Self-rated health and health care utilization after military deployments

Self-rated general health is one element of the standard health assessment required of U.S. military service members upon completion of major deployments. A cohort study of 22,229 male U.S. Army and Air Force personnel returning from Europe or Southwest Asia in 2000 used survival analysis methods and Cox proportional hazard models to examine postdeployment self-rated health (SRH) status and subsequent hospitalization, separation, and ambulatory care visits. Self-rated health was fair/poor for 1.5% and good for 20.4%; 11% documented at least one health concern. During 30,433 person-years of follow-up (median, 1.5 person-years), there were 22.8 hospitalizations per 1,000 person-years and 4.0 ambulatory care visits per person-years. After adjustment, deployers with fair/poor SRH had an increased risk for hospitalization (hazard ratio [HRI, 1.6; 95% confidence interval [CI], 1.0,2.7); the risk was lower for those with good SRH (HR, 1.3; 95% CI,1.1,1.5). Deployers with fair/poor SRH health had an increased risk for illness-related ambulatory care visits (HR, 1.8, 95%; CI, 1.6,2.1) and administrative visits (HR, 1.4; 95% CI, 1.1,1.7), but not injury-related visits (HR, 1.2; 95% CI, 0.8,1.7). Self-reported low health status and other health concerns identify military members with higher levels of health care needs following return from major deployments.     

Postdeployment health care for returning OEF/OIF military personnel and their social networks: a qualitative approach

Little is known regarding the health care needs of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) deployed veterans seeking care outside of Veterans Affairs facilities. Responding to this gap, we conducted a mixed methods study of postdeployment health among veterans and members of their social networks in six community-based primary care clinics. A total of 347 patients completed a survey dealing with deployment to Iraq/Afghanistan (whether their own or that of a family member, friend, or coworker), and subsequent psychosocial and health problems. A subset of 52 participants responded to an open-ended question requesting additional information about experiences during and postdeployment. Content analysis of these responses revealed five overarching themes: connectedness, perceptions of conflict, consequences of deployment, health and treatment concerns, and respect and concern for service members/veterans. These data point to significant deployment-related disruptions in the well-being of service members and those in their broader social networks, with implications for defining service needs in community health settings.     

Seatbelt use among military personnel during operational deployment

OBJECTIVE: This study analyzed the wearing of seatbelts among British Forces personnel in Iraq and explored the various factors that prevented their use. METHODS: Questionnaires were administered to 237 British Forces personnel in southern Iraq from December 2003 to January 2004. Data analysis was by percentages. RESULTS: A total of 78% of respondents knew the seatbelt regulations (i.e., to wear seatbelts always). Respondents perceived the biggest threats to driving to be bad roads, speeding, security dangers, and Iraqi drivers. Seatbelt usage by drivers was 52% always, 25% sometimes, and 22% never. This was similar to usage by front seat passengers (52%, 27%, and 21%, respectively). The main reasons for not wearing seatbelts for drivers and front seat passengers were inhibition of exit and weapons. A total of 66% of back seat passengers in Land Rovers never wore seatbelts. CONCLUSIONS: The wearing of seatbelts is mandatory. The Ministry of Defence seatbelt policy is clear and is understood by most service personnel. However, this study shows a disparity between awareness regarding the mandatory use of seatbelts and actual use. Soldiers perceive the use of seatbelts as restrictive in a hostile environment. More effective education is needed and should emphasize the importance of seatbelt usage even in hostile areas such as Iraq.     

Schistosomiasis in Belgian military personnel returning from the Democratic Republic of Congo

The detection of schistosomiasis cases among Belgian military personnel returning from a mission in the Democratic Republic of Congo (DRC) prompted a nested case-control study of all military personnel deployed in the DRC between 2005 and 2008 to identify all infections and to start appropriate treatment. Of 197 patients exposed at Lake Tanganyika in the Kalemie area of DRC, 49 (24.9%) were diagnosed with schistosomiasis. Swimming was significantly more frequent than wading in the seropositive group than in the seronegative group (88.9% vs. 73.6%; odds ratio [OR], 2.86; 95% confidence interval [CI], 0.97-9.01). Thirty-one of 49 patients (63.3%) were symptomatic; including skin problems in 34.7%, respiratory symptoms in 12.2%, fever in 14.3%, and 51.0% with gastrointestinal problems. Median eosinophil counts were significantly higher in seropositive patients (375 vs. 138 per tL; Wilcoxon rank sum test [Ws] = 10,559.00; p < 0.01; r = -0.49). In total, 20 (40.8%) of the 49 patients were treated for symptomatic infections and the remainder for asymptomatic schistosomiasis. Our study emphasizes the need for active systematic post-tropical screening in military personnel after deployment to Schistosoma-endemic regions of the world.     

