II. Demographic Variables and Illness Onset in an Attack Carrier’s Crew

Approximately one third of the enlisted crew of an attack carrier (N = 738) was studied during a six-month deployment to Vietnam. Questionnaires about personal background and military status were given at the beginning of the cruise, and the illnesses developed by these men during the cruise were tabulated. This paper discusses the relationship of 16 demographic variables to illness onset: job specialty, pay grade, age, race, religion, birth region, marital status, number of dependents, education, intelligence level, parents’ status (living or deceased), birth order, father’s occupation, father’s education, socioeconomic status, and active duty status (regular vs reserve).

On the basis of analyses of variance, the following demographic variables were found to have a significant overall relationship to illness incidence: job specialty, age, pay grade, race, birthplace, and number of dependents. The remaining ten variables were statistically unrelated to illness incidence. Relatively high illness rates occurred in younger, nonrated seamen, especially those in the Fireman/Fireman Apprentice category who worked on the ship’s engines. Relatively high illness rates also occurred in Negro and American Indian sailors.     

III. Prior Life Change and Illness Onset in an Attack Carrier’s Crew

Approximately one third of the enlisted crew of an attack carrier (N = 687) was studied during a six-month deployment to Vietnam. The Schedule of Recent Experience (SRE), designed to document significant recent life change, was administered at the beginning of the cruise, and the illnesses developed by these men during the cruise were tabulated. This paper discusses the relationship of prior life change to illness onset.

Initially, an item weighting system which was constructed from civilian populations was used in scoring, but this scoring system failed to discriminate future illness. A new weighting system was then derived by stepwise multiple regression analysis, which was done separately for unrated seamen and petty officers. Several different items emerged as unique predictors for these two groups of men. The life change scores based on the regression-derived weighting system clearly and significantly discriminated future illness, indicating that new SRE scoring methods can be useful in illness prediction in small samples.     

Tobacco use and perceived financial strain among junior enlisted in the U.S. Military in 2002

ObjectiveThe detrimental health effects of tobacco use have long been documented and accepted. Recent research has begun to explore the financial strain that tobacco places on those who use it (e.g. Mokdad, A.H., Marks, J.S., Stroup, D.F., Gerberding, J.L., 2004. Actual causes of death in the United States, 2000. J. Am. Med. Assoc. 291, 1239–1245). The issue of this financial burden is particularly salient for young enlisted in the military who often struggle with financial issues and who continue to use tobacco at relatively high rates.MethodsUsing the 2002 Department of Defense Survey of Health Related Behaviors among Military Personnel, the current study examines the percentage of income young military members spend on tobacco given varying levels of consumption. In addition, a representative sample of junior enlisted (E1–E4) from all four military branches were surveyed about their tobacco use and their experiences of financial strain and experienced stress from financial problems.ResultsAdjusted logistic models demonstrated that smokers reported substantially higher amounts of both financial strain and stress from financial problems then those who did not smoke.ConclusionsThis study suggests there is a relationship between financial stress and tobacco use among junior military members.     

Unintended pregnancy among active-duty women in the United States military, 2011

ObjectivesTo estimate unintended pregnancy rates among a representative sample of active-duty women in the U.S. military aged 18–44 years in 2011.Study designCross-sectional data came from the 2011 Department of Defense Health Related Behaviors Survey of Active Duty Military Personnel; 9038 women provided data on unintended pregnancy. Unintended pregnancy rates were calculated for all women and by available background characteristics, including military branch, marital status (married versus unmarried), pay grade (enlisted versus officer) and deployment in the previous 12 months. Multivariable logistic regression testing for associations between unintended pregnancy and subgroups was also performed.ResultsThe unintended pregnancy rate was 72/1000 women. Married women (odds ratio (OR) 1.30, 95% confidence interval (CI) 1.11–1.54) and enlisted women (OR 2.71, 95% CI 1.99–3.69) had higher odds of reporting unintended pregnancy compared to their counterparts, as did women in the Navy (OR 1.51, 95% CI 1.19–1.91) and Marine Corps (OR 2.38, 95% CI 1.92–2.95) compared to women in the Air Force. Unintended pregnancy rates did not differ between women who were deployed in the previous 12 months and nondeployed women. Additionally, 10% of women who were deployed for 11–12 months in 2011 reported an unintended pregnancy in the previous year, suggesting that their pregnancies occurred during deployment.ConclusionUnintended pregnancy is higher in the military, including during deployment, compared to the general U.S. population (52/1000 women). All branches need to address the issue in a comprehensive manner including evidence-based provision of contraception and education among servicemembers.ImplicationsUnintended pregnancy is high in the military, including during deployment; further efforts to improve evidence-based provision of contraception and education are needed.     

