Smoking and body weight as markers of fitness for duty among U.S. military personnel

BACKGROUND: Both tobacco and overweight present serious threats to public health. Although the military has targeted both health issues, only weight status is included in tests of fitness. This study contrasted the relative utility of body weight and smoking as markers for fitness for duty. METHODS: Using data from the 2002 Department of Defense Survey of Health-Related Behaviors among Military Personnel (N = 12,149; 24.7% female), troops were categorized according to weight (underweight, healthy weight, overweight, or obese) and smoking status (never smoker, former smoker, or current smoker). RESULTS: Logistic models were developed to examine the usefulness of smoking status and weight status as predictors of items assessing four domains of military fitness for duty, namely, physical health, mental health, substance abuse, and legal problems. Smoking status was a consistent and strong predictor of items within all four fitness domains. In contrast, weight status was not a consistent predictor of fitness. CONCLUSION: The military should consider adding smoking status to assessments of military fitness. Also, given that underweight and not overweight status predicted negative outcomes among military members, the services should consider revising their weight status fitness standards.     

Feeding female soldiers: Consideration of sex-specific nutrition recommendations to optimise the health and performance of military personnel

Appropriate nutrition recommendations are required to optimise the health and performance of military personnel, yet limited data are available on whether male and female military personnel have different nutrition requirements.ObjectivesTo consider the evidence for sex-specific nutrition requirements to optimise the health and performance of military personnel.DesignNarrative review.MethodsPublished literature was reviewed, with a focus on sex-specific requirements, in the following areas: nutrition for optimising muscle mass and function, nutrition during energy deficit, and nutrition for reproductive and bone health.ResultsThere are limited data on sex differences in protein requirements but extant data suggest that, despite less muscle mass, on average, in women, sex-specific protein feeding strategies are not required to optimise muscle mass in military-aged individuals. Similarly, despite sex differences in metabolic and endocrine responses to energy deficit, current data do not suggest a requirement for sex-specific feeding strategies during energy deficit. Energy deficit impairs health and performance, most notably bone and reproductive health and these impairments are greater for women. Vitamin D, iron and calcium are important nutrients to protect the bone health of female military personnel due to increased risk of stress fracture.ConclusionsWomen have an increased incidence of bone injuries, less muscle mass and are more susceptible to the negative effects of energy deficit, including compromised reproductive health. However, there are limited data on sex differences in response to various nutrition strategies designed to improve these elements of health and performance. Future studies should evaluate whether sex-specific feeding recommendations are required.     

A comparison between two systems for pre-employment medical assessment in the Royal Netherlands Army by a randomized, controlled study

In 1998, the basic medical requirements for the Royal Netherlands Army were introduced as a standard for the assessment of the medical suitability of military personnel, consisting of 43 dichotomized points of judgment. This system replaced the old physical capacity, upper limbs, locomotion, hearing, eyesight, and emotional and mental state system, based on the detection of diseases and infirmities. We compared the two different examination systems for their ability to identify suitable recruits. For the latter purpose, we used the two operational measures of availability and health care costs. We performed a randomized, controlled study in which 352 soldiers were monitored for 2 years after being declared fit by one of the pre-employment medical assessment systems in question and having passed their general military training. We found that the pre-employment medical assessment system was the dominant factor for predicting the number of days fit-for-duty, as well as for the health care costs incurred. Those declared fit by the new system showed a statistically significant higher mean number of days fit-for-duty (648 compared with 612) and incurred significantly lower mean health care costs (6396 compared with 746 Euro). In this study, we were not able to uncover the mechanism by which the "basic medical requirements" examination system led to an improvement in outcome. For the present, this mechanism is interpreted because of differences between the two systems.     

