Heat Illness in the Army in Cyprus

Heat illness in the British Armed Forces is a significant occupationalrisk. This paper analyzes reports of heat casualties occurringin Episkopi, Cyprus from January 1990 through December 1994.A total of 96 casualties were reported from 48 separate incidents.On seven occasions, three or more casualties occurred concurrently(maximum 19). There were 20 incidents causing 32 casualtiesfrom Cyprus-based units and 28 incidents causing 64 casualtiesfrom units visiting Cyprus. There was a clear seasonal variationof reports with the maximum number of reports occurring fromMay to August. The majority of reported casualties occurredwhen the Wet Bulb Globe Temperature was between 26°C and29°C. Cyprus-based units had most casualties occurring asa consequence of forced marching whereas most casualties fromvisiting units occurred during military field exercise training.Visiting Territorial Army units had the highest incidence ofheat casualties for visiting units. The majority of heat casualtieswere mild; there were only ten severe cases. It was not possibleto identity any particular risk factors applicable to individualsexcept incomplete acclimatization. The study showed that thecurrent guidelines used by the British Armed Forces do not preventall heat casualties. It is not possible to estimate how manycasualties are prevented by the guidelines. All incidents involvinga serious casualty or multiple casualties should be investigatedto determine whether the guidelines should be further amended.     

A survey of the provision of educational supervision in occupational medicine in the Armed Forces

OBJECTIVE: The aim of this study was to assess whether balanced educational supervision was being provided for occupational medicine (OM) specialist registrars (SpRs) in the Armed Forces and to consider the effectiveness of current supervision. METHODS: Anonymized postal questionnaires, using Likert five-point response scales, were sent to Service OM SpRs and their educational supervisors (Ed Sup) to assess the degree of understanding of the purpose, effectiveness and organization of the educational supervision being provided. RESULTS: Completed questionnaires were returned from 35 (92%) specialists and 14 (61%) SpRs. Less than a third of the specialists were involved as Ed Sup and only three (11%) had undergone any formal medical education training. There was an agreement about the purpose and effectiveness of educational supervision between both the groups, though there appeared to be a bias towards providing supportive functions with patient management and educational components scoring less highly. CONCLUSIONS: A high response rate enabled an accurate assessment of OM supervision practices in the Armed Forces to be made. There was agreement over the relative effectiveness, importance and coverage of educational supervision, though this was being provided by a relatively small group of OM specialists, few of whom had undertaken any formal medical education training. The supervision provided also appeared to be biased towards providing supportive functions rather than patient management and educational components of training, which may result in an unbalanced training for the SpRs. Having assessed the relatively close-knit service OM community, there would be value in seeing whether similar patterns prevail in the wider OM community.     

The burden of psychological symptoms in UK Armed Forces

OBJECTIVE: To assess the prevalence of psychological symptoms during periods of relatively low deployment activity and the factors associated with each psychological health outcome. METHODS: A survey of 4500 randomly selected UK service personnel was carried out in 2002. The questionnaire included the General Health Questionnaire (GHQ-12), the post-traumatic stress disorder checklist (PCL), 15 symptoms and an assessment of alcohol intake. RESULTS: A total of 20% were above cut-offs for GHQ-12, 15% for symptoms, 12% for alcohol intake and 2% for PCL. Gender, age, excessive drinking and smoking were independently associated with most outcomes of interest. Number of deployments was independently associated with multiple symptoms and excessive drinking. High post-traumatic stress disorder score was more frequent in the Army and in lower ranks. CONCLUSIONS: Psychological symptoms are highly prevalent in UK Armed Forces. Many risk factors are associated with measures of psychological ill-health.     

