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1.
JAMA Netw Open ; 3(1): e1919935, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31995212

RESUMO

Importance: Understanding suicide ideation (SI) during combat deployment can inform prevention and treatment during and after deployment. Objective: To examine associations of sociodemographic characteristics, lifetime and past-year stressors, and mental disorders with 30-day SI among a representative sample of US Army soldiers deployed in Afghanistan. Design, Setting, and Participants: In this survey study, soldiers deployed to Afghanistan completed self-administered questionnaires in July 2012. The sample was weighted to represent all 87 032 soldiers serving in Afghanistan. Prevalence of lifetime, past-year, and 30-day SI and mental disorders was determined. Logistic regression analyses examined risk factors associated with SI. Data analyses for this study were conducted between August 2018 and August 2019. Main Outcomes and Measures: Suicide ideation, lifetime and 12-month stressors, and mental disorders were assessed with questionnaires. Administrative records identified sociodemographic characteristics and suicide attempts. Results: A total of 3957 soldiers (3473 [weighted 87.5%] male; 2135 [weighted 52.6%] aged ≤29 years) completed self-administered questionnaires during their deployment in Afghanistan. Lifetime, past-year, and 30-day SI prevalence estimates were 11.7%, 3.0%, and 1.9%, respectively. Among soldiers with SI, 44.2% had major depressive disorder (MDD) and 19.3% had posttraumatic stress disorder in the past 30-day period. A series of analyses of the 23 grouped variables potentially associated with SI resulted in a final model of sex; race/ethnicity; lifetime noncombat trauma; past 12-month relationship problems, legal problems, and death or illness of a friend or family member; and MDD. In this final multivariable model, white race/ethnicity (odds ratio [OR], 3.1 [95% CI, 1.8-5.1]), lifetime noncombat trauma (OR, 2.1 [95% CI, 1.1-4.0]), and MDD (past 30 days: OR, 31.8 [95% CI, 15.0-67.7]; before past 30 days: OR, 4.9 [95% CI, 2.5-9.6]) were associated with SI. Among the 85 soldiers with past 30-day SI, from survey administration through 12 months after returning from deployment, 6% (5 participants) had a documented suicide attempt vs 0.14% (6 participants) of the 3872 soldiers without SI. Conclusions and Relevance: This study suggests that major depressive disorder and noncombat trauma are important factors in identifying SI risk during combat deployment.


Assuntos
Militares/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Ideação Suicida , Suicídio/psicologia , Adaptação Psicológica , Adulto , Campanha Afegã de 2001- , Fatores Etários , Feminino , Humanos , Masculino , Militares/estatística & dados numéricos , Resiliência Psicológica , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Suicídio/estatística & dados numéricos , Adulto Jovem
2.
Diving Hyperb Med ; 49(4): 283-290, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31828747

RESUMO

INTRODUCTION: Hearing loss (HL) is common in the adult working population. It is widely assumed that diving is a risk factor for HL. However, studies with sufficient follow-up comparing HL in divers to non-divers are limited. This study aimed to assess the hearing threshold (HT) of Royal Netherlands Navy divers who had been diving for more than 15 years and to compare it to the ISO standard 7029:2017 reference table. METHODS: In this 25-year retrospective cohort study the Royal Netherlands Navy Diving Medical Centre audited the medical records of 1,117 Navy divers. Yearly dive medical assessments were performed according to professional standards, including audiometry. HTs were compared to the ISO 7029:2017 reference table, including Z-distribution, using paired t-tests. RESULTS: Thirty-five divers were included who had been diving for 15 years or longer. The HT increased significantly in nine of the 16 measured frequencies, while the Z-score decreased significantly in nine of the 16 tested frequencies (eight in both ears). In the 25-year follow-up the pattern was more obvious, with one significantly increased HT, and 10 significantly decreased Z-scores. DISCUSSION: The absolute HT increases after 15 years of military diving, but less than would be expected from normal age-related deterioration. Moreover, when comparing Z-scores, this sample of divers actually hear better than non-divers. We conclude that military diving is not an increased risk for HL compared to regular occupational hazards and suggest withdrawing the requirement for routine yearly audiometric evaluation as part of a dive medical examination.


