Chemical exposure guidelines for deployed military personnel

In light of the absence of guidelines and standards applicable to deployed military personnel, the U.S. Army Center for Health Promotion and Preventive Medicine (USACHPPM) has completed Technical Guide 230A, Short-term Chemical Exposure Guidelines for Deployed Military Personnel. This guide provides estimated concentration levels associated with various types of effects for short-term exposures from 1 hour up to 2 weeks. A second TG (TG230B, Long-term Chemical Exposure Guidelines for Deployed Military Personnel) is being developed to address potentially longer deployment related exposures (i.e. greater than 2 weeks up to 1 year). This article focuses on TG230A which describes varying severity levels and health effects associated with short-term chemical exposures in a format consistent with the existing doctrinal military risk management paradigm. It is a consolidated reference tool for trained military medical staff to evaluate different chemical hazards, and will ensure more expedient risk management decisions during deployments. The TG also establishes the standard reference for pre- and post-deployment evaluations and risk management decisions, including determinations of resource requirements and equipment specifications.     

Self-Medication: A survey of nonprescription drug use

A sample of adults (n = 148) which reflected age, gender, and race characteristics of the 1980 U.S. Census was surveyed on the incidence of obtaining over the counter (OTC) drugs during the previous year and the nature of the drugs used. Most (78%) reported obtaining OTC drugs, and of 15 categories, headache or pain remedies, cold or flu remedies, and vitamins were most frequently (>50%) reported as used. No gender or race effects were found for obtaining OTC drugs or for the nature of OTC drugs used. Identified patterns of OTC drug use were related to previous research and have implications for drug development, health care, and marketing concerns. © 1993 Wiley-Liss, Inc.     

Clinical and economic outcomes of pharmacist-managed antiepileptic drug therapy

This study explores the associations between pharmacist-managed antiepileptic drug therapy in hospitalized Medicare patients and diagnoses indicating the need for these drugs. It also explores the following major heath care outcomes: death rate, hospital length of stay (LOS), Medicare charges, drug charges, laboratory charges, complications, and adverse drug reactions. Data were drawn from the 1998 MedPAR and 1998 National Clinical Pharmacy Services databases. Pharmacist-managed antiepileptic drug therapy was evaluated in a study population of 9380 Medicare patients with diagnosed epilepsy or seizure disorders treated in 794 United States hospitals. This population was derived from the 38,311 hospitalized Medicare patients with epilepsy or seizure disorders (MedPAR). In hospitals without pharmacist-managed antiepileptic drug therapy, death rates were 120.61% higher, with 374 excess deaths (chi(2)=5.983, df=1, p=0.014, odds ratio [OR]=1.553, 95% confidence interval [CI] 1.102-2.189). Hospital LOS was 14.68% higher, with 8069 patient-days (Mann-Whitney U test [U]=3833132, p=0.0009); total Medicare charges were 11.19% higher, with 14,372,550 dollars in excess total charges (U=3644199, p=0.0003); per-patient drug charges were $115 +/- $92 higher (p=NS); laboratory charges were 32.24% higher, with 5,664,970 dollars in excess charges; and aspiration pneumonia rate was 54.61% higher (chi(2)=5.848, df=1, p=0.015, OR=1.233, 95% CI 1.081-1.901). Although the frequencies of other complications and adverse effects were higher, these differences were not statistically significant compared with hospitals with pharmacist-managed antiepileptic drug therapy. Clinical and economic outcomes were improved among hospitalized Medicare patients whose antiepileptic drug therapy was managed by pharmacists.     