Frequency of illness in mother‐infant dyads

The purpose of this study was to identify the frequency and types of illnesses experienced by mothers and their infants who were in the second half of the first year of life, the actions taken concerning these illnesses, the number of days the mother was hospitalized or in bed because of illness, and the subjective health status of both as rated by the mothers. During home visits mothers (N = 182) completed the Health Status Interview. They were asked about infant and maternal illness in the previous month and the actions taken in response to them. The number and types of illnesses reported indicate that mothers of full‐term infants who were healthy at birth must deal with a number of minor illnesses in themselves and in their infants. The possible relationship of maternal illness to stress is discussed and suggestions are given for interventions by health professionals.     

System Failure: Work Organization and Injury Outcomes among Latino Forest Workers

ABSTRACT

Objectives: Forestry services is a hazardous industry with high job-related injury, illness, and fatality rates. The Northwest workforce is largely Spanish-speaking, Latino, and immigrant, working in poor conditions with insufficient attention paid to safety and health. Institutional racism fundamentally shapes the structural vulnerability of Latino immigrant workers. Given this context, we sought to understand how workplace organizational factors and safety climate affect job-related injuries in this industry.

Methods: We developed 23 case studies from personal interviews after selecting from an initial participant survey pool of 99 Latino forest workers in southern Oregon who had been injured at work in the previous 2 years. Workers were recruited through snowball sampling and door-to-door canvassing. Questions spanned work conditions, tasks, employer safety practices, injury experience, medical treatment, and workers’ compensation benefits.

Results: Workers reported broken bones, chainsaw lacerations, back pain, heat and pesticide illnesses, and other occupational injuries. One-third of the cases fell into a Systems Functional category in which they reported their injuries to their supervisors and received medical treatment and workers’ compensation benefits. The remaining two-thirds experienced System Failures with difficulties in receiving medical treatment and/or workers’ compensation benefits, employer direction to not report, being fired, or seeking alternative home remedies.

Conclusion: Workers employed by companies with more indicators of safety climate were more likely to obtain adequate treatment for their injuries and fully recover. Workers for whom interpretation at medical exams was provided by someone unaffiliated with their employers also reported better treatment and recovery outcomes.     

Temporal trends in disability evaluation and retirement in the Army,Navy, and Marine Corps: 2005–2011

BackgroundSurveillance of trends in disability is necessary to determine the burden of disability on the U.S. military, the most common types of disability conditions, and the prevalence of combat exposures in the disability population. Previous studies of disability in the U.S. military have focused on a particular service or condition rather than examining the epidemiology of disability in the military overall.ObjectiveThis study's objective is to describe rates of disability evaluation and retirement in U.S. Army, Navy, and Marine Corps.MethodsA cross-sectional study of 126,170 service members evaluated for disability discharge from the U.S. military in fiscal years 2005–2011 was conducted. Crude and standardized rates of disability evaluation and retirement were calculated per 10,000 service members by year of disability, demographic characteristics, and type of disability evaluation or retirement. Temporal trends in the prevalence of combat-related disability in the disability evaluated and retired population were also examined.ResultsRates of disability evaluation and retirement were highest among female, enlisted, and active duty service members. Overall rates of disability evaluation significantly decreased, while rates of disability retirement increased. Rates of psychiatric disability evaluation and retirement significantly increased in all services during the same time period from 2005 to 2011. Combat-related disability evaluations and retirements have substantially increased in all services particularly among psychiatric disability cases.ConclusionsPsychiatric disability, combat-related disability, and disability retirement continue to increase in the military, despite observed decreases in the rates of disability the Department of Defense since 2005.     