Assuntos
Mergulho , Transtornos da Audição , Perda Auditiva , Militares/estatística & dados numéricos , Adulto , Audiometria , Limiar Auditivo/fisiologia , Mergulho/efeitos adversos , Audição/fisiologia , Transtornos da Audição/etiologia , Perda Auditiva/etiologia , Humanos , Países Baixos , Estudos Retrospectivos
3.
Nurs Clin North Am ; 54(4): 503-515, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703776

RESUMO

Mental illness and injury, including post-traumatic stress disorder, represents a significant source of disability and morbidity among military and veteran populations. This article explores the pathophysiology, identification, and treatment of military service-connected trauma-related and stressor-related disorders. Particular attention is given to trauma informed care, evidence-based practice recommendations, and the sequencing of psychotherapy and pharmacotherapy in pursuit of optimal patient outcomes.


Assuntos
Prática Clínica Baseada em Evidências , Militares/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Terapia Cognitivo-Comportamental , Humanos , Transtornos de Estresse Pós-Traumáticos/terapia
4.
NeuroRehabilitation ; 45(2): 163-185, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31707378

RESUMO

OBJECTIVE: To synthesize the current evidence on sleep disturbances in military service members (SMs) and veterans with traumatic brain injury (TBI). METHODS: An electronic literature search first identified abstracts published from 2008-2018 inclusively referencing sleep, TBI, and military personnel from Operation Enduring Freedom, Operation Iraqi Freedom, Operation New Dawn, and Persian Gulf veterans. Selection criteria eliminated studies on non-combat TBI, open or penetrating injuries, and articles where the relationship between sleep and TBI was not directly examined. Articles on all military branches and components, those currently serving and veterans-ranging from medical chart reviews to clinical trials, were included. Forty-one articles were selected for full text-review. RESULTS: Twenty-four papers estimated the prevalence of sleep disturbances in TBI. Eight studies demonstrated the contribution of common co-occurring conditions, most notably posttraumatic stress disorder, to the relationship between disrupted sleep and TBI. Ten studies differentiated sleep profiles between military SMs and veterans with and without acute TBI and detected significant differences in sleep disturbances across the course of injury. Longitudinal studies were scarce but helped to establish the temporal relationship between sleep disturbances and TBI and isolate sleep-related mechanisms influencing TBI prognosis. Only three studies reported on interventions for improving sleep quality and TBI symptoms. Systematic research testing assessments and interventions that target sleep disturbances for improving sleep, TBI symptoms, and long-term functional outcomes were identified as critical knowledge gaps. CONCLUSION: Findings unequivocally establish that sleep disturbances are highly prevalent in SMs and veterans with TBI. However, studies testing the effectiveness of treatments for improving sleep in military groups with TBI have been limited and their results inconsistent. This review highlights a critical opportunity for advancing military medicine through future research aimed at identifying and testing sleep-focused treatments in SMs and veterans with combat-related TBI.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Militares/estatística & dados numéricos , Transtornos do Sono-Vigília/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Veteranos/estatística & dados numéricos , Adulto , Campanha Afegã de 2001- , Feminino , Humanos , Guerra do Iraque 2003-2011 , Masculino
5.
BMC Public Health ; 19(1): 1394, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660935

RESUMO

BACKGROUND: Alcohol misuse is an important contributor to sexual acquisition and transmission of HIV in military communities. This cross-sectional study quantified the prevalence of probable problematic alcohol use among male service members in the Armed Forces of the Democratic Republic of the Congo (FARDC), identified associated factors, and investigated associations of alcohol misuse with risky sexual behaviors. METHODS: Participants included 2549 active duty male soldiers ≥ 18 years old. Data were collected via computer-assisted personal-interview from October 2013-April 2014. The Alcohol Use Disorders Identification Test (AUDIT) was used to identify probable problematic alcohol use (AUDIT score ≥ 8) compared to no/low-risk alcohol use (AUDIT score ≤ 7). Bivariate logistic regressions were used to identify factors associated with probable problematic alcohol use. Several multivariable logistic regressions (adjusted for age, marital status, education level) were used to examine associations of probable problematic alcohol use with risky sexual behaviors. Tests were two sided; statistical significance was defined as p < 0.05. RESULTS: Fifteen percent of men screened positive for probable problematic alcohol use. The odds of probable problematic alcohol use were elevated among men who were single and living with a partner (OR = 1.66; 95% CI = 1.24-2.21), ranked as a non-commissioned officer [NCO] (OR = 1.40; 95% CI = 1.10-1.77), and in the 30-39 and 40-49 age groups (OR 30-39 age group = 2.17; 95% CI = 1.56-3.02; OR 40-49 age group = 1.79; 95% CI = 1.26-2.55). Probable problematic alcohol use was associated with increased odds of having sex with a sex worker (SW), having multiple sexual partners, and participating in transactional sex (aOR sex with a SW = 2.36; 95% CI = 1.78-3.13; aOR multiple sexual partners = 2.08; 95% CI = 1.66-2.60; aOR transactional sex = 1.99; 95% CI = 1.59-2.50). CONCLUSIONS: Results emphasize the need to address alcohol use in the FARDC and integrate alcohol abuse education into HIV prevention programs among male service members. Alcohol abuse prevention efforts should target men who are 30-49 years of age, unmarried, and ranked as a NCO. Messages and interventions to reduce alcohol misuse in relation to risky sexual behaviors are needed.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Militares/psicologia , Assunção de Riscos , Comportamento Sexual/psicologia , Adolescente , Adulto , Estudos Transversais , República Democrática do Congo/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Militares/estatística & dados numéricos , Prevalência , Adulto Jovem
6.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190009, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576985

