Discharges during U.S. Army basic training: injury rates and risk factors.

This study examined injury rates and risk factors for discharge in a cohort of 756 men and 474 women in U.S. Army basic combat training (BCT) at Fort Jackson, South Carolina. Investigators systematically screened trainee medical records for injuries and collected medical recommendations to temporarily remove a trainee from BCT to allow recovery from an injury. The BCT unit provided Army Physical Fitness Test (APFT) scores and trainee demographic data. Discharges were identified by reviewing discharge packets and were confirmed through rosters from the BCT units. There were 102 men and 108 women discharged. Person-time injury incidence rates (for time-loss injuries) among discharged and nondischarged men were 1.87 and 0.45 cases/100 person-days, respectively (p < 0.01); the rates for discharged and nondischarged women were 1.95 and 1.01 cases/100 person-days, respectively (p < 0.01). Men had a higher risk of discharge if they had a time-loss injury (p < 0.01), but women did not (p = 0.28). Other discharge risk factors for both men and women included a medical recommendation for removal from training to recover from an injury, lower performance on any of the three APFT events, and lower educational level. Women with more body mass or a higher body mass index also had a marginally higher risk of discharge.

Norwalk-like viral gastroenteritis outbreak in U.S. Army trainees.

An outbreak of acute gastroenteritis hospitalized 99 (12%) of 835 U. S. Army trainees at Fort Bliss, El Paso, Texas, from August 27 to September 1, 1998. Reverse transcriptase polymerase chain reaction tests for Norwalk-like virus were positive for genogroup 2. Gastroenteritis was associated with one post dining facility and with soft drinks.

Hepatitis C in Peru: risk factors for infection, potential iatrogenic transmission, and genotype distribution.

A large seroepidemiologic and genotyping study of hepatitis C virus (HCV) was conducted in Lima, Peru, during the periods of 1986 to 1993 (cohort A) and 1994 (cohort B). Anti-HCV seroprevalence rates were 15.6% (216 of 1,389) and 11.7% (168 of 1,438), respectively. Low rates were seen among volunteer blood donors (1.1% and 0.8%). Anti-HCV rates were much higher among patients undergoing hemodialysis (43.7% and 59.3%), hemophiliacs (60.0% and 83.3%), in those more than 39 years old (18.2% and 26.0%), in females (25.0% and 27.4%), and in less-educated persons (16.9%). Age- and gender-adjusted risk factors in cohort B included blood transfusion history (adjusted odds ratio [AOR] = 29.8), prior organ transplantation (AOR = 9.1) or a history of hepatitis (AOR = 4.9), previous hospitalization (AOR = 3.7), a history of intravenous drug use (AOR = 3.5), prior major surgery (AOR = 2.6), a history of acupuncture (AOR = 2.1), previous dental procedures (AOR = 1.2), and prior medical injections (AOR = 1.04). The most prevalent HCV genotype was type 1 (86%), followed by type 3 (10%) and type 2 (2%). Transmission through unsafe injection-related and medical/dental procedures appears to play an important role in HCV infection among Peruvians.

An accelerated schedule for tick-borne encephalitis vaccine: the American Military experience in Bosnia.

Tick-borne encephalitis (TBE) is a viral illness endemic to the Balkan region. United States military forces were deployed to Bosnia in early 1996 as part of Operation Joint Endeavor, a U.S.-led multinational peace-keeping operation. To counteract the TBE threat, an inactivated, parenteral vaccine (FSME-Immun Inject; Immuno AG, Vienna, Austria) was offered to soldiers at high risk on a volunteer basis in an accelerated, 3-dose schedule (0, 7, and 28 days). Passive adverse reaction surveillance was conducted on 3,981 vaccinated personnel. Paired sera from a randomly selected group of 1,913 deployed personnel (954 who received vaccine and 959 who were unvaccinated) were tested for antibodies to TBE by an ELISA. Three-dose recipients demonstrated an 80% seroconversion rate (4-fold or greater increase in anti-TBE titers). By comparison, the TBE infection rate in the unvaccinated cohort was found to be only 0.42% (4 of 959). Only 0.18% of vaccinees reported self-limited symptoms. An accelerated immunization schedule appears to be an acceptable option for military personnel or travelers on short-term notice to TBE-endemic areas.

Serologic response to oral polio vaccine and enhanced-potency inactivated polio vaccines.