Factors affecting mental health service utilization among deployed military personnel

This study contrasts the characteristics of clients using military mental health services in deployed and nondeployed settings, the communications between their mental health providers and commanders, and the impact of mental health services on their military duties. The study explored the rates of command communication and duty restrictions across settings and referral sources. The study used secondary data from two predominantly Air Force sources: (1) deployed data collected in 2005 at Al Udeid Air Base, Qatar; and (2) nondeployed data collected in 2001 at various nondeployed settings. Chi2 analyses were used to compare the demographic variables, command communication, and duty restrictions. Among self-referrals, there were higher rates of command communication and duty restrictions in the deployed setting. Further analysis found that the rate of self-referral to mental health services did not vary significantly across settings despite the barriers of increased command communications and duty restrictions in the deployed setting. This study extends the findings of Rowan and Campise's 2006 initial nondeployed study into the deployed environment.     

Smokeless tobacco use in military personnel

Military personnel are more than twice as likely as civilians to use smokeless tobacco (ST), and recent studies indicate that military prevalence rates are rising. However, few studies have examined factors related to ST use in the military. The present study evaluated the characteristics of ST use in 785 active duty military personnel. The results indicated that the average age of initiation was 17.7 years, participants had used ST for 12.3 years, and they used approximately four tins or pouches of tobacco per week. Army personnel were more likely than Air Force personnel to be older, to have used ST longer, and to be heavier users. Officers had used ST longer than enlisted personnel and were more likely to have had a recent quit attempt. Enlisted personnel were more than three times as likely to report concurrent cigarette smoking. These results indicate that there are significant differences in ST use patterns in military personnel, and cessation programs should be tailored to meet these differences.     

Characteristics of deployed Operation Iraqi Freedom military personnel who seek mental health care

INTRODUCTION: This study reports on the feasibility of using validated mental health screening instruments for deployed Operation Iraqi Freedom military personnel. METHODS: For a 3-month period in 2005, all service members (N=296) who initially presented to the U.S. Military Hospital Kuwait mental health clinic completed an intake questionnaire that gathered demographic information and contained validated instruments to screen for mental disorders and functional impairment. RESULTS: A total of 19% of the sample subjects screened positive for post-traumatic stress disorder-related symptoms, 35% for a major depressive disorder, and 11% for severe misuse of alcohol. Significant levels of distress and functional impairment were reported by 58% of the sample. Women represented a disproportionately high percentage of those presenting for care (27%). CONCLUSIONS: Screening instruments were well accepted and useful in detecting psychopathological conditions and functional impairment. Female service members might represent a high-risk group. These results are useful for those caring for service members during or after deployment.     

少数民族军人心身健康状况及其影响因素分析

目的 探讨少数民族军人的心身健康状况及其影响因素.方法 采用随机整群抽样法选取各大军区陆、海、空不同年代不同民族的军人共11362人,采用中国心身健康量表进行测评,对数据资料进行t检验、相关分析、多元逐步回归分析等统计学处理.结果 总体比较,少数民族军人的呼吸系统、心血管系统、消化系统、焦虑等因子分低于汉族军人(P＜0.05,P＜0.01).20世纪80年代,少数民族军人的心身健康总分、心理健康因子、躯体健康因子与汉族军人比较差异无统计学意义(P＞0.05),而在20世纪90年代和2000-2009年,少数民族军人的3个心身健康因子分显著低于汉族军人(P＜0.05,P＜0.01).统计学分析显示,军人的心身健康总分、心理健康因子、躯体健康因子与年代、民族呈现显著负相关(P＜0.01).不同年代、民族均被选人心身健康总分、心理健康因子、躯体健康因子的回归方程(P＜0.05,P＜0.01).结论 20世纪80年代军人的心身健康水平不存在民族差异,而90年代以后少数民族军人的心理健康因子、躯体健康因子、心身健康总水平均优于汉族军人.     