RESUMO

INTRODUCTION: Knowledge about risky sexual behavior among young people has been widely acknowledged as a key tool to controlling the spread of HIV. This article aimed at presenting the risk behavior of Brazilian Army conscripts toward HIV infection according to the country's geographic regions. . METHOD: We collected data from 37,282 conscripts, aged 17 to 22, during enlistment in the Brazilian Army in 2016. The prevalence of HIV infection, both self-reported and measured through laboratory results, and risk behavior factors were estimated by region. RESULTS: 75% of the sample of conscripts reported to have already started sexual activity, and the average age of their sexual initiation was 15. Condom use varied according to the type of sexual relationship, being lower among steady partners and greater among less stable relationships. HIV prevalence assessed by laboratory tests was 0.12% across the country and the highest prevalence was observed in the North region (0.24%). Alcohol and illicit drug usage was higher in the South region. DISCUSSION: The study allowed the observation of risk behavior monitoring for HIV infection among young Brazilians. Lower condom usage among steady partners may be contributing to an increase in the number of HIV-infected individuals. CONCLUSION: Results suggest the need to intensify prevention campaigns to disseminate safe sex practices among young people, in addition to the expansion of testing offer to this population.


Assuntos
Infecções por HIV/etiologia , Comportamentos de Risco à Saúde , Militares/estatística & dados numéricos , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Brasil/epidemiologia , Preservativos/estatística & dados numéricos , Estudos Transversais , Geografia , Infecções por HIV/epidemiologia , Humanos , Masculino , Prevalência , Medição de Risco , Fatores de Risco , Comportamento Sexual/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
7.
J Spec Oper Med ; 19(3): 110-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539444

RESUMO

This article traces the early history of military airborne operations and examines studies that have provided overall incidences of parachute-related injuries over time. The first US combat parachute assault was proposed during World War I, but the war ended before the operation could be conducted. Experimental jumps were conducted near San Antonio, Texas, in 1928 and 1929, but it was not until 1939, spurred by the developments in Germany, that the US Army Chief of Infantry proposed the development of an "air infantry." An Airborne Test Platoon was instituted with 48 men at Fort Benning, Georgia, and mass training of paratroopers began in 1940. The US entered World War II in December 1941 with the attack on Pearl Harbor and declaration of war by Germany. In January 1942, US War Department directed that four parachute regiments be formed. The 509th Parachute Infantry Battalion made the first US Army combat jumps into Morocco and Algeria in November 1942. At the US Army Airborne School in the 1940-1941 period, the parachute-related injury incidence was 27 injuries/1000 jumps; by 1993 it was 10 injuries/1000 jumps and in 2005-2006, 6 injuries/1000 jumps. Analysis of time-loss injuries in operational units showed a decline in injuries from 6 injuries/1000 jumps to 3 injuries/1000 jumps to 1 injury/1000 jumps in the periods 1946-1949, 1956-1962, and 1962-1963, respectively. When all injuries (not just time-loss) experienced in operational units are considered, the overall injury incidence was about 8 injuries/1000 jumps in the 1993- 2013 period. In jump operations involving a larger number of risk factors (e.g., high winds, combat loads, rough drop zones) injury incidences was considerably higher. The few studies that have reported on parachute-related injuries in combat operations suggest injury incidence ranged from 19 to 401 injuries/ 1000 jumps, likely because of the number of known injury risk factors present during these jumps. Despite the limitations of this analysis stemming from different injury definitions and variable risk factors, the data strongly suggest that military parachute injuries have sharply declined over time. Part 2 of this series will discuss techniques and equipment that have likely improved the safety of parachute operations.