Semen analysis of military personnel associated with military duty assignments

A collaborative study between the U.S. Army Biomedical Research and Development Laboratory (USABRDL) and the National Institute for Occupational Safety and Health (NIOSH) was designed to assess fecundity of male artillery soldiers with potential exposures to airborne lead aerosols. Potential exposure assessment was based upon information provided in an interactive questionnaire. It became apparent from extensive questionnaire data that many soldiers in the initial control population had potentially experienced microwave exposure as radar equipment operators. As a result, a third group of soldiers without potential for lead or microwave exposures, but with similar environmental conditions, was selected as a comparison population. Blood hormone levels and semen analyses were conducted on artillerymen (n = 30), radar equipment operators (n = 20), and the comparison group (n = 31). Analysis of the questionnaire information revealed that concern about fertility problems motivated participation of some soldiers with potential artillery or microwave exposures. Although small study population size and the confounding variable of perceived infertility limit the reliability of the study, several statistically significant findings were identified. Artillerymen who perceived a possible fertility concern demonstrated lower sperm counts/ejaculate (P = 0.067) and lower sperm/mL (P = 0.014) than the comparison group. The group of men with potential microwave exposures demonstrated lower sperm counts/mL (P = 0.009) and sperm/ejaculate (P = 0.027) than the comparison group. Variables used to assess endocrine, accessory sex gland, and sperm cell function were not different than the comparison group. Additional studies, incorporating larger numbers of individuals, should be performed in order to more optimally characterize potential lead and microwave exposure effects on male fecundity.     

我院军人门诊处方用药分析

目的采用世界卫生组织的合理用药指标和其他指标,了解我院军人药房门诊患者的用药现状和门诊处方的合理性情况。方法采用回顾性分析,随机抽样我院2009年3月至2009年12月10个月军人药房门诊处方3000张,进行统计分析。结果平均每张处方用药3.2种,处方平均金额113.3元,超过100元的处方占40%;使用注射剂处方占5%,注射剂使用率较低;心血管药物使用率为35%,这与主要保障对象为老年患者相符合,其中主要为抗高血压药物(钙通道阻滞剂占18%,其次为血管紧张素转化酶抑制剂,占13%);使用抗菌素处方占33%,比率偏高,还应该加强管理;军人分类保障范围内药品占处方用药的100%,通用名药品占处方药品的100%;不合理用药处方占9%,主要问题为无适应证用药、诊断书写不全、用法用量不合理等。结论我院军人门诊用药情况基本合理,但仍要加强抗菌药物的管理和不合理用药的管理。     

Clinical impact of a pharmacist-managed diabetes mellitus drug therapy management service

STUDY OBJECTIVE: To evaluate the impact of clinical pharmacist interventions, including drug therapy management, on outcomes relevant to diabetes mellitus. DESIGN: Retrospective chart review. SETTING: Ambulatory, multispecialty physician group practice within a managed care environment in suburban Chicago, Illinois. PATIENTS: Three hundred sixteen patients aged 18 years or older, with a diagnosis of diabetes mellitus (89% with type 2), who were referred to a clinical pharmacy service. INTERVENTION: Drug therapy management and education service provided by a clinical pharmacist. MEASUREMENTS AND MAIN RESULTS: Data were collected for glycosylated hemoglobin A(1c) (A1C), blood pressure, and low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglyceride concentrations. Data also were collected regarding patient adherence with American Diabetes Association guidelines for preventive care, including annual eye and foot examinations, influenza shots, and daily aspirin use at both baseline and follow-up. Mean +/- SD A1C reduction was 1.4% +/- 1.94% (p<0.001); the percentage of patients whose A1C was at goal level at baseline (< 7%) increased from 14.8% to 43.2% (p<0.001). Mean +/- SD LDL level reduction was 14 +/- 41.1 mg/dl (p=0.002), mean +/- SD triglyceride level reduction 42 +/- 97.6 mg/dl (p<0.001). The percentage of patients who reached goal for LDL level (< 100 mg /dl), HDL level (> 40 mg/dl), and blood pressure (< 130/80 mm Hg) did not increase significantly from baseline, whereas those who reached the triglyceride level goal (< 150 mg/dl) increased from 36% to 55% (p<0.005). Frequency of annual dilated retinal examinations and monofilament foot examinations increased by 29% (p<0.05) and 12.5% (p<0.05), respectively. Daily aspirin use increased from 35% to 59% (p<0.05). CONCLUSION: Significant clinical improvement occurred in patients referred to the pharmacist in a diabetes drug therapy management program.     