Post-traumatic stress disorder in occupational settings: anticipating and managing the risk

BACKGROUND: Post-traumatic stress disorder has had a substantial impact on employer liability for workplace psychological injury. The emergency services are an example of high-risk workforces that demand clear policies and procedures within an organization. The challenge is to minimize the injury to individuals and lessen the cost to organizations through the optimal application of preventative strategies. METHODS: This field is not well represented in standard keyword searches and Medline was examined with linked fields of practice and research. Consensus guidelines that refer to this domain were also utilized. Few conclusions can be reached from the literature which directly examined occupational settings. RESULTS: Organizations need to anticipate the possible traumatic exposures that may affect the workforce and have strategies to deal with the effects in the workplace, particularly the negative mental health outcomes in some personnel. This domain is relevant to all employers as accidents and violence are possible in most workplaces. Screening should be considered for high-risk individuals, particularly following a major traumatic event or cumulative exposure, such as in the emergency services. While psychological debriefing has no demonstrated benefit, the benefits of early intervention necessitate ready access to evidence-based treatments that have minimum barriers to care. Employers should be aware that distress may present indirectly in a similar way as conflict with management, poor performance and poor general health. CONCLUSION: The knowledge about the impact of traumatic events obliges employers to have an active strategy to anticipate and manage the aftermath of such events as well as cumulative traumatic exposures.     

Getting a peace of the action: measures of post traumatic stress in UK military peacekeepers

Objectives This study aimed to measure prevalence of post traumatic stress disorder (PTSD) in a sample of UK Armed Forces peacekeepers. The study also aimed to explore the influence of deploying without an established peer group (deployment status) upon health outcomes using an accepted diagnostic tool for PTSD (PCL-M) and an alternative measure of post-traumatic distress.

Design Using a sub-sample of the King's military cohort we surveyed personnel that deployed on peacekeeping operations between 1991 and 2000 (n=1198).

Setting Respondents' mean age was 36 years (min, 23 to max, 60) and 81% (n=964) were serving in the Armed Forces at the time of participation.

Main outcome measures PTSD prevalence was determined in British military peacekeepers using the PLC-M (cut-offs 44 and 50), the General Health Questionnaire (GHQ-12) and a composite brief measure of potential post traumatic symptomology, ‘PostTraumatic Stress Reaction’ (PTSR) for comparison.

Results PTSD prevalence varied from 3.6 to 5.5%. Officers and married personnel were less likely to be cases. Neither gender, age or deployment status influenced PTSD prevalence.

Conclusions PTSD was an uncommon disorder in this sample of British military peacekeepers, with prevalence rates being lower than those reported by other nations. Deploying without an established peer group was not associated with developing PTSD. We postulate that differences in culture and operational practices may account for the lower rates of PTSD.

     

The agenda of the organization. 1: A framework

It is difficult at times to know if the welfare and well-being of an organization is being best served by the individuals who make decisions on its behalf. Sometimes decisions made are driven more by the needs of individual persons rather than by the needs of the organization. Company politics, conflicts, work relationships, territory and turf, individual status and power and personality issues all influence what happens and how decisions are made. Major decisions in areas such as downsizing, re-organization and corporate strategy are often made by individuals. Do these decisions best suit the agenda of the organization or reflect the agenda of the individual? Who looks after the organizational agenda? Noer's (1993) model is used to illustrate how what is best for the organization, and not just individuals within it, can be attained.     

Medical downgrading, self-perception of health, and psychological symptoms in the British Armed Forces

Objective

To investigate the contribution of psychological symptoms to limited employability for medical reasons in the British Armed Forces.

Methods

A sample of 4500 military personnel was randomly selected to receive either a full or an abridged questionnaire. The questionnaires asked whether the participant was medically downgraded and if yes, the reason for it. The full questionnaire included the General Health Questionnaire‐12 (GHQ‐12), the post‐traumatic stress disorder (PTSD) checklist, 15 symptoms to assess somatisation, and selected items of the quality of life SF‐36 questionnaire. The abridged questionnaire included the GHQ‐4, a 14 item PTSD checklist, five symptoms, and the item on self‐perception of health from the SF‐36. Subjects above a threshold score for GHQ, PTSD, and symptoms were considered to have psychological symptoms.

Results

12.4% of the participants were medically downgraded. The majority (70.4%) had social or work limitations. Medically downgraded personnel had higher odds ratios in comparison to non‐downgraded personnel for psychological distress 1.84 (95% CI 1.43 to 2.37), PTSD 3.06 (95% CI 1.82 to 5.15), and number of symptoms 2.37 (95% CI 2.37 1.62 to 3.47). GHQ, PTSD, and symptoms scores were mainly, but not exclusively, related to chronic physical injury.

