Military nutrition: maintaining health and rebuilding injured tissue

Food and nutrition are fundamental to military capability. Historical examples demonstrate that a failure to supply adequate nutrition to armies inevitably leads to disaster; however, innovative measures to overcome difficulties in feeding reap benefits, and save lives. In barracks, UK Armed Forces are currently fed according to the relatively new Pay As You Dine policy, which has attracted criticism from some quarters. The recently introduced Multi-Climate Ration has been developed specifically to deal with issues arising from Iraq and the current conflict in Afghanistan. Severely wounded military personnel are likely to lose a significant amount of their muscle mass, in spite of the best medical care. Nutritional support is unable to prevent this, but can ameliorate the effects of the catabolic process. Measuring and quantifying nutritional status during critical illness is difficult. A consensus is beginning to emerge from studies investigating the effects of nutritional interventions on how, what and when to feed patients with critical illness. The Ministry of Defence is currently undertaking research to address specific concerns related to nutrition as well as seeking to promote healthy eating in military personnel.     

Why do UK military personnel refuse the anthrax vaccination?

The purpose of this study was to understand the reasons why some UK military personnel refused the anthrax vaccination. Data were collected from 5,302 members of the UK Armed Forces who had been deployed to Iraq since 2003 and had been offered the anthrax vaccination. As part of a larger questionnaire, information was collected on acceptance or refusal of the vaccination. Twenty-eight percent of participants refused the anthrax vaccination; of these 51% indicated that they refused vaccination because of concern that it was being offered voluntarily. Reasons differed between those deployed during the war-fighting phase in Iraq, who were concerned about being supplied with insufficient or unclear information (75% vs. 66%), and those involved on subsequent deployments, who felt that there was no longer a risk that biological weapons would be used against them (61% vs. 43%). Thus, refusal rates were related to perception of the threat. In addition, our results indicated the importance of providing individuals with relevant information to aid them in making decisions to receive the anthrax vaccination or not. The findings provide evidence that for some people, the policy to increase confidence in the anthrax vaccination program may have led to a decrease in levels of trust.     

Determining optimal clothing ensembles based on weather forecasts,with particular reference to outdoor winter military activities

Military and civil defense personnel are often involved in complex activities in a variety of outdoor environments. The choice of appropriate clothing ensembles represents an important strategy to establish the success of a military mission. The main aim of this study was to compare the known clothing insulation of the garment ensembles worn by soldiers during two winter outdoor field trials (hike and guard duty) with the estimated optimal clothing thermal insulations recommended to maintain thermoneutrality, assessed by using two different biometeorological procedures. The overall aim was to assess the applicability of such biometeorological procedures to weather forecast systems, thereby developing a comprehensive biometeorological tool for military operational forecast purposes. Military trials were carried out during winter 2006 in Pokljuka (Slovenia) by Slovene Armed Forces personnel. Gastrointestinal temperature, heart rate and environmental parameters were measured with portable data acquisition systems. The thermal characteristics of the clothing ensembles worn by the soldiers, namely thermal resistance, were determined with a sweating thermal manikin. Results showed that the clothing ensemble worn by the military was appropriate during guard duty but generally inappropriate during the hike. A general under-estimation of the biometeorological forecast model in predicting the optimal clothing insulation value was observed and an additional post-processing calibration might further improve forecast accuracy. This study represents the first step in the development of a comprehensive personalized biometeorological forecast system aimed at improving recommendations regarding the optimal thermal insulation of military garment ensembles for winter activities.     

Incidence of Norovirus-Associated Medical Encounters among Active Duty United States Military Personnel and Their Dependents

BackgroundNorovirus is a leading cause of gastroenteritis episodes and outbreaks in US military deployments, but estimates of endemic disease burden among military personnel in garrison are lacking.MethodsDiagnostic codes from gastroenteritis-associated medical encounters of active duty military personnel and their beneficiaries from July 1998–June 2011 were obtained from the Armed Forces Health Surveillance Center. Using time-series regression models, cause-unspecified encounters were modeled as a function of encounters for specific enteropathogens. Model residuals (representing unexplained encounters) were used to estimate norovirus-attributable medical encounters. Incidence rates were calculated using population data for both active duty and beneficiary populations.ResultsThe estimated annual mean rate of norovirus-associated medically-attended visits among active duty personnel and their beneficiaries was 292 (95% CI: 258 to 326) and 93 (95% CI: 80 to 105) encounters per 10,000 persons, respectively. Rates were highest among beneficiaries <5 years of age with a median annual rate of 435 (range: 318 to 646) encounters per 10,000 children. Norovirus was estimated to cause 31% and 27% of all-cause gastroenteritis encounters in the active duty and beneficiary populations, respectively, with over 60% occurring between November and April. There was no evidence of any lag effect where norovirus disease occurred in one population before the other, or in one beneficiary age group before the others.ConclusionsNorovirus is a major cause of medically-attended gastroenteritis among non-deployed US military active duty members as well as in their beneficiaries.     