Assuntos
Aviação/história , Militares/história , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/história , História do Século XX , Humanos , Incidência , Masculino , Militares/estatística & dados numéricos , Estados Unidos , II Guerra Mundial
8.
Aerosp Med Hum Perform ; 90(9): 757-763, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31426890

RESUMO

OBJECTIVE: The goal of this study was to estimate noise exposure and hearing impairments in Swedish military pilots. It also aimed to analyze possible relations between noise exposure and hearing impairments.METHODS: The study group was an open cohort of 337 male pilots. They were longitudinally followed with pure tone audiograms every fifth year from the beginning of flight service until discharge. Outcome measures were prevalence of thresholds >20 dB HL and >40 dB HL at different ages, and incidence of impairments >20 dB HL, 30 dB HL, and 40 dB HL. Exposure variables were individual flight data and noise dose measurements. The ISO 1999 Database A was used for reference data.RESULTS: At 50 yr of age, 41% of the pilots were exposed to an equivalent noise dose exceeding the EU action level of Leq 80 dB(A). We observed significant elevated prevalence values of thresholds >20 dB HL in all age classes compared to the ISO 1999 Database A. These elevations were most pronounced at ages 30 and 40 yr and at 4 and 6 kHz in the left ear. Significantly elevated prevalence values of thresholds >40 dB HL compared to the ISO 1999 Database A were observed at age 40 and 50 yr at 4 and 6 kHz. In a Cox analysis we observed elevated hazard ratios of deteriorating thresholds with longer flight time/year in fast jet pilots.DISCUSSION: Military pilots had elevated prevalence values of hearing impairment. Of the subjects, 41% had been exposed to noise exceeding the EU risk limit. Increased flight time/year and flying fast jets were associated with elevated risk of hearing deterioration.Muhr P, Johnson A-C, Selander J, Svensson E, Rosenhall U. Noise exposure and hearing impairment in air force pilots. Aerosp Med Hum Perform. 2019; 90(9):757-763.


Assuntos
Perda Auditiva Provocada por Ruído/epidemiologia , Militares/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Pilotos/estatística & dados numéricos , Adulto , Audiometria de Tons Puros/estatística & dados numéricos , Perda Auditiva Provocada por Ruído/diagnóstico , Perda Auditiva Provocada por Ruído/etiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Doenças Profissionais/etiologia , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Suécia/epidemiologia , Adulto Jovem
9.
Aerosp Med Hum Perform ; 90(9): 788-791, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31426894

RESUMO

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a chronic neurological disorder characterized by persistent patterns of inattention, impulsivity, and hyperactivity. The most common treatment for this disorder is methylphenidate, which is a disqualifying medication for flight. Candidates with previous use of methylphenidate are not necessarily disqualified from the Israeli Air Force (IAF) flight academy.METHODS: Flight cadets from 12 consecutive flight courses who have used methylphenidate at least once in the past were identified according to their medical records. The graduation ratio of cadets with previous use of methylphenidate was compared with that of the rest of the cadets. A comparison was also made with regard to the causes of disqualification from the flight course. Statistical significance was assessed using the Fischer Test.RESULTS: Among the 90 flight cadets who have used methylphenidate, only 2 (2.2%) successfully graduated from the IAF flight academy. Among the 2983 flight cadets who have no history of methylphenidate use, 461 (15.4%) successfully graduated. We found no significant differences in the disqualification causes between the two groups.CONCLUSION: The IAF flight academy graduation rate was meaningfully and significantly lower among cadets who reported previous use of methylphenidate. The study design, however, limits the inference of causal relationship.Sarfati S, Nakdimon I, Tsodyks J, Assa A, Gordon B. Success rates at an air force pilot academy and its relation to methylphenidate use. Aerosp Med Hum Perform. 2019; 90(9):788-791.


Assuntos
Sucesso Acadêmico , Estimulantes do Sistema Nervoso Central/farmacologia , Cognição/efeitos dos fármacos , Metilfenidato/farmacologia , Militares/educação , Pilotos/educação , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Uso Indevido de Medicamentos , Feminino , Humanos , Israel , Masculino , Metilfenidato/uso terapêutico , Militares/estatística & dados numéricos , Pilotos/estatística & dados numéricos , Estudos Retrospectivos , Instituições Acadêmicas/estatística & dados numéricos , Adulto Jovem
10.
MSMR ; 26(8): 2-9, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31442063

RESUMO

This report provides an update through June 2019 of the results of routine screening for antibodies to the human immunodeficiency virus (HIV) among civilian applicants for military service and among members of the active and reserve components of the U.S. Armed Forces. From January 2014-June 2019, full-year seroprevalences among applicants for service peaked in 2015 (0.34 per 1,000 tested) and then decreased during the subsequent 2 years (0.33 and 0.29 per 1,000 tested, respectively). Seroprevalences also peaked in 2015 for active component service members of the Army, Navy, and Air Force and among reservists of the Navy and Marine Corps. Overall (January 2014- June 2019) HIV antibody seroprevalences were highest among Army reservists, Army National Guard members, and Navy reservists. Across active and reserve components of all services, HIV antibody seroprevalences continued to be higher among men than women.