Conclusions

Psychological symptoms are common among medically downgraded personnel. Although the mechanisms involved are unclear, tackling issues of psychological symptoms among these subjects could contribute to faster restitution to full employability in the Armed Forces.     

Auditing stress

Stress is now recognized as an occupational hazard and it is incumbent on all employers to carry out an assessment in order to assess the risk to health. A stress audit would be an appropriate tool to use. An audit should concentrate on organizational issues. Most audits use a questionnaire and it is sensible to use one which has already been validated. Results should be fed back to the employer in a form which is easily understandable and which contains clear recommendations for action. A repeat audit after one year is advised.     

Dietary Supplement Use in a Large,Representative Sample of the US Armed Forces

Background

Dietary supplement (DS) use is prevalent among the US Armed Forces personnel, but representative cross-service comparisons and characteristics of personnel using DSs are limited.

The perceptions of occupational health in primary care

AIM: A random sample of general practitioners (GPs), practice nurses (PNs) and practice managers (PMs) in Sheffield and Manchester was recruited into a study to evaluate the perceptions of occupational health (OH) in primary care. METHODS: Qualitative data were collected using focus groups with three groups of primary care sector professionals. Quantitative data were collected nationally from 295 GPs using a postal questionnaire. RESULTS: GPs and PNs had minimal OH training, and 60% of GPs reported constraints in addressing OH matters with patients. The lack of referral routes (63 and 67%, respectively) was also seen as a barrier. OH was regarded as a speciality, and primary care professionals preferred to refer patients with OH problems to specialist centres because they perceived barriers to their dealing with the issues. A total of 74% of GPs surveyed thought that speedier access to secondary care would help them to address OH problems. CONCLUSIONS: This study has identified some of the problems associated with delivering OH through primary care. It also demonstrated a need for greater emphasis on OH education in medical and nurse training, and a need for better advice for GPs, PNs and PMs regarding support services for OH.     

Provision of armed force personnel with sanitary-and-epidemiological well-being under the current conditions

Health protection and provision of sanitary-and-epidemiological well-being in military personnel are largely determined by the efficiency of the prophylaxis unit of the medical service of the Armed Forces of the Russian Federation, which is part of the uniform federal state sanitary-and-epidemiological surveillance system of the Russian Federation. The activity of the prophylaxis unit of a medical service of the Armed Forces of the Russian Federation in maintaining sanitary-and-epidemiological well-being in the troops (forces) of the Ministry of Defense of the Russian Federation is accomplished in the presence of a number of unsolved problems to make sanitary-and-hygienic provision of military staff with vital activity and in that of the high epidemiological significance of acute respiratory infections, community-acquired pneumonias, streptococcal infections, childhood infections, tuberculosis, and meningococcal or HIV infections, etc. The author has defined the priority activities of the prophylaxis unit of a medical service in maintaining sanitary-and-epidemiological well-being in the Armed Forces of the Russian Federation under the present conditions, including the objectification of state sanitary-and-epidemiological surveillance in its Armed Forces, by using the capabilities of a modernized laboratory base of sanitary-and-epidemiological facilities, improving the system for immunoprophylaxis of infectious diseases, and organizing disinfection measures in the Armed Forces of the Russian Federation.     

Medical emergencies at sea and injuries among Scottish fishermen

BACKGROUND: It has long been known that fishing is one of the most dangerous occupations. In 2001, 33 boats were lost and 10 fishermen killed in UK waters. Despite the dangerous nature of the occupation, very little research has been conducted on fishermen's health and safety. Aims To address this gap in current knowledge, research was conducted to gain an understanding of health and lifestyle issues affecting Scottish fishermen. It was hoped that the study would identify aspects of fishermen's health that could be improved. This paper considers medical emergencies at sea and injuries among fishermen. METHODS: Data were collected using a postal questionnaire sent to the Scottish fishermen population and health diaries in a small sub-sample. RESULTS: In total, 1157 usable responses were received, giving a response rate of 57%. One-fifth of respondents had been involved in a medical emergency at sea that required them to be evacuated to shore for immediate treatment. The incidence of injuries was high, and one-third of the injuries experienced were to the back. The likelihood of evacuation for a medical emergency or experiencing an injury was increased both for certain occupations and with increasing number of boats worked on during the fisherman's career. CONCLUSION: Groups identified as being at a high risk of experiencing medical emergencies or injuries should be targeted in training initiatives or accident awareness and prevention initiatives.     