Brief interventions to reduce harmful alcohol use among military personnel: lessons learned from the civilian experience

Unhealthy alcohol use is among the leading causes of morbidity and mortality in the United States. Among military personnel, service members between the ages 18 and 25 had a 27.3% prevalence of heavy drinking in the previous 30 days, compared to 15.3% among civilians in the same age group. In the civilian world, > 100 million patients are treated in U.S. emergency departments (ED) annually; 7.9% of these visits are alcohol related. Alcohol is associated with a broad range of health consequences that may ultimately present in the ED setting: traumatic injuries (e.g., motor vehicle crashes, intentional violence, falls); environmental injuries (e.g., frostbite); cardiovascular problems (e.g., hypertension, dilated cardiomyopathy); gastrointestinal disorders (e.g., hepatitis, pancreatitis, gastrointestinal bleeding); neurological problems (e.g., encephalopathy, alcohol withdrawal, withdrawal seizures), as well as psychological problems (e.g., depression, suicide). Seminal work has been done to create behavioral interventions for at-risk drinkers. These motivational interventions have been found to be successful in encouraging clients to change their risky behaviors. We present such a technique, called the Brief Negotiated Interview as performed in a civilian ED setting, in hopes of adapting it for use in the military context. Military health care providers could easily adapt this technique to help reduce risky levels of alcohol consumption among service members, retirees, or military dependents.     

Reported stress and its relationship to tobacco use among U.S. military personnel

In addition to common stressors, members of the U.S. Armed Forces experience a high level of stress unique to their status as service members. In an effort to combat stress, many military personnel report high levels of nicotine use. This study investigated the relationship between tobacco use and perceived stress among military members in all four armed services. Results indicate that those who use tobacco products specifically to reduce stress report significantly higher stress levels than those who do not use tobacco. Moreover, current users and those who both smoked and used smokeless tobacco were far more likely to report experiencing "a lot" of stress from a variety of sources than former or never users. Tobacco users also engaged more frequently in negative coping behaviors and relied less on the positive coping strategies used more often by former or never smokers. These findings are consistent with the larger body of literature suggesting that tobacco is not only an ineffective stress-reducing strategy, it also likely perpetuates a stress response in users. It is, therefore, critical that the military improve effective means of coping among nicotine-using troops.     

The financial impact of deployments on reserve health care providers

This study retrospectively surveyed the financial impact of deployments on 17 U.S. Army Reserve health care providers. Due to multiple mobilizations, 29 separate deployments were reported. The deployments, mostly between 2001 and 2005, typically lasted 3 months during which 86% reported no civilian income and 76% reported no civilian benefits. Solo practice providers reported the greatest financial losses due to continuing financial responsibility related to their civilian practice despite being deployed. Overall, 2 deployments did not change, 9 increased, and 16 decreased the medical officer's income. Two were not reported. In this small retrospective convenience sample study, solo practice U.S. Army Reserve health care providers were found to be at highest risk of financial losses during military deployments. This being said, no price can be put on the privilege of serving our men and women in uniform.     

Investigating the respiratory health of deployed military personnel

Recent news media articles have implied a direct relationship between environmental exposures such as burn pits during current deployments and the development of serious and debilitating chronic pulmonary disease. These articles suggest that the military is superficially investigating evidence that establishes a link between deployment and development of chronic lung disease. Anecdotal cases of military personnel with lung disease are detailed to suggest a systemic problem with undiagnosed and untreated pulmonary disease in deployed service members. Despite these contentions, the U.S. Army Medical Department and other agencies have been actively pursuing numerous scientific investigations into deployment-related lung disease to define the severity and prevalence of the issue. This article will review relevant research efforts by the U.S. military in the existing medical literature and address the current efforts planned by the services to systematically investigate the possibility of deployment-related pulmonary disease.     

Tuberculosis morbidity among military personnel in modern conditions

Among identified in the army for one year of active tuberculosis patients constitute 38.7% of the number of soldiers from young recruits, including 59.7% of infiltrative pulmonary tuberculosis. At the same time during the examination of these individuals revealed only about half of patients. Timely delivery of fluorographic examination recruitment plays a crucial role in preventing the spread of tuberculosis in the Armed Forces. From the military doctors need more work in groups at increased risk of tuberculosis, early identification of need in the dispensary dynamic observation and conducting a full range of therapeutic and preventive measures in foci of tuberculous infection.