Assuntos
Infecções por HIV/epidemiologia , Soroprevalência de HIV , Militares/estatística & dados numéricos , Adulto , Feminino , Anticorpos Anti-HIV/sangue , Infecções por HIV/sangue , Infecções por HIV/diagnóstico , Humanos , Masculino , Programas de Rastreamento , Vigilância da População , Prevalência , Distribuição por Sexo , Estados Unidos/epidemiologia
11.
MSMR ; 26(8): 10-16, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31442064

RESUMO

Impulse control disorders (ICDs) are a group of behavioral disorders characterized by failure to resist impulsive thoughts and behaviors that can lead to significant adverse social, legal, and financial consequences. ICDs have been associated with previous diagnoses of depression, anxiety, and post-traumatic stress disorder and have been widely recognized as an adverse effect of dopamine agonist (DA) therapy. The epidemiology of these disorders in the U.S. Armed Forces is unknown. The current study evaluated the incidence of ICD diagnoses in the U.S. Armed Forces during 2014-2018. The overall incidence was 13.7 per 10,000 person-years (p-yrs), with the highest rates among females and younger personnel. The current case-control study evaluated the association between DA exposure in the year preceding an incident ICD diagnosis. Although few individuals had received DA therapy in the past year, DA therapy was independently associated with incident ICD diagnosis (adjusted odds ratio [AOR]=2.34; 95% confidence interval [CI]: 1.29-4.24, p<.0001). Previous mental health disorder diagnosis (AOR=12.0; 95% CI: 11.09-12.98, p<.0001) and fibromyalgia (AOR=1.30; 95% CI: 1.14-1.48, p<.0001) were also associated with incident ICD diagnosis. The impact of ICDs on mission readiness, medical evacuation, and deployability should be further evaluated.


Assuntos
Transtornos Disruptivos, de Controle do Impulso e da Conduta/induzido quimicamente , Transtornos Disruptivos, de Controle do Impulso e da Conduta/epidemiologia , Agonistas de Dopamina/efeitos adversos , Militares/estatística & dados numéricos , Adulto , Distribuição por Idade , Estudos de Casos e Controles , Agonistas de Dopamina/administração & dosagem , Feminino , Fibromialgia/tratamento farmacológico , Humanos , Incidência , Masculino , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Vigilância da População , Distribuição por Sexo , Estados Unidos/epidemiologia , Adulto Jovem
12.
MSMR ; 26(8): 22-26, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31442066

RESUMO

Lyme disease diagnostic workups conducted on active and retired U.S. service members and their dependents at U.S. Air Force military treatment facilities (MTFs) in Germany between 2013 and 2017 were assessed to determine the appropriateness of laboratory testing and antibiotic prescriptions. Of the 1,176 first-tier immunoassays, 1,114 (94.7%) were negative, and of the 285 immunoglobulin M (IgM) immunoblots, 242 (84.9%) followed a negative first-tier assay or were performed without an antecedent first-tier assay. Eighty-three positive IgM immunoblot tests were adjudicated using modified published criteria, of which 40 (48.2%) were deemed false positives. Thirtytwo patients with false-positive tests were treated with an antibiotic. Additionally, 30 patients with uncomplicated erythema migrans could have been treated without laboratory confirmation. Understanding the use and limitations of 2-tier diagnostic criteria, as well as the common pitfalls in diagnosing Lyme disease, may help prevent overdiagnosis, reduce unnecessary testing, and promote antibiotic stewardship.