Attitudes and access to electronic exchange of information on occupational disease

BACKGROUND: THOR is a network of work-related disease surveillance schemes dependent on volunteer case reporting by medical specialists. Data collection and dissemination has hitherto been paper-based. AIMS: To elicit the opinion of existing reporters in THOR on electronic exchange of information and to assess the practical capabilities of the same reporters to participate in electronic communication. METHODS: A mail-based questionnaire of randomly selected THOR reporters using closed format questions. RESULTS: The response rate to the questionnaire was 66% (253/383). Almost half (47%) of the responders wanted dissemination of information solely in an electronic form, 35% favoured paper-based reports, while 16% wanted both paper and electronic reports. Two-thirds (66%) would make use of electronic archives of reports and 59% would use this facility to resolve questions by accessing accumulated data. The majority (82%) read e-mail more than once a week and 34% browsed the web as frequently. However, 5% did not have e-mail and 6% never browsed the web. Most responders judged their internet connectivity to be rapid (68%) and convenient (83%), and 91% could receive e-mail attachments. CONCLUSIONS: Most responders have the skills and infrastructure required to engage in electronic information exchange, and are favourably disposed to electronic means of communication. However it is also relevant to note that one-third of responders have a preference for the existing paper-based system.     

武警某部官兵健康素养现状及其影响因素研究

目的了解武警某部官兵健康素养情况及其影响因素,为有效实施部队健康教育提供基本依据及评价指标。方法采用整群抽样方法抽取某部839名官兵,应用自行设计问卷对其进行健康素养调查。结果具备健康素养官兵比例为12．6％,其中基本知识和理念知晓率为102人（12．2％）、健康生活方式与行为形成率为297人（35．4％）、基本技能持有率为275人（32．8％）。多因素结果显示,年龄越高,健康素养水平越高（β=1．116,P〈0．05,OR=1．123）。文化程度越高,健康素养水平越高（β=0．778,P〈0．05,OR=2．178）。结论武警某部官兵健康素养水平高于全国人群平均水平,但健康知识知晓率明显小于其他两方面水平,与任职要求不符合。应该将健康素养纳入到部队基础健康教育中。     

Occupational stress and strain in the Naval Service: 1999 and 2004

BACKGROUND: Surveys of occupational stress were undertaken in 1999 and 2004. OBJECTIVE: To measure the prevalence of psychological strain and exposure to work-related stressors in personnel. METHOD: A cross-sectional survey using a validated, reliable questionnaire was undertaken in 1999 and was replicated in 2004. The data were combined and models of stress-strain were developed for male and female personnel in the Royal Navy (RN) and males in the Royal Marines (RM). RESULTS: The response rates were 78% in 1999 and 67% in 2004. Strain prevalence was 32% in 1999 and 33.5% in 2004. Strain rates were higher in females than in males and in personnel serving at sea. Reduced organizational commitment was associated with strain in males and females. Dissatisfaction with the physical work environment was associated with strain in RN females and RM. Role conflict was associated with strain in all groups. Work-family conflict was associated with strain in males, but not in females. The models accounted for 20-30% of the variance in strain. CONCLUSION: The strain rate in the Naval Service appeared to be similar to that in the other service occupations such as the UK Police, as did the sex difference in strain. The strain rate and stressor exposure ratings were remarkably stable over the period. Role conflict was found to be a generic stressor associated with strain.     

Are Armed Forces infants more at risk than civilian infants?