军人能力健康管理的核心内涵分析

概括提出能力健康的基本概念,重点围绕能力健康测评、能力健康评价和能力训练3个基本环节剖析了能力健康管理的核心内涵。概括了能力测评的定义,测评项目的确定流程和测评程序标准化的主要内容;系统梳理了能力健康评价的基本要素,包括评价指标体系、评价标准、评价方法和评价流程;对能力训练的作用、分类和原则进行了阐述。最后指出军人能力健康管理的根本目的在于全面提升军人以能力为核心的健康水平,巩固和提高部队战斗力。     

The outlook for improved medical control over the health status of the flight personnel in a military unit]

The article studies methodological and methodical questions for improving medical control (MC) over the flight personnel. The authors analyse the main components of MC, i.e. basic control which is built on clinicophysiological methods, and dynamic control which is aimed for estimation of performance characteristics in the process of professional activities. The authors substantiate the structure of the perspective computerized automated system for MC consisting of three functional units: terrain complex of medical operational control, on-board equipment for aircrew health monitoring in flight, expert and diagnosis system for estimation and prognostication of professional health status.     

Stress, mental health, and job performance among active duty military personnel: findings from the 2002 Department of Defense Health-Related Behaviors Survey

This study examined the extent to which high levels of occupational and family stress were associated with mental health problems and productivity loss among active duty military personnel. We analyzed data from the 2002 Department of Defense Survey of Health-Related Behaviors among Military Personnel, which provided extensive population-based information on 12,756 active duty personnel in all branches of the military worldwide. Military personnel reported higher levels of stress at work than in their family life. The personnel reporting the highest levels of occupational stress were those 25 or younger, those who were married with spouses not present, and women. Personnel with high levels of stress had significantly higher rates of mental health problems and productivity loss than those with less stress. We recommend that prevention and intervention efforts geared toward personnel reporting the highest levels of stress be given priority for resources in this population.     

Gender and trauma as predictors of military attrition: a study of Marine Corps recruits

Recent studies have shown high rates of premilitary trauma exposure among U.S. military enlistees. Given the association of trauma with later stressor vulnerability, it is important to examine the role of premilitary stress and trauma in adaptation to the stress of recruit training. U.S. Marine Corps recruits (N = 1,530) were surveyed for premilitary histories of interpersonal trauma to examine the relationship between premilitary trauma and attrition from recruit training. The majority of the recruits (47.5% of men and 68.1% of women) reported experiencing at least one interpersonal trauma before entering the Marine Corps. Individuals with a history of interpersonal trauma were at significantly greater risk for attrition; they were 1.5 times more likely to drop out of recruit training than were individuals without a trauma history. These findings suggest that developing interventions to bolster recruits' coping skills may improve adaptation to the recruit training environment and thus decrease attrition.     

Disease prevention strategies for Army aviators: clues from a descriptive analysis of the flying duty medical examination.

The U.S. government spends approximately $300,000 to train an Army aviator. Maintaining a healthy aviator population is important not only to the completion of the aviation mission, but also for budgetary reasons. We reviewed Army aviator physical examinations and self-reported risk behavior questionnaires from the Aeromedical Epidemiological Data Repository at Fort Rucker, Alabama, to assess aviator health. Overall, aviators are healthy adults; however, the health status of aviators can be improved by reducing tobacco use, limiting cholesterol and fat intake, and wearing hearing protection devices both during and off duty.     

Demographic, physical, and mental health factors associated with deployment of U.S. Army soldiers to the Persian Gulf

A total of 675,626 active duty Army soldiers who were known to be at risk for deployment to the Persian Gulf were followed from 1980 through the Persian Gulf War. Hospitalization histories for the entire cohort and Health Risk Appraisal surveys for a subset of 374 soldiers were used to evaluate prewar distress, health, and behaviors. Deployers were less likely to have had any prewar hospitalizations or hospitalization for a condition commonly reported among Gulf War veterans or to report experiences of depression/suicidal ideation. Deployers reported greater satisfaction with life and relationships but displayed greater tendencies toward risk-taking, such as drunk driving, speeding, and failure to wear safety belts. Deployed veterans were more likely to receive hazardous duty pay and to be hospitalized for an injury than nondeployed Gulf War-era veterans. If distress is a predictor of postwar morbidity, it is likely attributable to experiences occurring during or after the war and not related to prewar exposures or health status. Postwar excess injury risk may be explained in part by a propensity for greater risk-taking, which was evident before and persisted throughout the war.     