一起小学校内乙型流感暴发的调查

2004年9月下旬，浙江省江山市某乡镇中心小学发生了一起由乙型流感病毒引起流行性感冒暴发。经调查本次乙型流感共发现患者65例，罹患率15．26％。     

Pregnancy Attitudes and Contraceptive Plans Among Women Entering Jail

ABSTRACT

Unplanned pregnancies are an important and costly public health problem. Women entering jail are at particularly high risk for unplanned pregnancies when they leave jail, given the high rates of poverty, substance abuse and sexually transmitted infections (STIs) in this population, all of which are associated with unplanned pregnancies. Attitudes toward pregnancy vary substantially, influencing openness of incarcerated women to starting a birth control method. This study was conducted as part of a Title X service evaluation and examined varying attitudes towards pregnancy and associated plans to use contraceptives. The current study included 223 women entering jail who were, under 36 years of age, fertile, sexually active with men, and not planning to become pregnant in the near future. Nearly half of the women had negative pregnancy attitudes (PAs), indicating that they did not want to become pregnant, while 41.3% endorsed ambivalent PAs. Compared to those with ambivalent PAs, those with Negative PAs were more likely to report a previous unplanned pregnancy (90.6% vs. 75.4%), a previous pregnancy termination (40.0% vs. 22.8%), and recent consistent use of contraceptives (37.0% vs. 21.7%). Women with negative PAs were significantly more likely to want to start or to continue a birth control method compared to those with ambivalent PAs (66% vs. 47%). Tailoring services to women's specific pregnancy attitudes during periods of incarceration may aid in preventing unplanned pregnancies in populations of high-risk women.     

Junior doctors' experiences of personal illness: a qualitative study

Medical Education 2011: 45 : 1251–1261 Objectives Professional status and working arrangements can inhibit doctors from acknowledging and seeking care for their own ill health. Research identifies that a culture of immunity to illness within the medical profession takes root during training. What happens when trainee doctors become unwell during their formative period of education and training? What support do they receive and how do they perceive that the experience of ill health affects their training trajectory? These research questions were developed by a multidisciplinary team of researchers and health professionals, who adopted a qualitative approach to investigate the experiences of personal illness among trainees in their Foundation Programme (FP) years. Methods Semi‐structured interviews were conducted with eight FP trainees from the Severn Deanery in southwest England who had experienced significant illness. Interpretative phenomenological analysis was used to conduct and analyse the interviews, resulting in a comprehensive list of master themes. This paper reports an interpretative analysis of the themes of Support, Illness Experience, Crossing the Line, Medical Culture, Stigma and Disclosure. Results Ineffective communication within the medical education and employment system underpins many of the difficulties encountered by trainees who are unwell. Coping style plays a key role in predicting how trainees experience support during and after their illness, although this may be influenced by their particular diagnoses. The barriers to disclosure of their illnesses are discussed within the context of mobilising and maintaining support. Concern about the impact of missing training as a result of ill health appears to be significant in the transmitting of an ethos of invulnerability within the medical culture. Conclusions Suggestions to improve support procedures for trainees who are unwell include the provision of greater flexibility within the rotation system along with independent pastoral support. Promoting the importance of disclosing significant illness as early as possible might go some way towards challenging the culture of invulnerability to illness that prevails among doctors.     

Delirium During Acute Illness in Nursing Home Residents

ObjectivesTo ascertain the incidence of delirium during acute illness in nursing home residents, describe the timing of delirium after acute illness onset, describe risk factors for delirium, and explore the relationship between delirium and complications of acute illness.DesignProspective observational cohort study.SettingThree nursing homes in metropolitan New York.ParticipantsIndividuals who were expected to remain in the nursing home for at least 2 months, who, as part of a parent study, were receiving opioids, antidepressants, or antipsychotics on a routine basis, and who did not have an acute medical illness at the time of screening. Acute illness surveillance was performed twice weekly through communication with nursing home nursing staff and medical providers using established clinical criteria for incipient cases.MeasurementsWe followed patients for 14 days after illness onset, and, if applicable, an additional 14 days each after hospital admission and hospital discharge. Delirium was assessed 3 times weekly using the Confusion Assessment Method (CAM). Physical function decline was calculated using change in the Minimum Data Set Activities of Daily Living Scale (MDS-ADL) and cognitive function decline using change in the Minimum Data Set Cognitive performance scale (MDS-CPS). Falls were ascertained by record review.ResultsAmong 136 nursing home patients followed for a mean of 11.7 months, 78 experienced 232 acute illnesses, of which 162 (71%) were managed in the nursing home. The most common diagnoses were urinary tract infection (20%), cellulitis (15%), and lower respiratory tract infection (9%). Subjects experienced delirium during 41 (17.7%) of 232 acute illnesses. Female sex was associated with a greater risk of delirium (odds ratio 2.59; 95% confidence interval [CI] 1.04–6.43) but there were no other risk factors identified. Delirium was a risk factor for cognitive function decline (odds ratio 4.59; 95% CI 1.99–10.59; P = .0004), but not ADL function decline or falling.ConclusionDelirium occurred frequently as a complication of acute illness in the nursing home, and was a risk factor for cognitive function decline. This finding supports the rationale to target individuals at the onset of an acute medical problem in the design of interventions to prevent delirium in the nursing home setting.     