The black citizen-subject: black single mothers in US military recruitment material

This article examines how the US military uses race inequalities to mobilize black single mothers for enlistment of their children in the Armed Forces. Through an analysis of military recruitment materials during the height of the US War on Terrorism, I demonstrate how the military disproportionately shows black single mothers going through a process of reacting to their child's enlistment (with fear and worry), welcoming the military institution as the co-parent, and accepting enlistment as a venue for education and career opportunities (productive citizenship). The military models a citizen-mother who supports their child's enlistment, while unquestionably supporting the war. This exploits the obligations of citizenship for black single mothers, whose citizenship is already under scrutiny. By targeting the children of these mothers for recruitment, the military encourages a higher burden of military participation on an already underprivileged segment of the population.     

Experiences and psycosocial impact on soldier boys and girls from the civil war in El Salvador

Exploratory research with 293 excombatants who participated as child soldiers in the El Salvador civil war as FMLN (Marti Front for National Liberation) members or as Armed Forces soldiers was conducted to examine their current living conditions and the impact of past military experience. Although nearly ten years have passed since the peace accords were signed, the excombatant exhibited signs of emotional disturbance. Current underprivileged living conditions and social marginalization were decisive factors which inhibited reentry into civilian life and constituted an important psychosocial impact by placing at risk their integration at the family, community and society levels.     

HDL-raising strategies in the treatment of coronary artery disease: perspectives from the Armed Forces Regression Study

PURPOSE OF REVIEW: Even with the aggressive reduction of LDL-cholesterol, the risk of cardiovascular events in patients with coronary artery disease remains substantial. The Armed Forces Regression Study was a randomized, double-blind, placebo-controlled trial of combination drug therapy aimed at raising HDL-cholesterol in patients with angiographically evident coronary artery disease. Drug therapy ultimately resulted in regression of the angiographic lesions and a reduction in cardiovascular events. This review places the Armed Forces Regression Study within the context of other recent studies. RECENT FINDINGS: In the past few years a number of other important papers have further defined the important role HDL-cholesterol plays in the pathobiology of atherosclerosis. These studies have focused on three general areas: HDL-cholesterol metabolism and the reverse cholesterol transport pathway; novel therapeutic interventions and their effects on coronary artery disease as assessed through non-invasive imaging modalities; and finally a re-analysis of previous outcomes trials with established HDL-cholesterol modifying agents. SUMMARY: The results of the Armed Forces Regression Study fit nicely within the evolving paradigm of targeting HDL-cholesterol in patients at risk of cardiovascular events. The use of niacin and well-tolerated fibrates as an adjunct to statins or as primary therapy in patients intolerant of statins appears reasonable in patients with low levels of HDL-cholesterol and at high risk of cardiovascular events. The further development of novel therapeutic approaches, in addition to broadening our pharmacological armamentarium, should further advance our understanding of HDL-cholesterol.     

军队医院聘用人员管理中的法律风险与防范对策

聘用人员是军队医院发展中不可缺少的支持力量,也为军队医院人力资源管理工作带来了一定的法律风险。从招聘录用、纪律管理、人事管理3个环节着手,分析了军队医院聘用人员管理中容易产生的法律风险,并提出了防范的具体措施。     

Radiation scientists and homeland security

Radiation scientists represent an important resource in homeland defense. Security analysts worry that a crude but deadly radiological bomb might be fashioned from stolen nuclear material and a few sticks of dynamite. Such a device could kill dozens, hundreds, and possibly thousands and could contaminate a square mile or more. Emergency workers may call upon radiation scientists to aid the injured. Educational materials are available on the ACR, ASTRO, and RRS websites, linked to the Armed Forces Radiobiology Research Institute and the Oak Ridge National Laboratory, to provide radiation workers material that they can use to help emergency room and civil defense personnel after a terrorist attack. Radiation scientists are urged to obtain these materials and contact their local hospital and public health authorities to volunteer their services and expertise.     