Ultrasonography-guided ethanol ablation of predominantly solid thyroid nodules: a preliminary study for factors that predict the outcome

Objectives

The aim of this study was to evaluate the success rate in ultrasonography-guided ethanol ablation (EA) of benign, predominantly solid thyroid nodules and to assess the value of colour Doppler ultrasonography in prediction of its success.

Methods

From January 2008 to June 2009, 30 predominantly solid thyroid nodules in 27 patients were enrolled. Differences in the success rate of EA were assessed according to nodule vascularity, nodule size, ratio of cystic component, amount of injected ethanol, degree of intranodular echo-staining just after ethanol injection and the number of EA sessions.

Results

On follow-up ultrasonography after EA for treatment of thyroid nodules, 16 nodules showed an excellent response (90% or greater decrease in volume) and 2 nodules showed a good response (50–90% decrease in volume) on follow-up ultrasonography. However, 5 nodules showed an incomplete response (10–50% decrease in volume) and 7 nodules showed a poor response (10% or less decrease in volume). Statistical analysis revealed a significant association of nodule vascularity (p = 0.002) and degree of intranodular echo-staining just after ethanol injection (p = 0.003) with a successful outcome; however, no such association was observed with regard to nodule size, ratio of cystic component, amount of infused ethanol and the number of EA sessions. No serious complications were observed during or after EA.

Conclusion

The success rate of EA was 60%, and nodule vascularity and intranodular echo-staining on colour Doppler ultrasonography were useful in predicting the success rate of EA for benign, predominantly solid thyroid nodules.Livraghi et al [1] used ultrasonography-guided ethanol ablation (EA) for the treatment of hyperfunctioning thyroid nodules; EA has since been established as the first-line treatment for benign cystic thyroid nodules, and may be considered an appropriate alternative to clinical follow-up, radioiodine therapy or thyroid surgery for treatment of autonomous functioning thyroid nodules (AFTNs) or toxic nodules. Advantages of EA include low risk, low cost, practicability in the outpatient clinic and ease of performance [2-14]. However, radioiodine therapy and surgery remain the treatments of choice for large toxic thyroid nodules [5,8,9,15].Following the initial use of EA in the treatment of benign cystic thyroid nodules [16], many published studies have reported appreciable efficacy of EA in the treatment of benign cystic thyroid nodules and recurrent cystic nodules [17-26]. However, published data regarding the EA of solid thyroid nodules have shown varying results, depending on nodule size, the volume of ethanol instilled and the presence of nodule toxicity (2-14]. Thus, the use of EA in the treatment of solid thyroid nodules has been limited owning to controversy over its efficacy and clinical indications. Several studies have attempted to determine factors that might be predictive of the effectiveness of EA in AFTNs or toxic nodules. These studies found that an initial nodule volume [5,8-10] and the presence of a cystic component making up more than 30% of the total volume are important factors in predicting a positive response to EA [14]. Despite these results, EA is rarely selected for the treatment of a solid thyroid nodule compared with the options of clinical follow-up, radioiodine therapy or surgery. Identification of factors that might aid in the accurate prediction of the success of EA in the treatment of solid thyroid nodules could result in more frequent clinical use of EA. To the best of our knowledge, no study of the feasibility of colour Doppler ultrasonography for predicting the success in EA of predominantly solid thyroid nodules has been conducted to date.

Table 1

The published data of ethanol ablation for solid thyroid nodules

The role of chaplains in maintaining the psychological health of military personnel: an historical and contemporary perspective

For many hundred of years, military forces have included chaplains of various faiths. Although these personnel mainly concentrate on providing for the religious and spiritual needs of the armed forces, they also contribute to the mental health of service personnel. This article provides a historical overview of military chaplains, examines their contributions to the psychological health of allied forces in World War I and World War II, and offers an overview of the scope of their present and future mental health related activities. The importance of the relationship between medical officers and chaplains in diagnosing and treating mental health problems is also discussed. We conclude that chaplains are capable of contributing significantly to the mental health of armed forces personnel if they are able to do so in informal and collaborative way.