Assuntos
Doença de Lyme/sangue , Militares/estatística & dados numéricos , Testes Sorológicos/normas , Feminino , Alemanha/epidemiologia , Humanos , Doença de Lyme/epidemiologia , Masculino , Família Militar/estatística & dados numéricos , Valor Preditivo dos Testes , Estados Unidos/epidemiologia
14.
J Bone Joint Surg Am ; 101(16): 1470-1478, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31436655

RESUMO

BACKGROUND: Severe upper-extremity injuries account for almost one-half of all extremity trauma in recent conflicts in the Global War on Terror. Few long-term outcomes studies address severe combat-related upper-extremity injuries. This study's objective was to describe long-term functional outcomes of amputation compared with those of limb salvage in Global War on Terror veterans who sustained severe upper-extremity injuries. Limb salvage was hypothesized to result in better arm and hand function scores, overall functional status, and quality of life, with similar pain interference. METHODS: This retrospective cohort study utilized data from the Military Extremity Trauma Amputation/Limb Salvage (METALS) study for a subset of 155 individuals who sustained major upper-extremity injuries treated with amputation or limb salvage. Participants were interviewed by telephone 40 months after injury, assessing social support, personal habits, and patient-reported outcome instruments for function, activity, depression, pain, and posttraumatic stress. Outcomes were evaluated for participants with severe upper-extremity injuries and were compared with participants with concomitant severe, lower-extremity injury. The analysis of outcomes comparing limb salvage with amputation was restricted to the 137 participants with a unilateral upper-extremity injury because of the small number of patients with bilateral upper-extremity injuries (n = 18). RESULTS: Overall, participants with upper-extremity injuries reported moderate to high levels of physical and psychosocial disability. Short Musculoskeletal Function Assessment (SMFA) scores were high across domains; 19.4% screened positive for posttraumatic stress disorder (PTSD), and 12.3% were positive for depression. Nonetheless, 63.6% of participants were working, were on active duty, or were attending school, and 38.7% of participants were involved in vigorous recreational activities. No significant differences in outcomes were observed between patients who underwent limb salvage and those who underwent amputation. CONCLUSIONS: Severe, combat-related upper-extremity injuries result in diminished self-reported function and psychosocial health. Our results suggest that long-term outcomes are equivalent for those treated with amputation or limb salvage. Addressing or preventing PTSD, depression, chronic pain, and associated health habits may result in less disability burden in this population. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Amputação/métodos , Traumatismos do Braço/cirurgia , Salvamento de Membro/métodos , Militares/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Amputação/psicologia , Traumatismos do Braço/diagnóstico , Traumatismos do Braço/reabilitação , Membros Artificiais , Estudos de Coortes , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Guerra do Iraque 2003-2011 , Salvamento de Membro/psicologia , Masculino , Militares/psicologia , Medidas de Resultados Relatados pelo Paciente , Implantação de Prótese/métodos , Estudos Retrospectivos , Medição de Risco , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
15.
Medicine (Baltimore) ; 98(32): e16401, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393348

RESUMO

Viral hepatitis is caused by different etiological agents with distinct epidemiological, clinical, and laboratory characteristics accounting for significant worldwide morbidity and mortality. Since 1996, the Brazilian Department of Sexually Transmitted Infections (STIs), Acquired Immune Deficiency Syndrome (AIDS) and Viral Hepatitis (DIAHV) in collaboration with the Ministry of Defense has been conducting periodic serosurveys of conscripts enlisted for the Brazilian army to assess STI prevalence and obtain data on knowledge and risk factors pertaining to STIs. This article aims to present the hepatitis B (hepatitis B surface antigen - HBsAg) and C (anti-HCV) seroprevalence estimates and risk factors as per the 8th edition of the Conscript Survey performed in 2016.This cross-sectional study was conducted among conscripts across Brazil aged 17 to 22 years from August to December 2016. It included a self-reported questionnaire and blood testing for syphilis, human immunodeficiency virus (HIV), and hepatitis B and C.In total 38,247 conscripts were enrolled; after applying exclusion criteria, 37,282 conscripts were included. The estimated HBsAg and anti-HCV prevalence rates were 0.22% and 0.28%, respectively. Higher HBsAg and anti-HCV prevalence rates were observed in the North Region (0.49%) and in the Central-west Region (0.65%), respectively. Regarding hepatitis B vaccination, 23.5% (n = 8412) of the individuals reported being unvaccinated and 47.4% (n = 16,970) did not know if they had been vaccinated. Among the anti-HCV positive conscripts, 53% (n = 51, 0.56%, P = .049) reported that they had never had sexual intercourse. Regarding self-reported STI status, most of the positive anti-HCV (n = 100, 0.29%, P < .01) and positive HBsAg (n = 76, 0.22%, P = .205) conscripts reported not having a STI. From those who tested positive for HBsAg, 89% (n = 42, 0.28%, P = .005) reported not making consistent use of condoms with steady partners.Our data suggest a low prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among Brazilian young men, and relatively low rates of self-reported HBV immunization. History of STIs, higher number of partners, inconsistent use of condoms, and lack of awareness of routes of transmission were significantly associated with HBV and HCV infections. To achieve the World Health Organization's goal of viral hepatitis elimination, access to hepatitis information, testing, and surveillance need to be improved.