Health Profiles,Health Services Use,and Transition to Dementia in Inpatients With Late-Life Depression and Other Mental Illnesses

ObjectivesDepression has been reported as a risk factor for dementia. We compared health and health service use profiles in older people hospitalized with late-life depression and older people hospitalized with other mental illnesses and examined the transition to dementia.DesignA retrospective population-based study using linked administrative health data over 11 years.Setting and ParticipantsThe sample includes 55,717 inpatients age 65+ years with depression and 104,068 inpatients age 65+ years with other mental illnesses in New South Wales, Australia.MethodsThe risk of subsequent dementia under consideration of sociodemographics, comorbidities, and health service use was analyzed with logistic regression.ResultsThe most prominent differences were the rates of delirium and self-harm with a 6 times lower rate of delirium and an 8 times higher rate of self-harm in people with late-life depression compared with those with other mental illness. Inpatients with late-life depression had an increased risk of subsequent dementia by 12% and received a dementia diagnosis at a younger age compared with inpatients with other mental illnesses. Besides depression only 3 other conditions, delirium, diabetes, and cerebrovascular accidents, were associated with an increased dementia risk. Other factors associated with an increased dementia risk were longer hospital stays, low socioeconomic status, male sex, and older age.Conclusions and ImplicationsResults from this study lead to a better understanding of the risk for dementia and of differences in health profiles and health services use in older people with depression compared with those with other mental illnesses. Our findings highlight the importance of the clinical management and prevention of self-harm and delirium in older people.     

Health policy responses to rising rates of multi‐morbid chronic illness in Australia and New Zealand

Objective: To examine current health policy in Australia and New Zealand and assess the extent to which the policies equip these countries to meet the challenges associated with increasing rates of multi‐morbid chronic illnesses. Method: We examined reports from agencies holding data relating to chronic illness in both countries, looking at prevalence trends and the frequency of multiple morbidities being recorded. We undertook content analysis of health policy documents from Australian and New Zealand government agencies. Results: The majority of people with chronic illness have multiple morbidities. Multi‐morbid chronic illnesses significantly effect the health of people in both Australia and New Zealand and place substantial demands on the health systems of those countries. These consequences are both predicted to increase dramatically in the near future. Despite this, neither country explicitly acknowledges multi‐morbidity as a major factor in their policies addressing chronic illness. Conclusion and Implication: In addition to considering policy responses to chronic illness, policy makers should explicitly consider policies shaped to address the needs of people with multi‐morbid chronic illness.     

Disability Associated with Comorbid Anxiety Disorders in Women with Chronic Physical Illness in Ontario,Canada

ABSTRACT

Anxiety disorders are more prevalent in individuals with chronic physical illness compared to individuals with no such illness, and about twice as prevalent in women as in men. This study used data collected in the 2005 Canadian Community Health Survey (21,198 women and 20,478 men) to examine factors associated with comorbid anxiety disorders and to assess the relation of these disorders on short-term disability and suicidal ideation. Comorbid anxiety disorders were more prevalent among women who were young, single, poor, and Canadian-born, and among women with chronic fatigue syndrome; fibromyalgia, bowel disorder or stomach or intestinal ulcers, or bronchitis had the highest rates of anxiety disorders. The presence of comorbid anxiety disorders was significantly associated with short-term disability, requiring help with instrumental daily activities, and suicidal ideation. Our findings underscore the importance of early detection and treatment of anxiety disorders in the physically ill, especially those who also suffer from mood disorders.     

Cold periods and coronary events: an analysis of populations worldwide

STUDY OBJECTIVE: To investigate the association between cold periods and coronary events, and the extent to which climate, sex, age, and previous cardiac history increase risk during cold weather. DESIGN: A hierarchical analyses of populations from the World Health Organisation's MONICA project. SETTING: Twenty four populations from the WHO's MONICA project, a 21 country register made between 1980 and 1995. PATIENTS: People aged 35-64 years who had a coronary event. MAIN RESULTS: Daily rates of coronary events were correlated with the average temperature over the current and previous three days. In cold periods, coronary event rates increased more in populations living in warm climates than in populations living in cold climates, where the increases were slight. The increase was greater in women than in men, especially in warm climates. On average, the odds for women having an event in the cold periods were 1.07 higher than the odds for men (95% posterior interval: 1.03 to 1.11). The effects of cold periods were similar in those with and without a history of a previous myocardial infarction. CONCLUSIONS: Rates of coronary events increased during comparatively cold periods, especially in warm climates. The smaller increases in colder climates suggest that some events in warmer climates are preventable. It is suggested that people living in warm climates, particularly women, should keep warm on cold days.     

