Gaps in expectations among clients of secondary medical services in the military system compared with the civilian system as a satisfaction index

The Israel Defense Forces Medical Corps operates a health network for Israel Defense Forces soldiers. Secondary medicine is included in the services to which soldiers are entitled. It is provided to military personnel through two parallel systems: within the Medical Corps specialists' clinics and through the auspices of a number of civilian hospital outpatient clinics. The military medical system, like the civilian medical system, is designed to serve its clientele. One of the indices for ascertainment of satisfaction with medical services is compatibility of client expectations with the service actually received. In this study, we present a gap index that demonstrates that there is gap in satisfaction among soldiers receiving secondary medical services from the military network compared with soldiers who receive secondary medical services from the civilian network. We designed a questionnaire administered to 1,532 soldiers and used 1,359 (89% response rate) for our analysis. The military system provides soldiers with services fully in synch with military regulations. Consequently, in most cases, there is a gap between soldiers' expectations from military medical service and the service they receive in practice-a phenomena that impairs soldier satisfaction. On the other hand, soldiers receiving medical services and treatment from the public civilian system receive, for the most part, service and treatment that meets or even exceeds their expectations because the system operates according to other regulations.     

Perceptions of deployment of Australian Army reservists by their employers

The views and concerns of the employers of reservists sent on overseas deployments are largely unknown. A survey was conducted of 126 Australian employers who participated in Exercise Boss Lift sponsored by the Australian Defence Force, which involved a visit to their employees deployed on overseas service in the Solomon Islands and Malaysia during the period 2006-2010. Employers reported a substantial number of positive aspects of reservist deployment for both their enterprise and the individual reservist employee, including an increase in leadership, teamwork, skills, maturity, and confidence. There were 40% fewer reported negatives, which primarily concerned the costs associated with the absence of an important employee. The employers expressed needs for greater information regarding dates of absence of their reservist employee and assistance from the ADF to enable them to enhance the overall deployment. Importantly, employers sought confirmation of ways to effectively manage the transition of their reservist from military service back to their civilian roles. Some employers offered to act as advocates.     

Civilian medical qualification determinations

Much like their counterparts in private industry, federal medical officers, particularly preventive and occupational medicine physicians, must ensure a workforce fit to perform their duties. Meeting this objective often requires balancing competing interests between employers and employees. The medical examination is the method for protecting the government's interests in identifying federal civilian applicants and workers who are medically unqualified to perform their duties while also preventing discrimination against qualified individuals with disabilities. Scant published guidance on performing authorized medical examinations and analyzing the resultant information is available for federal medical officers. This is needed to foster an equitable, compliant decision for both federal employers and employees. Using the Department of Defense as an example, this article provides a legal road map for the practitioner by defining medical standards and physical requirements, discussing medical examinations, and examining disability determinations.     

Comparison of nondeployable hearing profiles by Army component (Active Duty, National Guard, and Reserve) and by gender

The Hearing Conservation Service at Fort Bliss conducted baseline-hearing assessments from January 2003 to March 2005 on 14,974 soldiers in the Active Duty (AD), National Guard (NG), and Reserve Component (RC). The percentages of soldiers with >H-2 (i.e., nondeployable) hearing profiles based on Army component and gender are as follows: AD male = 2.21%; AD female = 0.65%; NG male = 5.05%; NG female = 1.64%; RC male = 5.02%; and RC female = 0.54%. Female soldiers in all three components and AD male soldiers are not significantly different (p < 0.05) from each other and have a significantly lower percentage of >H-2 hearing profiles than NG and RC male soldiers after adjusting for age. With the Army engaged in worldwide missions, these results should prove useful to commanders and medical officers for assessing deployment capabilities and for hearing conservation interventions.     

The smoking habits of young soldiers.

In a survey of the smoking habits of over 6,000 young soldiers, it was found that the prevalence of regular smoking was 45%. Though the prevalence of regular smoking in young soldiers is higher than the general prevalence rate for smoking in 16 to 19-year olds in the civilian population, the excess is considered to be a reflection of the social and geographical background of Army recruits. The survey found that young soldiers who smoke, smoke heavily. Eighty two percent smoked more than 20 cigarettes per week, 58% more than 40 cigarettes per week. This is higher than has been recorded by any previous survey of young soldiers. The proportion of young soldiers who have never smoked has risen markedly over the years. This survey found that 34% had never smoked.     