The aim of the present study is to compare the health status of Armed Forces and civilian infants, accounting for social class. In a prospective cohort study, demographic data were obtained from mothers of liveborn infants from 436 civilian and 162 Armed Forces families. Birth details were taken from hospital maternity and child health systems. A six month follow-up was completed by health visitors. Standard social class classification, based on occupation, was used for civilian families and a new equivalent scheme for military personnel. No significant differences were found between civilian and military infants for birthweight, prematurity and failure to thrive. Military infants had significantly more hospital admissions (P=0.015) and accident and emergency attendances (P=0.002) mainly accounted for by the 'manual' social classes of the Armed Forces. Infant health status of civilian and military babies did not differ overall. Increased uptake of hospital services by military families can be explained by local circumstances.     

Peer-group risk assessment: a post-traumatic management strategy for hierarchical organizations

BACKGROUND: Organizations have moral and legal duties to consider the psychological needs of their workforce following exposure to potentially traumatic events related to the workplace. Additionally, it makes economic sense to avoid loss of valuable personnel to the effects of psychological trauma. There have been attempts to provide a range of psychological interventions for staff after exposure to potentially traumatizing events, but recent evidence-based medicine publications have questioned their effectiveness and, indeed, some studies show that single-session psychological debriefings may be harmful. AIM: This paper presents a post-traumatic management strategy based upon peer-group risk assessment which was developed by the British military and is in use with other hierarchical organizations. The presented model keeps employees functioning after traumatic events and provides support and education to those who require it. Additionally, the strategy aims to identify those who are unable to cope after potentially traumatizing events and aims to refer them for early intervention, which has been shown to be of benefit.     

What happens to British veterans when they leave the armed forces?

BACKGROUND: Little is known about the factors associated with leaving the armed forces, or what predicts subsequent employment success for veterans. It is likely that there is a complex interaction of adverse social outcomes and mental health status in this group. METHOD: Analysis of existing data from the King's Military Cohort, a large, randomly selected, longitudinal cohort of service personnel, many of whom have now left the armed forces. The sample consisted of 8195 service personnel who served in the armed forces in 1991; a third deployed to the Gulf (1990-91), a third deployed to Bosnia (1992-97) and the final third an 'Era' control group in the Armed Forces in 1991 but not deployed. RESULTS: The majority of service leavers do well after leaving and are in full-time employment. Those with poor mental health during service were more likely to leave and had a greater chance of becoming unemployed after leaving. Mental health problems appear to remain static for veterans after leaving. Veterans of the Gulf War enjoyed more favourable employment outcomes, provided that they came home well. CONCLUSIONS: Only a minority of veterans fare badly after service, even amongst those with active tours of duty behind them. Veterans with mental health problems during service seem to be at higher risk of social exclusion after leaving and therefore these individuals represent an especially vulnerable group of the veteran population.     

Respiratory symptoms and wheat flour exposure: a study of flour millers

The objective of this study was to determine the prevalence of respiratory symptoms and their relationship to sensitization to wheat flour allergens and fungal amylase, in a group of workers from the UK flour milling industry. A cross-sectional study was used to evaluate symptoms, using a structured interview technique, and sensitization, using skin prick test findings, from 679 employees in flour milling and packing operations at 18 flour mills. A total of 147 workers (147/679, 22%) described upper respiratory tract symptoms of some kind. In the majority (139/147, 95%) these symptoms were of an occasional or transitory nature and were related to short-term exposures to high levels of dust. Three individuals (3/679, 0.4%) were identified whose symptoms were thought to be the result of allergy to wheat flour. The prevalence of positive skin prick tests to wheat flour allergens and to fungal amylase was 1.2% (8/678) and 0.9% (6/678), respectively. Measurements of total inhalable dust exposure for personnel exposed to flour dust were taken at 10 of the sites (116 samples). For production personnel the levels were typically between 1 and 10 mg/m3 (8-h time weighted average), with a median of 6.2 mg/m3. Hygiene operatives had appreciably higher exposure than production personnel, with a median of 18.7 mg/m3. Overall, 43% (50/116) of all samples exceeded 10 mg/m3 (8-h time weighted average). The findings suggest that the risk of sensitization to wheat flour allergens from current dust exposures in flour mills is very low. Wheat allergy was responsible in only a small proportion of the total who had respiratory symptoms. The principal causation of symptoms experienced by the workforce was considered to be a non-specific irritant effect related to short-term exposures to high levels of total inhalable dust.