Assuntos
Hepatite B/epidemiologia , Hepatite C/epidemiologia , Adolescente , Fatores Etários , Brasil/epidemiologia , Preservativos/estatística & dados numéricos , Estudos Transversais , Escolaridade , Conhecimentos, Atitudes e Prática em Saúde , Hepatite B/imunologia , Hepatite B/prevenção & controle , Antígenos de Superfície da Hepatite B/sangue , Vacinas contra Hepatite B/administração & dosagem , Hepatite C/imunologia , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Militares/estatística & dados numéricos , Prevalência , Fatores de Risco , Estudos Soroepidemiológicos , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto Jovem
16.
Sleep Health ; 5(6): 651-657, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31377248

RESUMO

OBJECTIVES: The current study sought to characterize the sleep problems of soldiers entering Basic Combat Training and to identify the link between sleep problems and subsequent performance, psychological distress, anger reactions, and attention. DESIGN: Soldiers were surveyed at 4 time points throughout the standard 10 weeks of Basic Combat Training. Surveys were administered at weeks 1, 3, 6, and 9. Sleep problems were identified as either present or absent at each time point using a sleep problem screening questionnaire. Four sleep patterns were identified and then used to evaluate outcomes throughout training (n = 1577). RESULTS: When compared to those who never had a sleep problem ("healthy "; 60.6%), those who recovered from their initial sleep problem ("recovered"; 12.8%) started training with higher psychological distress and anger reactions and lower attention but steadily improved throughout training. Those who developed a sleep problem during training ("new onset"; 20.0%) and those who had a sleep problem throughout training ("chronic"; 6.6%) also started off significantly worse than the healthy group. The new-onset and chronic groups saw slower psychological distress improvement and a decline in attention throughout the course compared to the healthy group. The chronic group also significantly increased their anger reactions throughout training compared to the healthy group. CONCLUSION: Sleep problems during Basic Combat Training may be an indicator for difficulties managing entry into the military. These findings highlight the importance of improving sleep health for soldiers throughout Basic Combat Training and for others with similar training in high-risk occupations.


Assuntos
Militares/educação , Militares/psicologia , Desempenho Físico Funcional , Transtornos do Sono-Vigília/psicologia , Ensino , Adolescente , Adulto , Ira , Atenção/fisiologia , Feminino , Humanos , Masculino , Militares/estatística & dados numéricos , Medição de Risco , Transtornos do Sono-Vigília/epidemiologia , Inquéritos e Questionários , Adulto Jovem
17.
Aerosp Med Hum Perform ; 90(8): 720-724, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31331422

RESUMO

INTRODUCTION: The incidence of hypoxia-like symptoms in military aviators is on the rise. Cases can be related to On-Board Oxygen Generating System (OBOGS) malfunction, air contamination, loss of cabin pressurization, hyperventilation, or a combination of these issues simultaneously. Normobaric hypoxia training in tactical fighter simulations has been conducted in the Finnish Air Force since 2008. This training helps aviators to recognize their individual hypoxia symptoms and refreshes hypoxia emergency procedures in a realistic cockpit.METHODS: A flight mission included three set-ups and a return to base (RTB) after the third set-up. In a tactical Hawk simulator, different concentrations of oxygen were used (8%, 7%, and 6% oxygen in nitrogen) to create normobaric hypoxia exposures. During the RTB, the flight instructor evaluated the subjects' flight performance (N = 16) in order to estimate cognitive functions after hypoxia. A control flight was evaluated before or after the flight with normobaric hypoxia exposure.RESULTS: Instrumental flight rule performance during RTB decreased significantly from 4.81 to 3.63 after normobaric hypoxia and emergency procedures. Some pilots reported fatigue, headache, memory problems, and cognitive impairment as adverse effects up to 12 h after normobaric hypoxia training.DISCUSSION: Hypoxia has a significant effect on flight performance during RTB, even 10 min after hypoxia emergency procedures. Since 100% oxygen was used as emergency oxygen, as in a real aircraft, the oxygen paradox may decrease flight performance. Hypoxia training in tactical fighter simulations provides an opportunity for pilots to also understand the effects of the "hypoxia hangover" on their flight performance.Varis N, Parkkola KI, Leino TK. Hypoxia hangover and flight performance after normobaric hypoxia exposure in a Hawk simulator. Aerosp Med Hum Perform. 2019; 90(8):720-724.