Doctors five: African-American contract surgeons in the Spanish-American War.

The role played by African-American contract surgeons during the Spanish-American War has been a neglected aspect of the war's medical history. These men left their civilian practices, as did their white colleagues, to serve in the U.S. Army for relatively (even for the time) little compensation. After the war, as "civilian employees," they were not even eligible for a pension. Patriotism motivated their call to arms.     

闽南沿海地区2007年军地青壮年乙型肝炎病毒血清学调查

目的掌握闽南沿海地区军民乙型肝炎病毒(HBV)感染状况,为指导部队乙型病毒性肝炎(简称"乙肝")防治提供必要的科学依据。方法采用乙肝"两对半"血清学检测和询问调查的方法,对受检军地青壮年的乙肝"两对半"专项检测结果进行分析。结果 HBV总感染率、HBsAg阳性率和HBsAb阳性率三项指标,受检官兵和地方人员分别为50.50%、0.10%、63.28%与78.06%、17.03%、58.42%,两组人群比较差异有显著统计学意义(P<0.01)。结论闽南沿海地区人群HBsAg阳性率高于全国平均水平,而当地驻军HBsAg阳性率极低,受检部队乙肝防控成绩显著,未受地方乙肝疫情影响。     

Benefits of a musculoskeletal screening examination for initial entry training soldiers

Soldiers reporting for Individual Entry Training from basic training posts frequently arrive unable to initiate or complete training due to musculoskeletal injuries. Therefore, a screening examination was developed to identify musculoskeletal injuries and provide appropriate medical intervention as needed. During a consecutive 5-week period, 1013 soldiers reported for training to Fort Lee, Virginia. Of these, 105 (10.4%) reported for medical screening because they stated that they had an injury or could not pass a physical fitness test. After screening, 76 (72%) were found to have physical restrictions that would limit their ability to fully participate in training. The injured soldiers were referred for and received medical intervention. Of the total number of soldiers screened, 97 (92%) were able to complete their training, pass a physical fitness test, and graduate on time. This study documents the use and benefits of a brief musculoskeletal screening examination for individual entry training soldiers.     

Satisfaction among soldiers with secondary medical services within military and civilian clinical settings

The medical services system of the Israel Defense Forces (IDF) is founded on a principle that by definition considers it the military's role to maintain the health of its personnel in uniform. The 1994 Compulsory Health Insurance Law, Section 55 addresses health services for soldiers, stating that a soldier is entitled to health services from the Medical Corps of the IDF or an agent operating on its behalf. In the implementation of its responsibilities, the IDF Medical Corps operates an array of medical services, including secondary care. This study deals with the scope of utilization of secondary medical services by IDF personnel visiting military medical clinics and civilian hospital outpatient clinics: their character, the subjective health status of the respondents, and their degree of satisfaction with medical services. The results indicate that most of those seeking medical treatment at military and civilian clinics are not chronically ill. Most consider their health status to be good to excellent, but many of those referred for secondary care--more than half of the respondents who visited military specialist clinics-visited the clinics many times and even visited other clinics. No problem of access to clinics was found, but availability was problematic. There was a marked preference among patients to receive secondary health sevices from outside civilian agents rather than the military system.     

