Incidence of hypercholesterolemia in the active duty Navy population in 1986

A National Institutes of Health Consensus Conference recently advocated lowering the serum cholesterol levels required to diagnose moderate and severe hypercholesterolemia. We reviewed 998 active duty United States Navy personnel who underwent routine physical examinations with determinations of serum cholesterol. Analysis of the data revealed a gradual rise in mean serum cholesterol with increasing age. Moderate elevation of serum cholesterol ranged from 11.3% to 34.6% of the study group, depending on age. Severe hypercholesterolemia was also age dependent and occurred in 2.0% to 9.3% the group. Dietary and cholesterol-binding agents have been shown to reduce the occurrence of myocardial infarction in subjects with cholesterol greater than 265 mg/dl. The incidence of Navy personnel with serum cholesterol above this level ranged from 2 to 10%. It is likely that intervention with dietary or medical therapy would prevent the development or delay the occurrence of coronary artery disease in a large number of active duty U.S. Navy personnel.     

A survey of Navy physicians' attitudes toward the use of selective serotonin reuptake inhibitors in active duty military personnel.

A series of recent pharmacological discoveries have produced remarkable advances in psychotherapeutic medications. With the advent of newer antidepressants, there is a high degree of efficacy and a low risk profile. Potential benefits of these medications far outweigh the possible side effects, especially in contrast to older drugs. Navy Medicine now has the ability to treat active duty personnel during a deployment with safe antidepressant medications. The attitudes toward the use of selective serotonin reuptake inhibitors (SSRIs) on active duty service members has been surveyed. Profiles of prescribing patterns and attitudes toward the use of these medications and safety within the context of the operational environment were also surveyed. Group comparisons across various medical specialties and command organizations were made. The survey results suggest a very favorable attitude toward prescribing SSRIs in the active duty population.     

Post-traumatic stress disorder and depression in health care providers returning from deployment to Iraq and Afghanistan

OBJECTIVE: This study examines risk factors for post-traumatic stress disorder (PTSD), depression, and mental health care use among health care workers deployed to combat settings. METHODS: Anonymous surveys were administered to previously deployed workers at a military hospital. PTSD and depression were assessed by using the PTSD Checklist and the Patient Health Questionnaire depression scale, respectively. Deployment exposures and perceived threats during deployment were also assessed. RESULTS: There were 102 respondents (36% response rate). Nine percent (n=9) met the criteria for PTSD and 5% (n=5) met the criteria for depression. Direct and perceived threats of personal harm were risk factors for PTSD; exposure to wounded or dead patients did not increase risk. Those who met the criteria for PTSD were more likely to seek mental health care after but not before their deployment. CONCLUSIONS: For health care workers returning from a warfare environment, threat of personal harm may be the most predictive factor in determining those with subsequent PTSD.     

Knee joint kinaesthesia and neuromuscular coordination during three phases of the menstrual cycle in moderately active women

An increased incidence of sports related injuries in the premenstrual phase as well as in the menstrual phase of the menstrual cycle has been described. This may be explained by alterations in proprioception and neuromuscular coordination due to hormonal variations. Prospective, within women analysis of knee joint kinesthesia and neuromuscular coordination were performed by repeated measures analysis of variance in three hormonally verified phases of three consecutive menstrual cycles. Thirty-two healthy, moderately active female subjects volunteered to participate in the study. Twenty-five of the subjects performed at least one hormonally verified menstrual cycle. A specially designed device was used to investigate knee joint kinaesthesia and neuromuscular coordination was measured with the square hop test. These tests were carried out in the menstrual phase, ovulation phase and premenstrual phase determined by hormone analyses in three consecutive menstrual cycles. An impaired knee joint kinaesthesia was detected in the premenstrual phase and the performance of square hop test was significantly improved in the ovulation phase compared to the other two phases. The results of this study indicate that the variation of sex hormones in the menstrual cycle has an effect on performance of knee joint kinaesthesia and neuromuscular coordination.     

建立成批烧创伤急救体系,提高平战时救治能力

本文浅谈了成批烧创伤救治的经验与教训,分析了我国成批烧创伤急救体系的现状,提出应建立符合我国国情的成批烧创伤急救体系,通过课程学习与专科基地训练,加强研究与交流等措施,提高我国平战时成批烧创伤救治的能力.     

Life events in health care providers before and during Persian Gulf War deployment: the USNS Comfort.

Just before the onset of Operation Desert Storm, health care personnel (N = 250) onboard the USNS Comfort reported the occurrence of life events for the preceding year, including before deployment and during the Persian Gulf War. Study participants noted both total and negative life events. The mean number of negative life events during the preceding year was 1.44; a sizable proportion of participants (38%) reported no negative life events during this time. There were no differences in the mean number of total or negative life events by gender, although women checked significantly more life event items related to interpersonal factors and men noted more life events concerning financial issues. Women, nurses, the childless, and lower ranking officers noted significantly greater negative life events during predeployment than deployment. Negative life events were moderately related to anxiety, depression, and post-traumatic stress disorder symptoms. Both research and policy implications are discussed.     