Emergency Health Services in the Provincial and Municipal Spheres

To ensure survival in the event of a national disaster, legislation was passed to correct previous government inactivity and to stimulate an apathetic populace.In 1959, the Federal Government enacted legislation which introduced policy changes in civil defence. This new legislation gave governments at all levels new responsibilities which are now assumed in the course of routine daily operation. The onus of warning and rescue was placed on the Armed Forces. Emergency health services were established at the municipal level by integrating emergency health and public health units. The zone concept was evolved which provides an intermediate administrative base between regional headquarters and target areas.Preparedness for disaster begins with the family unit. In addition, training of key personnel at all levels of government must be maintained on an annual basis.     

Mental Health Status of Sri Lanka Navy Personnel Three Years after End of Combat Operations: A Follow Up Study

The main aim of this study was to assess the mental health status of the Navy Special Forces and regular forces three and a half years after the end of combat operations in mid 2009, and compare it with the findings in 2009. This cross sectional study was carried out in the Sri Lanka Navy (SLN), three and a half years after the end of combat operations. Representative samples of SLN Special Forces and regular forces deployed in combat areas were selected using simple random sampling. Only personnel who had served continuously in combat areas during the one year period prior to the end of combat operations were included in the study. The sample consisted of 220 Special Forces and 275 regular forces personnel. Compared to regular forces a significantly higher number of Special Forces personnel had experienced potentially traumatic events. Compared to the period immediately after end of combat operations, in the Special Forces, prevalence of psychological distress and fatigue showed a marginal increase while hazardous drinking and multiple physical symptoms showed a marginal decrease. In the regular forces, the prevalence of psychological distress, fatigue and multiple somatic symptoms declined and prevalence of hazardous drinking increased from 16.5% to 25.7%. During the same period prevalence of smoking doubled in both Special Forces and regular forces. Prevalence of PTSD reduced from 1.9% in Special Forces to 0.9% and in the regular forces from 2.07% to 1.1%. Three and a half years after the end of combat operations mental health problems have declined among SLN regular forces while there was no significant change among Special Forces. Hazardous drinking among regular forces and smoking among both Special Forces and regular forces have increased.     

Getting past the accident: explosive devices, limb loss, and refashioning a life in a military medical center

I describe the refashioning of a sense of self and identity of a junior officer in the U.S. Army who was injured in Iraq. Ethnographic data for this article were collected between July 2006 and January 2008. The setting for this article is the U.S. Armed Forces Amputee Patient Care Program at Walter Reed Army Medical Center. Two models of rehabilitation are contrasted in the rehabilitation program. The first focuses on the refashioning of identity through a sports model of rehabilitation emphasizing physical functioning. The second approaches rehabilitation by emphasizing individual interests and the concern of a person who has a future life to develop. I conclude by arguing that understanding the process of rehabilitation from traumatic injury would benefit from a perspective that melds multiple dimensions, taking into account both the physical body and the social world that patients have inhabited and will inhabit.     

Cancer incidence among Canadian Veterans: A matched cohort study

IntroductionOccupational exposures related to military service may increase the risk of cancer for military Veterans, while high levels of fitness during service may decrease risk. However, few studies have compared this post-career cancer risk directly to the employed general population.MethodsThis retrospective cohort study used linked administrative data. Canadian Armed Forces and Royal Canadian Mounted Police Veterans in Ontario, Canada were matched 1:4 on age, sex, geography, and community-level income to a group of non-Veterans most likely to have been employed during a period similar to the Veterans’ military service. Cancer diagnoses were identified using the Ontario Cancer Registry.ResultsDuring the study period, 642 of 30 576 included Veterans (2.1%) and 3408 of the 122 293 matched general population cohort (2.8%) experienced at least one cancer diagnosis. The crude rate of cancer was 153.5 per 100 000 person-years among Veterans vs. 205.9 per 100 000 person-years for the general population cohort. After adjusting for rurality and matching variables, Veterans had an 27% lower risk of developing any cancer than their matched comparators [hazard ratio = 0.73 (95% CI: 0.67–0.80)]. Among specific cancer types, the risk of lung and colorectal cancer was significantly lower for Veterans relative to the general population cohort; the risk of breast and prostate cancer was similar.DiscussionThis study adds to the growing international evidence suggesting that risk of many cancers among Veterans is lower or similar to the general population. Further understanding of the complex relationships among occupational exposures, environmental factors, and lifestyle factors is needed.     

