic Gaming Motives Questionnaire is a valid instrument for measuring motives for gaming.

Pregnancy outcomes after paternal radiofrequency field exposure aboard fast patrol boats.

OBJECTIVES: To investigate adverse reproductive outcomes among male employees in the Royal Norwegian Navy exposed to radiofrequency electromagnetic fields aboard fast patrol boats. METHODS: Cohort study of Royal Norwegian Navy servicemen linked to the Medical Birth Registry of Norway, including singleton offspring born between 1967 and 2008 (n = 37,920). Exposure during the last 3 months before conception (acute) and exposure more than 3 months before conception (nonacute) were analyzed. RESULTS: Perinatal mortality and preeclampsia increased after service aboard fast patrol boats during an acute period and also after increased estimated radiofrequency exposure during an acute period, compared with service aboard other vessels. No associations were found between nonacute exposure and any of the reproductive outcomes. CONCLUSIONS: Paternal work aboard fast patrol boats during an acute period was associated with perinatal mortality and preeclampsia, but the cause is not clear.

Suggested excess of occupational cancers in Norwegian offshore workers: preliminary results from the Cancer Registry Offshore Cohort.

OBJECTIVE: The aim of this communication was to report the overall incidence of cancer in a cohort of male Norwegian offshore oil workers. METHODS: The Offshore Cohort was comprised of >25,000 men who were employed at installations in the North Sea in the period 1965-1999, and who responded to a questionnaire that included work history offshore, other occupational experience, education, leisure-time activities, and lifestyle factors. Calculating standardized incidence ratios (SIR), we compared the number of prospective incident cancers diagnosed between 1999 and 2005 with those expected for age-, gender- and period-specific rates in the general Norwegian population. RESULTS: The overall cancer incidence did not differ from that of the reference population [SIR=1.0, 95% -confidence interval (95% CI) 1.0-1.1, N=695]. There were indications of excess risks of acute myeloid leukemia (SIR=2.0, 95% CI 1.0-3.7) and cancer of the pleura (SIR=2.2, 95% CI 0.9-4.6). No data on occupational history was used in these preliminary analyses. CONCLUSIONS: The cohort was relatively young and an extended observation period would be important for in-depth analyses. The suggested excess of leukemia and cancer of the pleura may be linked to occupational exposure during employment offshore; this issue needs to be addressed in further studies.