Stress, mental health, and job performance among active duty military personnel: findings from the 2002 Department of Defense Health-Related Behaviors Survey

This study examined the extent to which high levels of occupational and family stress were associated with mental health problems and productivity loss among active duty military personnel. We analyzed data from the 2002 Department of Defense Survey of Health-Related Behaviors among Military Personnel, which provided extensive population-based information on 12,756 active duty personnel in all branches of the military worldwide. Military personnel reported higher levels of stress at work than in their family life. The personnel reporting the highest levels of occupational stress were those 25 or younger, those who were married with spouses not present, and women. Personnel with high levels of stress had significantly higher rates of mental health problems and productivity loss than those with less stress. We recommend that prevention and intervention efforts geared toward personnel reporting the highest levels of stress be given priority for resources in this population.     

Development and testing of virtual reality exposure therapy for post-traumatic stress disorder in active duty service members who served in Iraq and Afghanistan

This study was an open-label, single-group, treatment-development project aimed at developing and testing a method for applying virtual reality exposure therapy (VRET) to active duty service members diagnosed with combat post-traumatic stress disorder (PTSD). Forty-two service members with PTSD were enrolled, and 20 participants completed treatment. The PTSD Checklist-Military version, Patient Health Questionnaire-9 for depression, and the Beck Anxiety Inventory were used as outcome measures. Of those who completed post-treatment assessment, 75% had experienced at least a 50% reduction in PTSD symptoms and no longer met DSM-IV criteria for PTSD at post treatment. Average PSTD scores decreased by 50.4%, depression scores by 46.6%, and anxiety scores by 36%. Intention-to-treat analyses showed that statistically significant improvements in PTSD, depression, and anxiety occurred over the course of treatment and were maintained at follow up. There were no adverse events associated with VRET treatment. This study provides preliminary support for the use of VRET in combat-related PTSD. Further study will be needed to determine the wider utility of the method and to determine if it offers advantages over other established PTSD treatment modalities.     

Kinematic analysis of the braking and propulsion phases during the support time in sprint running

The contact time (CT) and the ratio between the duration of braking (BP) and propulsion phase (PP) during the support are two mechanical parameters that are relevant for the performance in sprinting. Several different kinematic methods have been used to estimate the BP–PP transition point, with some disagreements among studies. The purpose of this study was to compare three criteria to individuate that point: the maximum knee flexion (KNEEFLEX), the maximum fall of the COM (COMVERT) and the horizontal COM acceleration (COMHORIZ). It was hypothesized that these three events would take place in different instants, representing different moments of the step cycle. The kinematic analysis was performed through stereophotogrammetry on seven male middle-level sprinters (mean ± SD height: 180 ± 5 cm; body mass: 75 ± 11 kg; personal best on 100 m: 10.96 ± 0.45 s).The COMVERT expressed as percentage of CT (mean ± SD 31.73 ± 8.29%) was on average strongly anticipated compared to both KNEEFLEX (45.07 ± 3.60%, p < 0.01) and COMHORIZ (56.86 ± 8.56%, p < 0.01). The ～12% difference between KNEEFLEX and COMHORIZ was also statistically significant (p < 0.01). The 40–60% relative proportion of BP and PP considered to be optimal in the literature, was reflected in this study only by the KNEEFLEX criterion. Given the importance of BP time as a reference parameter to assess the training status and efficacy of training interventions, it looks necessary both from a scientific and applied perspective to consider a standardized criterion to identify the BP–PP transition point.     

Racial variations in Department of Veterans Affairs ambulatory care use and unmet health care needs

Our objective was to describe racial/ethnic variations in Department of Veterans Affairs (VA) ambulatory care use and its association with the presence of unmet health care needs. Using the 1992 National Survey of Veterans, we examined race/ethnicity and unmet health care need for ambulatory care users of VA and non-VA facilities. Black and Hispanic veterans were more likely to report any VA use. In unadjusted analyses, American Indian/Eskimo, Hispanic, and black veterans were 4.4, 2.5, and 1.9 times more likely, respectively, than white veterans to report an inability to get needed care. Adjusting for VA ambulatory care use diminished the disparity in inability to get needed care between American Indian/Eskimo or Hispanic veterans and white veterans and eliminated the disparity between black and white veterans. Our findings support the VA's role as a medical safety net provider and suggest that VA ambulatory care use is effective in mitigating health-related racial disparities for some veterans. Additional facilitators for reducing unmet need should be explored.     

Ambulatory health care needs of women deployed with a heavy armor division during the Persian Gulf War.

A study was undertaken to assess the health care needs of women in a combat deployment. During a 6-month period during the Persian Gulf War, 10,165 ambulatory visits from an armor division were studied. The results demonstrate that the health care needs of women can be managed by competently and broadly trained practitioners. Referral sites should provide for gynecologic consultants along with equipment and resources needed to manage pregnancy complications, pelvic pain, and abnormal cervical cytology. It is unlikely that women deployed in this setting pose a significant health care burden attributable solely to their gynecologic needs.     

Scrutinising the duty of care and standard of care in English medical negligence

The aim of this article is to discuss the difficulties that claimants encounter in civil law action in English medical negligence cases. It argues that the current legal framework, in particular in relation to the existence of the duty of care and the assessment of standard of care, is haphazard and flawed. It suggests that the law should provide the boundaries that would encompass a moral obligation to rescue and to treat. In conclusion it discusses some timid attempts to reform the law in order to facilitate redress and compensation.