Viral Hepatitis: Problems of Incidence and Control in Military Personnel

(A) Hepatitis B virus (HBV) is now the major cause of infectious viral hepatitis in U.S. military personnel and probably also in the civilian population over 15 years of age. (B) The incidence of icteric, viral hepatitis is much higher in U.S. military personnel than in comparable age groups in the civilian population. The 17-to 20-year-old enlisted men show the highest rates. (C) In parts of the world (e.g., U.S.A., Germany) where most of the inapparent infection is caused by the adw subtype of HBV, most of the acute clinical disease is caused by the ayw subtype. In the U.S.A. and Germany, 95% or more of HB_s Ag isolates from U.S. military personnel with acute hepatitis is ayw. (D) It may be many years before one can expect to have sufficient data for a decision as to the possible availability of an effective HBV vaccine. Accordingly, a decision is urgently needed regarding either the immediate use of the best practically available hepatitis immune gamma globulin, that can be prepared by modern techniques, for the prevention of hepatitis in U.S. military personnel or postponement of such use until an adequate and properly controlled trial can be carried out in active duty military personnel in an area of high incidence.     

Military Veterans and Service Dogs: A Qualitative Inquiry Using Interpretive Phenomenological Analysis

There are over 18.8 million veterans of the United States of America's Armed Forces. After military service veterans may find it difficult transitioning back to civilian life. Veterans reintegrating may experience physical and psychological challenges related to their military service. For many, a successful role change takes considerable time and determination. In order to ease their transition, veterans are using the assistance of service dogs to aid in symptom management and assist with positive reintegration into civilian life. Service dogs are highly trained animals that help individuals perform life tasks to assist with physical and psychological challenges. The purpose of this qualitative study was to give voice to the experiential viewpoints of veterans who utilize service dogs. Guided by the theoretically informed method of interpretation— interpretive phenomenological analysis (IPA)—the researchers uncovered the veterans’ perspectives, which provided meaningful insight into their lives with a service dog. Semi-structured interviews were conducted with veterans (n = 21) who utilized a service dog. The interviews lasted approximately one hour and were video or audio recorded. The most salient themes that emerged from the interviews were grouped into four superordinate themes: Procurement, psychosocial functioning, value, and detriments. Results suggest that service dogs improved veterans’ physical and psychological health, provided a coping resource and a form of social support, and supported sustaining their independence. Veterans’ right to privacy and the public's lack of knowledge and understanding of legal accommodation requirements via the Americans with Disabilities Act (ADA) were perceptible. Implications for policy, practice, and research, are discussed.     

Prevalence of antibodies to Pseudomonas pseudomallei exotoxin and whole cell antigens in military personnel in Sabah and Sarawak, Malaysia.

Sera from 420 military personnel serving in Sabah and Sarawk, Malaysia, were tested for antibodies to Pseudomonas pseudomallei exotoxin and whole cell antigens by enzyme-linked immunosorbent assay procedure (ELISA). Data showed that 54.4% of serum samples were positive for antibodies to P. pseudomallei exotoxin and 65.7% were positive for antibodies to the whole cell antigens. Samples gave much lower titers for anti-exotoxin antibodies compared to titers against crude whole cell antigens. The incidence of antibody to exotoxin was highest in the age groups ranging from 26 to 32 years, where the positive rates were higher than 40% and 30% for military personnel serving in Sarawak and Sabah, respectively.     

Trends in suicidal behaviour and use of mental health services in Canadian military and civilian populations