Dental cost of deploying a National Guard unit to Bosnia

OBJECTIVES: To examine the dental readiness of a National Guard (NG) unit mobilizing to Bosnia, to estimate the civilian comparable cost for the necessary treatment to make the unit deployable, and to examine the effect on the active component (AC) dental readiness. MATERIALS AND METHODS: This study was a retrospective cohort analysis of dental fitness classifications (DFCs) and treatment provided for the 48th IN BDE (Mech) upon mobilization for a 6-month deployment to Bosnia. The NG unit mobilized through Fort Stewart, Georgia, from December 2000 through February 2001 en route to a 6-month deployment starting in February 2001. All soldiers received dental examinations and were classified in one of four DFCs. DFC 1 implies that the soldier has no dental treatment needs; DFC 2 indicates that the soldier needs dental treatment, but the condition is not expected to cause an emergency in the next 12 months; DFC 3 indicates that significant oral conditions present are expected to cause an emergency in the next 12 months; DFC 4 indicates that the soldier is in need of a dental examination. Dental treatment was provided for all DFC 3 soldiers. A database was created of DFCs of deploying soldiers upon arrival at the mobilization site and dental procedures performed. RESULTS: This retrospective review identified 1,378 soldiers who processed through the dental station at the mobilization site. Soldiers DFCs were as follows: DFC 1, 7.8%; DFC 2, 50.1%; DFC 3, 35.8%; DFC 4, 6.2%. Direct costs to the Fort Stewart Dental Activity were $95,602. The services provided to treat the DFC 3 patients are valued at $441,471. CONCLUSIONS: The dental readiness of this NG unit was greatly inferior to that of the AC, and there is a significant cost in personnel, dollars, and AC readiness to provide the needed dental treatment before mobilization.     

Dental class 3 intercept clinic: a model for treating dental class 3 soldiers

OBJECTIVE: Dental Fitness Classification (DFC) 3 indicates that a soldier has a dental condition that, if not treated, is expected to result in a dental emergency within 12 months. Forty-two percent of Army recruits have DFC 3 conditions as reported by the 2000 Tri-Service Center Recruit Study. Initial entry training schools allow minimal time for dental care. The Fort Hood Class Three Intercept Clinic (CTIC) was created to treat DFC 3 conditions prior to soldiers being assigned to their units. The purpose of this study was to evaluate CTIC's ability to make soldiers dentally deployable before joining their new units at Fort Hood, Texas. MATERIALS AND METHODS: A retrospective review of the CTIC daily sign-in logs for the period of January 1999 to May 2001 was used to identify DFC 3 soldiers. The data were analyzed to determine frequency of DFC 3 by rank, DFC after CTIC visits, distribution of treatment type needed to establish dental readiness, and to identify soldiers whose DFC 3 conditions were not treated. Additionally, for the 6 months between November 2000 and April 2001, all soldiers who remained a DFC 3 when released to their units were followed to assess how long it took for them to attain a DFC 1 or 2 status. RESULTS: The retrospective review of the CTIC records identified 5,851 DFC 3 soldiers who in-processed to Fort Hood from January 1999 to May 2001. CTIC successfully converted 86.9% (N = 5,083) of the soldiers to DFC 1 or 2. Of a sample of 185 DFC 3 soldiers released to their units as a DFC 3, only 54% had converted to DFC 1 or 2, with 60.5 days being the mean days to convert. CONCLUSIONS: Trainees have large demands for dental care with minimal time to seek treatment during Initial Entry Training. A CTIC, or hybrid, can provide the necessary emergent dental care to remove soldiers from DFC 3 prior to their being assigned to their first permanent duty station.     

Urinary incontinence among female soldiers

A self-administered questionnaire was developed to assess the prevalence of urinary incontinence among active duty female soldiers. The questionnaire also addressed basic demographic information, including height, age, weight, and the subjects' present and past military activities. Adaptive measures that the soldiers commonly used to continue exercising and perform their duties were also explored. Seven hundred thirteen questionnaires were handed out to female soldiers at Fort Lewis (Washington), Fort Benning (Georgia), and Fitzsimons Army Medical Center (Colorado) during preparation for physical fitness tests. Of the 563 soldiers (79%) who returned completed questionnaires, 31% indicated that they commonly experienced urinary incontinence during duty and/or training to the extent that it interfered with job performance, hygiene, or was socially embarrassing. Thus, urinary incontinence is a pervasive problem among female soldiers.     

The attitude of soldiers toward military service

Due to the formation of the new state--SR Yugoslavia and transformation of armed forces as well as social-political changes which resulted in changes of fundamental social values, the aim of this study is to analyze the factors influencing the attitudes of the youths to the military service in Yugoslav army. The sample consisted of 200 adapted (group A) and 400 nonadapted (group NA) soldiers. The applied instrument was the Adjustment questionnaire. The attitude to the military service has two poles: negative included 72.5% soldiers of group NA and positive included 78% soldiers of group A. Between two poles there were 27.5% soldiers of NA and 22% soldiers of group A who were ambivalent to the military service. It is concluded that the attitude to the military service of the group A soldiers was influenced by their parents, but of the group NA was not.     