Assuntos
Medicina Aeroespacial , Hipóxia/epidemiologia , Militares/estatística & dados numéricos , Pilotos/estatística & dados numéricos , Aeronaves , Altitude , Finlândia , Humanos , Hipóxia/etiologia , Incidência , Masculino , Militares/educação , Pilotos/educação , Treinamento por Simulação
19.
BMC Public Health ; 19(1): 855, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262273

RESUMO

BACKGROUND: According to internal observations within a German shipping company, obvious risk-behaviour persists among the crew members coming from the Pacific Island State of Kiribati and representing a large part of the crew aboard merchant vessels of this company. These observations were related to excessive eating habits. This study aims to assess the cardiovascular risk among seafarers and to compare lifestyle factors between Kiribati and European crew members. METHODS: In the present maritime field study 81 sailors (48 Kiribati, 33 European, average age at 38.9 and 36.8 years respectively) were examined from April until August 2014 aboard four container ships crossing the Atlantic Ocean (participation rate of 90.9%). RESULTS: Based on the number of established risk factors, 35.4% of the Kiribati and 16.7% of the European crew members were regarded as a high risk group for cardiovascular diseases. The HDL-values of Kiribati were found to be considerably lower (34.9 mg/dl) than the references values given by the WHO and in comparison to the European crew members (44.8 mg/dl) (p = 0.002). 91.7% of Kiribati and 51.5% of European participants were found to be overweight according to WHO-criteria - with a mean Body Mass Index (BMI) of 30.3 kg/m2 and 25.6 kg/m2 (p <  0.001). Regarding lifestyle factors Kiribati often claimed to eat significantly larger amounts of food aboard while most European sailors stated to eat less or about the same during their shipboard stay (p = 0.017). Daily sleeping hours were slight on both sides; however with a mean of 5.2 h a day Kiribati crew members had significant fewer sleep (p = 0.038). The examined Kiribati sailors had a mean increase in weight of 6 kg over a 12 months period of observation. CONCLUSIONS: In total the compiled data points towards a higher risk of cardiovascular diseases particularly due to alimentary habits within the Kiribati crew members. The distinct weight-gain measured among the Kiribati in spite of higher energy consumption levels at sea is alarming. Thus, the results of this study confirm the necessity of health-improving interventions aboard cargo vessels.


Assuntos
Doenças Cardiovasculares/epidemiologia , Estilo de Vida , Militares/psicologia , Adulto , Europa (Continente)/epidemiologia , Humanos , Masculino , Micronésia/epidemiologia , Pessoa de Meia-Idade , Militares/estatística & dados numéricos , Projetos Piloto , Prevalência , Fatores de Risco , Adulto Jovem
20.
Womens Health Issues ; 29 Suppl 1: S74-S82, 2019 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-31253246

RESUMO

PURPOSE: Trauma has been associated with risky sexual behavior in diverse populations. However, little is known about this association among men and women veterans. This study hypothesized that 1) a history of trauma would be associated with risky sexual behavior among men and women veterans, 2) interpersonal trauma would predict risky sexual behavior among women, whereas noninterpersonal trauma would predict risky sexual behavior among men, and 3) military-related trauma would constitute additional risk. Using data from 567 women and 524 men veterans enrolled at the Veterans Health Administration, this study investigated the association between trauma-related experiences and risky sexual behavior in the last 12 months. Risk and protective factors that have been frequently associated with sexual behavior in previous research were also included in the model. METHODS: This study was drawn from the Women Veterans Cohort Study, a national survey of veterans. Bivariate and multivariate analyses were performed after multiple imputation for missing data. RESULTS: Predictive factors associated with risky sexual behavior differed between men and women veterans. Among women, childhood sexual victimization and intimate partner violence were associated with risky sexual behavior. Among men, binge drinking was the single significant risk factor. Military exposures were not significantly associated with risky sexual behavior in either men or women. CONCLUSIONS: This study lays the groundwork for theory-generating research into the psychological underpinnings of noted associations and underscores the importance of integrated health services to address the range of issues affecting sexual behavior and related health outcomes.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Vítimas de Crime/psicologia , Violência por Parceiro Íntimo/psicologia , Assunção de Riscos , Comportamento Sexual , Veteranos/psicologia , Adulto , Idoso , Bullying , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Militares/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários , Estados Unidos , United States Department of Veterans Affairs , Saúde dos Veteranos
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