Background:In the context of the Canadian mission in Afghanistan, substantial media attention has been placed on mental health and lack of access to treatment among Canadian Forces personnel. We compared trends in the prevalence of suicidal behaviour and the use of mental health services between Canadian military personnel and the general population from 2002 to 2012/13.Methods:We obtained data for respondents aged 18–60 years who participated in 4 nationally representative surveys by Statistics Canada designed to permit comparisons between populations and trends over time. Surveys of the general population were conducted in 2002 (n = 25 643) and 2012 (n = 15 981); those of military personnel were conducted in 2002 (n = 5153) and 2013 (n = 6700). We assessed the lifetime and past-year prevalence of suicidal ideation, plans and attempts, as well as use of mental health services.Results:In 2012/13, but not in 2002, military personnel had significantly higher odds of both lifetime and past-year suicidal ideation than the civilian population (lifetime: adjusted odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17–1.50; past year: adjusted OR 1.34, 95% CI 1.09–1.66). The same was true for suicidal plans (lifetime: adjusted OR 1.64, 95% CI 1.35–1.99; past year: adjusted OR 1.66, 95% CI 1.18–2.33). Among respondents who reported past-year suicidal ideation, those in the military had a significantly higher past-year utilization rate of mental health services than those in the civilian population in both 2002 (adjusted OR 2.02, 95% CI 1.31–3.13) and 2012/13 (adjusted OR 3.14, 95% CI 1.86–5.28).Interpretation:Canadian Forces personnel had a higher prevalence of suicidal ideation and plans in 2012/13 and a higher use of mental health services in 2002 and 2012/13 than the civilian population.Suicide is a leading cause of death around the world in military and civilian populations. ^1–3 There has been increased attention paid to suicidal behaviour in Canada, and a number of initiatives are being put in place to prevent suicide through better recognition and treatment of mental disorders.⁴ Examples of major Canadian initiatives include creation of a national Mental Health Commission of Canada,⁵ development of a federal framework for suicide prevention,⁶ large investments in military and veteran mental health services, and targeted efforts to formulate comprehensive suicide prevention strategies among military and veteran populations.^4,7 Despite these initiatives, the prevalence of suicide in Canada has not changed appreciably in recent years.^8,9A recent report on suicides in the Canadian Forces did not find an overall increase in the prevalence of suicide between 1995 and 2014.¹⁰ However, the prevalence increased substantially over that time in the subgroup of male army personnel in the Regular Force.¹⁰ In the United States, the army has observed steady increases in the prevalence of suicide attempts and completed suicide by soldiers since 2004, whereas the prevalence of suicide has remained unchanged in the general population.^3,11,12 Findings from the US are not generalizable to the Canadian military because of differences in recruitment, deployment policies and health care systems.¹³Suicidal ideation, plans and attempts are strong risk factors for death by suicide.¹⁴ A history of suicide attempt is the strongest predictor of future attempts.¹⁵ Suicidal ideation is also an important target for intervention because previous work has shown a rapid transition from first-onset suicidal ideation to plans and attempts within the same year.¹⁶ It remains unknown whether nonfatal suicidal behaviour in military and civilian populations in Canada has changed over time.Another area of major public health concern is that most people with suicidal behaviour do not receive mental health services. In nationally representative civilian samples in Canada and 21 other countries, most respondents with suicidal behaviours (60%) did not receive mental health services. ^17,18 The use of such services among Canadian military personnel with suicidal behaviours remains unknown. The media has recently been critical of the Canadian Armed Forces and Veterans Affairs Canada about insufficient services available to military personnel and veterans.¹⁹We compared trends in the prevalence of suicidal behaviours and help-seeking between Canadian civilian and military populations over a 10-year period from 2002 to 2012/13 using data from 4 nationally representative surveys.     

Simultaneous low-density lipoprotein-C lowering and high-density lipoprotein-C elevation for optimum cardiovascular disease prevention with various drug classes, and their combinations: a meta-analysis of 23 randomized lipid trials

PURPOSE OF REVIEW: Our analysis presents an alternative hypothesis to the prevailing view that low-density lipoprotein-C is the only important target of lipid therapy. RECENT FINDINGS: Two recently published studies showed surprising results. In the Armed Forces Regression Study, low-density lipoprotein-C was lowered only 22% with cholystyramine, niacin and gemfibrozil. Coronary stenosis regressed, however, and the primary clinical event rate was reduced by 54%. Conversely, in the FIELD trial, the primary event rate reduction was only 11% (P = NS). These differences appeared to be explained largely by the difference in high-density lipoprotein response to these regimens (38 vs. 3%). This meta-analysis of 23 trials strongly supports the notion that the sum of percent reduction in low-density lipoprotein-C plus percent increase in high-density lipoprotein-C predicts benefits much more effectively than either lipoprotein component. SUMMARY: Epidemiology suggests that the cardiovascular event rate is reduced by nearly 1% for each 1% reduction in low-density lipoprotein-C and by at least 1% for each 1% increase in high-density lipoprotein. These effects are statistically independent; thus, for moderate lipid changes, they are additive. If this simple algorithm is proven accurate, a 30% high-density lipoprotein-C increase and a 40% low-density lipoprotein-C reduction would result in a nearly 70% CHD risk reduction - and a revolution in cardiovascular prevention.     

A modified mini-primer set for analyzing mitochondrial DNA control region sequences from highly degraded forensic samples

To facilitate the analysis of mitochondrial DNA (mtDNA) control region sequences from highly degraded skeletal remains, a modified mini-primer set was designed to overcome the limitations of the Armed Forces DNA Identification Laboratory (AFDIL) mini-primer set. This modified mini-primer set is less affected by nucleotide variability and PCR amplification conditions than the AFDIL mini-primer set, and was able to amplify the mtDNA sequences of 55-year-old skeletal remains with high efficiency, indicating that it is a useful tool for analyzing mtDNA control region sequences from highly degraded forensic samples.