中国10个地区30~79岁成年人被动吸烟行为特征分析

目的 描述中国慢性病前瞻性研究（CKB）项目10个地区非吸烟人群被动吸烟行为特征的地区和人群分布差异。方法 分析10个地区317 486名30~79岁非吸烟者在基线调查时的被动吸烟行为信息,描述其被动吸烟行为特征的地区和人群分布差异。结果 按照全国人口普查结果进行标化,我国成年人被动吸烟率为56.7%,与吸烟者共同居住率为66.5%,其中农村高于城市。周被动吸烟频率、周被动吸烟累计时长、日均被动吸烟时长具有明显的地区差异,城市地区的周被动吸烟累计时长随周被动吸烟频率的增加而增加,女性中湖南省的周被动吸烟频率较高,但周被动吸烟累计时长较低,日均被动吸烟时长最低,河南省却与之相反;与吸烟者共同居住者的被动吸烟率是从未共同居住者的2.27倍（95% CI：2.24~2.29）,且在女性中关联更强（OR=2.61,95% CI：2.58~2.64）,而在男性中二者无关（OR=1.01,95% CI：0.95~1.06）。女性除日均被动吸烟时长小于男性外,其余指标均大于男性;且年龄较小、文化程度较低者的多数被动吸烟指标较高;家庭年收入较低者的被动吸烟率和与吸烟者共同居住率较低,但日均被动吸烟时长较高;女性在婚者的被动吸烟率、与吸烟者共同居住率较高,男性与之相反。结论 CKB项目10个地区非吸烟人群的被动吸烟率、周被动吸烟频率、周被动吸烟累计时长和日均被动吸烟时长以及与吸烟者共同居住率、共同居住年限均存在明显的地区和人群分布差异。     

Gender Differences in the Impact of Warfare Exposure on Self-Rated Health

BackgroundThis study examined gender differences in the impact of warfare exposure on self-reported physical health.MethodsData are from the 2010 National Survey of Veterans, a nationally representative survey of veterans from multiple eras of service. Regression analyses assessed gender differences in the association between warfare exposure (deployment to a war zone, exposure to casualties) and health status and functional impairment, adjusting for sociodemographics.FindingsWomen reported better health status but greater functional impairment than men. Among men, those who experienced casualties only or both casualties and deployment to a war zone had worse health compared with those who experienced neither stressor or deployment to a war zone only. Among women, those who experienced casualties only or both stressors reported worse health than those who experienced war zone only, who did not differ from the unexposed. No association was found between warfare exposure and functional impairment in women; in men, however, those who experienced exposure to casualties or both stressors had greater odds of functional impairment compared with those who experienced war zone only or neither stressor.ConclusionsExposure to casualties may be more predictive of health than deployment to a war zone, especially for men. We did not find a stronger association between warfare exposure and health for women than men. Given that the expansion of women's military roles has allowed them to serve in direct combat, their degree and scope of warfare exposure is likely to increase in the future.     

A Study of Mental Health Literacy Among North Korean Refugees in South Korea

Objectives:

This study aimed to investigate North Korean refugees’ knowledge of mental illnesses and treatments and analyze the factors affecting this knowledge.

Methods:

Subjects were selected via a snowball sampling method, and the survey outcomes of 152 North Korean refugee participants were analyzed. The factors affecting knowledge of mental illnesses were analyzed via a regression analysis by constructing a multivariate model with mental illness knowledge score as the dependent variable.

Results:

The North Korean refugees’ mental illness scores ranged from 3 to 24 points, with an average score of 13.0. Regarding the factors that influence mental illness knowledge, the subjects with South Korean spouses and those who had spent more time in South Korea had higher knowledge scores. Furthermore, the subjects who considered the mental health of North Korean refugees to be a serious issue revealed lower knowledge scores than those who did not believe it was a serious issue. The subjects who visit psychiatric clinics showed higher knowledge scores than those who do not. The South Korean subjects who had at least a college education exhibited higher scores than did those without advanced education. The subjects who are satisfied with life in South Korea manifested a higher mental illness knowledge score than those who are not.

Conclusions:

This study is significant as being the first study to ever measure and evaluate the level of North Korean refugees’ knowledge of mental illnesses. In addition, the evaluations of North Korean refugees’ mental illness knowledge and influencing factors while residing in South Korea created basic data that formed the foundation of an effort to enhance mental health literacy and provide proper mental health services. The results of this study can be utilized to solve mental health problems that might frequently occur during the unification process of North and South Korea in the future.