Update: malaria, U.S. Armed Forces, 2011

U.S. service members are at risk of malaria when they are assigned to endemic areas (e.g., Korea), participate in operations in endemic areas (e.g., Afghanistan, Africa) and visit malarious areas during personal travel. In 2011, 124 service members were reported with malaria. Nearly three-fourths of cases were presumably acquired in Afghanistan (n=91) and one-fifth were considered acquired in Africa (n=24). One-quarter of cases were caused by P. vivax and one-fifth by P. falciparum (including 6 Afghanistan-acquired infections); most cases were reported as "unspecified" malaria. Malaria was diagnosed/reported from 51 different medical facilities in the United States, Afghanistan, Kyrgyzstan, Iraq, Germany and Korea. Providers of care to military members should be knowledgeable regarding and vigilant for clinical presentations of malaria outside of endemic areas.     

A Review of Stature,Body Mass and Maximal Oxygen Uptake Profiles of U17, U20 and First Division Players in Brazilian Soccer

Investigations in the physiological demands of soccer have identified that a significant percentage of energy production in match performance is provided through the aerobic pathways. It is therefore important to assess maximal oxygen uptake (VO_2Max) of players in order to evaluate their aerobic fitness status and optimize their physical conditioning. However, it is also important to consider the variation of (VO_2Max) profiles for soccer players, with differences having been identified in terms of playing position as well as playing style. This paper reviews the academic literature between 1996 and 2006 and reports on the methodologies employed and the values obtained for stature, body mass and (VO_2Max) profiles of soccer players of different positions in professional Brazilian clubs at U-17, U-20 and First Division levels. Indirect measurements accounted for the majority of tests conducted at U-17 (70%) and U-20 (84.6%) levels whereas at First Division level almost half of the (VO_2Max) evaluations were performed by direct measurements (47.8%). The mean (VO_2Max) profiles obtained for outfield players in U-17 was 56.95 ± 3.60 ml·kg^-1·min^-1, 58.13 ± 3.21 ml·kg^-1·min^-1 for U-20 players and 56.58 ± 5.03 ml·kg^-1·min^-1 for First Division players. In Brazil, the U-20 players appear to have highest VO_2Max values, however the profiles reported for all outfield positions in U-17 and First Division levels are often lower than those reported for the same category of players from other countries. This may be a reflection of the style of play used in Brazilian soccer. This is further emphasized by the fact that the playing position with the highest VO_2Max values was the external defenders whereas most findings from studies performed in European soccer indicate that midfielders require the highest VO_2Max values.

Key points

• Physical and physiological differences exist between Brazilian soccer and European soccer.
• Players in Brazil appear to be shorter in stature, similar in body mass and have a lower overall aerobic capacity to their European equivalents
• In Brazil, there seems to be a physical development phase for players at U-20 level which prepares them for the demands at First Division level.

Key words: Soccer, maximal oxygen uptake, playing positions     

Update: Exertional rhabdomyolysis, active component, U.S. Armed Forces, 2011

In 2011, there were 435 incident episodes of rhabdomyolysis likely due to physical exertion and/or heat stress ("exertional rhabdomyolysis") among U.S. service members. The annual rates of exertional rhabdomyolysis nearly doubled from 2007 to 2011. The highest incidence rates occurred in males, black, non-Hispanics, service members younger than 20 years of age and in the Marine Corps and Army. Most cases were diagnosed at installations that support basic combat/recruit training centers or major Army and Marine Corps combat units. Medical care providers should consider exertional rhabdomyolysis in the differential diagnosis when service members -- particularly recruits -- present with muscular pain, swelling, limited range of motion, or the excretion of dark urine possibly due to myoglobinuria after strenuous physical activity, particularly in hot, humid weather.     

Urinary stones, active component, U.S. Armed Forces, 2001-2010

Urinary stones can cause debilitating morbidity that impairs the operational effectiveness of affected members of the U.S. Armed Forces. This report describes a "gender shift," i.e., the narrowing of prevalence differences between men and women, similar to trends described in the U.S. civilian population. Rates of incident diagnoses of urinary stones increased in the active component during the past decade - particularly among females. On average, 60 service members were medically evacuated from combat zones each year during the period. Service members with a history of urinary stones should be counseled on reducing risk, particularly in the deployment setting.     

Update: heat injuries, active component, U.S. Armed Forces, 2011

In 2011, the number of service members treated for heat stroke (n=362) was higher than the number in 2010, but lower than the numbers in 2007-2009. Incidence rates of heat stroke were highest among males, service members in combat-specific occupations, in the Marine Corps and Army, and among those younger than 20 years of age. The number of service members treated for "other heat injuries" was higher in 2011 (n=2,652) than in any of the four prior years; however, there were fewer hospitalizations for "other heat injuries" in 2011 than in recent prior years. In contrast to heat stroke, the incidence rate of "other heat injuries" was higher among females than males and the rate among enlisted members was more than twice that of officers.