A historical look at alcohol abuse trends in army and civilian populations, 1980-1995

OBJECTIVES: The purpose of this study was to compare civilian and Army alcohol-related hospitalization trends and to plot temporal changes in rates relative to alcohol-related legislation and social policies. METHOD: We compared population-based civilian and Army annual hospitalization rates for overall alcohol-related diagnoses and for alcohol-related diagnostic subgroups (1980-1995) and plotted them against civilian and military substance abuse regulations. Civilian data were adjusted to Army age, gender, and race. RESULTS: Although overall civilian and Army alcohol hospitalization rates were similar, alcohol subgroup rates varied. Simultaneous drug and alcohol abuse (polyabuse) rates were higher among civilians (16.6 per 10,000) than Army soldiers (5.1 per 10,000). Army rates for dependent alcohol-related disorders were higher and increased. Army nondependent alcohol disorders tracked with alcohol-related regulations as rates fell 69% between 1985 and 1995. CONCLUSION: Army and civilian alcohol abuse trends vary by abuse type. Without longitudinal, diagnosis-specific subgroup analyses, these trends would not have emerged. Army policies and screening may explain divergent nondependent alcohol abuse and lower polyabuse rates.     

Pregnancy during Operation Iraqi Freedom/Operation Enduring Freedom

OBJECTIVE: The purpose of this study was to evaluate pregnancy during war-time deployment. METHODS: A retrospective review of gynecology visits was evaluated at Camp Doha, Kuwait, from August 2003 through April 2004. Of the 1,737 visits, 77 demonstrated a positive pregnancy test. These charts were evaluated for factors that may lead to important information for future deployments. RESULTS: The average age of the female soldier with a positive pregnancy test in theater was 27 +/- 7 years. The primary presenting complaint was amenorrhea. Ninety-two percent had an ultrasound. Fifty-four percent of visits were active duty, followed by Reserve, National Guard, and civilian government employees. Ninety-two percent were administratively redeployed. Seventy-seven percent of the soldiers became pregnant in country. Twenty-three percent arrived in country pregnant. CONCLUSIONS: Given the number of pregnancies before and during deployment, current screening procedures as well as new concepts in prevention need to be addressed.     

Attitudes toward intentional weight loss and dietary behavior among U.S. Army reserve soldiers during annual training

OBJECTIVE: The command of a U.S. Army Reserve Combat Support Hospital designed this study to evaluate soldiers' behavior related to and attitudes toward skipping meals while on annual training (AT). METHODS: The command administered an anonymous survey on attitudes about weight loss and weightloss behavior while on AT. Of 180 soldiers given the opportunity to respond, 100 responses were received (55%). RESULTS: Before AT, 50% of reservists responding thought about losing weight while on AT, 62% of soldiers were trying to lose weight while on AT, and 25% of soldiers skipped meals. Soldiers who felt that they were overweight had a 2.9-fold increased risk for skipping meals, and those who thought about losing weight before AT had a 3.0-fold risk. Neither age, gender, rank, nor history of previously being on weight control was a predictor of skipping meals. CONCLUSION: Most soldiers considered and tried to lose weight while at AT, and soldiers who considered themselves overweight or thought about losing weight were at increased risk for skipping meals.     