Regional differences in alcohol use among U. S. military personnel

OBJECTIVE: The purpose of this study was to examine differences in heavy alcohol use and alcohol-related negative effects among U.S. military personnel stationed in different world regions and to examine factors that may account for regional differences. METHOD: Data were drawn from the 1998 Department of Defense Survey of Health Related Behaviors among Military Personnel, which had a large representative sample of active-duty U.S. forces. Heavy alcohol use and related negative effects (severe consequences, productivity loss and alcohol overuse) were examined in four regions (Asia, Europe, Hawaii and continental United States; N = 17,154; 86% men) using multivariate logistic regression models that controlled for demographic factors. RESULTS: U.S. military personnel stationed in Asia were significantly more likely to be heavy alcohol users than personnel stationed in the other regions. Productivity loss was also significantly greater in Asia, whereas severe consequences and alcohol overuse were not. Possible explanations for the findings include local regional culture, availability of alcohol, freedom from restraints, response to stress, military culture and selection effects. CONCLUSIONS: Heavy alcohol use of military personnel varies by region of assignment and may be attributable to a variety of factors. Future studies need to examine regional alcohol use in greater detail and to include measures specific to potential explanatory domains to permit a more complete understanding of underlying causal mechanisms of heavy drinking by U.S. forces in Asia. Current findings suggest that alcohol use prevention and early intervention programs should be tailored to take account of regional differences.     

Remote sensing and malaria risk for military personnel in Africa

Background.  Nonimmune travelers in malaria-endemic areas are exposed to transmission and may experience clinical malaria attacks during or after their travel despite using antivectorial devices or chemoprophylaxis. Environment plays an essential role in the epidemiology of this disease. Remote-sensed environmental information had not yet been tested as an indicator of malaria risk among nonimmune travelers.
Methods.  A total of 1,189 personnel from 10 French military companies traveling for a short-duration mission (about 4 mo) in sub-Saharan Africa from February 2004 to February 2006 were enrolled in a prospective longitudinal cohort study. Incidence rate of clinical malaria attacks occurring during or after the mission was analyzed according to individual characteristics, compliance with antimalaria prophylactic measures, and environmental information obtained from earth observation satellites for all the locations visited during the missions.
Results.  Age, the lack of compliance with the chemoprophylaxis, and staying in areas with an average Normalized Difference Vegetation Index higher than 0.35 were risk factors for clinical malaria.
Conclusions.  Remotely sensed environmental data can provide important planning information on the likely level of malaria risk among nonimmune travelers who could be briefly exposed to malaria transmission and could be used to standardize for the risk of malaria transmission when evaluating the efficacy of antimalaria prophylactic measures.     

Potential benefit of Bayesian forecasting for therapeutic drug monitoring in neonates.

Therapeutic drug monitoring in neonate has been hampered by invasiveness of blood samplings raising ethical problems. A methodologic approach has been developped in adults and in children that is still unsufficiently developped in neonates, the Bayesian forecasting of drug plasma concentration. This method is particularly attractive in neonates using a few blood samples from an individual patient and more informations from a prior patient sample representative of the population the individual patient belongs to. The present article aims at reviewing the different procedures and methods to minimize invasiveness during therapeutic drug monitoring in neonate and at reviewing the methods for improving the quality of different dose adjustments using a Bayesian approach.     

Co-occurrence of alcohol, smokeless tobacco, cigarette, and illicit drug use by lower ranking military personnel

The Worldwide Survey of Health Related Behaviors is administered periodically to a probability sample of military personnel. Earlier reports of these surveys suggested that illicit drug use was highest among the lowest ranking personnel. This paper reports a secondary analysis of the 1992 and 1995 surveys of the lowest ranking personnel. The results suggested that in general illicit drug users tended also to use alcohol, smokeless tobacco, and cigarettes. Heavy drinkers were more likely than light drinkers to use illicit drugs. No such relationship was observed between illicit drug use and the level of use of cigarettes or smokeless tobacco. Moreover, among the heavy drinkers, illicit drug users were especially likely to use cigarettes and among males, smokeless tobacco. The relevance of these results to military policies toward illicit drug use is discussed.