Physical training and exercise-related injuries. Surveillance, research and injury prevention in military populations

Athletes and soldiers must both develop and maintain high levels of physical fitness for the physically demanding tasks they perform; however, the routine physical activity necessary to achieve and sustain fitness can result in training-related injuries. This article reviews data from a systematic injury control programme developed by the US Army. Injury control requires 5 major steps: (i) surveillance to determine the size of the injury problem; (ii) studies to determine causes and risk factors for these injuries; (iii) studies to ascertain whether proposed interventions actually reduce injuries; (iv) implementation of effective interventions; and (v) monitoring to see whether interventions retain their effectiveness. Medical surveillance data from the US Army indicate that unintentional (accidental) injuries cause about 50% of deaths, 50% of disabilities, 30% of hospitalisations and 40 to 60% of outpatient visits. Epidemiological surveys show that the cumulative incidence of injuries (requiring an outpatient visit) in the 8 weeks of US Army basic training is about 25% for men and 55% for women; incidence rates for operational infantry, special forces and ranger units are about 10 to 12 injuries/100 soldier-months. Of the limited-duty days accrued by trainees and infantry soldiers who were treated in outpatient clinics, 80 to 90% were the result of training-related injuries. US Army studies document a number of potentially modifiable risk factors for these injuries, which include high amounts of running, low levels of physical fitness, high and low levels of flexibility, sedentary lifestyle and tobacco use, amongst others. Studies directed at interventions showed that limiting running distance can reduce the risk for stress fractures, that the use of ankle braces can reduce the likelihood of ankle sprains during airborne operations and that the use of shock-absorbing insoles does not reduce stress fractures during training. The US Army continues to develop a comprehensive injury prevention programme encompassing surveillance, research, programme implementation and monitoring. The findings from this programme, and the general principles of injury control therein, have a wide application in civilian sports and exercise programmes.     

Smoking impairs the response to a physical training regime: a study of officer cadets.

One hundred and sixty five officer cadets completed a 6 month physical training programme; 47 (28%) were smokers and 118 (72%) were not. Improvements in fitness were measured by the Army Personal Fitness Assessment (APFA) which scores for both strength and endurance. Initially both groups had similar APFA scores [mean (SEM)]: smokers 114 (3.1), non smokers 120 (2.3), difference not significant. Six months later both groups had improved their scores: smokers 131 (2.7), non smokers 143 (2.3), but the smokers were now significantly less fit (p < 0.01). The British Army needs a more effective anti smoking policy as 50% of young soldiers continue to smoke, and have an increased risk of premature ischaemic heart disease when compared with their civilian counterparts. Physical fitness remains important in the Army and evidence such as this may help persuade soldiers to give up smoking before standard tests of cardiovascular or lung function show any abnormalities, with benefits for the future health of the Army.     

Knowledge and screening of testicular cancer in the French Armed Forces: a prospective study

We performed a prospective study in the French Armed Forces regarding testicular cancer. Our primary objective was to assess whether willingness to have a testicular examination by medical doctor could be improved by a self-administered questionnaire through invitation to self-reflection. A total of 415 soldiers were enrolled. The study used a test-posttest design in that soldiers estimated their willingness to have a testicular palpation before and after responding to a self-administered questionnaire. The willingness to have testicular palpation significantly increased after responding to the questionnaire (p < 0.000001). Acceptance of testicular palpation after responding the questionnaire did not change in 82.25%, increased in 15%, and decreased in 2.75%. Analysis of responses to the questionnaire showed that 26.75% of soldiers (n = 107) had previously received general information on testicular cancer and 85.8% (n = 343) declared that they would be delighted if they were proposed a short educational course on testicular cancer. As a conclusion, this study demonstrates that the willingness to have a testicular examination by medical doctor could be easily improved, since there is a strong demand on medical education regarding testicular cancer.     

Survey of personal protection measures against mosquitoes among Australian defense force personnel deployed to East Timor

A questionnaire was completed by 955 Australian Defense Force soldiers from two battalion groups to determine their usage of mosquito repellents and bed nets during peacekeeping duties in East Timor. The survey showed that most soldiers (84%) used repellents, but only 19% used them daily. The soldiers used a number of repellent formulations; however, few soldiers used the Australian Defense Force deet (diethyl methylbenzamide) formulation containing 35% deet in a gel. Most soldiers preferred several commercial formulations, which contained 7 to 80% deet. The occurrence of mosquito-borne disease in soldiers was not affected by repellent usage, as the use of repellents was comparable between infected and noninfected individuals. The overall frequency of bed net usage differed in the two battalion groups. The occurrence of malaria in soldiers from one battalion group who did not sleep under a bed net every night of their deployment was significantly (p = 0.007) higher than those who did.