In a randomized, controlled trial carried out from November 1980 to July 1983 involving 1,114 infants in Baltimore City and in Baltimore and Prince George's counties, Maryland, the serologic response to three doses of two enhanced-potency inactivated polio vaccines was compared with the response to three doses of oral polio vaccine. The mean ages at vaccination were 2.2, 4.7, and 19.9 months, respectively, for the three doses. Seroconversion after the first dose varied from 35% to 84%, and it was higher after oral polio vaccine than after either of the enhanced-potency inactivated polio vaccines for polioviruses types 2 and 3. Approximately two and one-half and 16 months after the second dose, almost all inactivated polio vaccine recipients had antibodies against all three virus types (98-100%). Fewer oral polio vaccine recipients had detectable antibodies to type 1 (89-92%) and to type 3 (96%). After three doses of vaccine, all children had antibodies against types 2 and 3. Approximately 1% of the inactivated polio vaccine recipients and 3% of the oral polio vaccine recipients lacked antibody to type 1. One or two doses of oral polio vaccine stimulated higher reciprocal geometric mean antibody titers against type 2 poliovirus than did the inactivated polio vaccine. For the other two types, the results were mixed. The third dose of inactivated polio vaccine produced significant increases in the reciprocal geometric mean titers against each of the three poliovirus types and resulted in significantly higher reciprocal geometric mean titers after three doses of vaccine for recipients of inactivated polio vaccine than for recipients of oral polio vaccine.

Effects of physician counseling on the smoking behavior of asbestos-exposed workers.

Physician antismoking advice has been shown to increase smoking cessation, particularly among patients who have medical problems or perceive themselves to be at risk. The present study tested three hypotheses: (a) providing 3 to 5 min of behavioral counseling regarding a cessation strategy would be more effective than simply warning the smoker to quit smoking; (b) smokers with abnormal pulmonary function would be more likely to comply with medical advice than would smokers with normal pulmonary function; and (c) that smokers with abnormal pulmonary function who receive behavioral counseling would be the group most likely to achieve prolonged abstinence. Asbestos-exposed smoking men undergoing screening in a mandated program for naval shipyard workers were categorized as having normal or abnormal pulmonary status on the basis of chest X ray and pulmonary function tests (PFT). They were then randomly assigned within PFT categories to receive either a simple warning or 3 to 5 min of behavioral cessation counseling from the physician who gave them the results of their pulmonary tests. Subjects' smoking status was evaluated at 3- and 11-month intervals following the physician intervention. Smokers who received behavioral counseling were more likely to quit and remain abstinent over the 11-month period (8.4% abstinent) than were smokers given a minimal warning (3.6% abstinent). Prolonged abstinence rates among abnormal PFT subjects (3.7%) did not differ from those of normals (5.9%). The group with normal PFT who received behavioral counseling achieved the highest level of abstinence (9.5%). Maintaining adequate physician compliance with the counseling protocol proved difficult; implications of this for future efforts are discussed.

Blood pressure self-monitoring in the workplace.

Automated blood pressure devices are available in a growing number of shopping malls, drug stores and workplaces. This study evaluates behavior changes that occurred in employees who used these devices to self-monitor blood pressure at work. A cohort design with a nonequivalent control group was used to study blue-collar hospital employees. Experimental participants (N = 91) had daily access to a Vita Stat automated blood pressure device while controls (N = 102) did not. Life-style scores included one point for each of five risk-reducing behaviors. Experimentals who self-monitored at least weekly showed significant increases in life-style scores. The proportion of this group practicing at least three of five of the recommended behaviors increased from 56% at baseline to 76% at the four-month and 88% at the 12-month follow-up (p less than .001). Scores for experimentals who self-monitored less than weekly and for controls remained unchanged during the same period. These results suggest that weekly blood pressure self-monitoring at work is associated with improvements in life-style behaviors related to smoking, exercise, sodium restriction, and dieting.

Behavioral, attitudinal, and physiologic characteristics of smoking and nonsmoking asbestos-exposed shipyard workers.

The smoking characteristics of shipyard workers participating in an Asbestos Medical Surveillance Program (N = 3,991) were assessed. Sources of data were: (1) a self-assessment questionnaire on the smoking history and respiratory symptomatology of the 871 current smokers who participated in the smoking study, and (2) chest roentgenograms and pulmonary function test results and medical records for the entire population. The study population included 1,711 current smokers, 988 former smokers and 1,292 never smokers. The annual "quit rate" for former smokers had increased from less than 1% in 1961 to 4.2% in 1978. Of the 871 current smokers who participated in the smoking study, 19% had resumed smoking after having given up cigarettes for one year or longer. Men in the smoking study were reasonably well informed about the health consequences of smoking. While they perceived themselves to be susceptible to disease, and the disease to be serious, the benefits they saw in quitting were related more to economics and aesthetics than to health. When the results were age adjusted, no differences in rate of pulmonary function abnormalities and chest film abnormalities were found between current smokers who voluntarily participated in the smoking study and those who did not. All pulmonary function testing abnormality and chest film abnormality rates were significantly lower for former smokers and never smokers.

A continuing medical education program in chronic obstructive pulmonary diseases: design and outcome.

A continuing medical education course was developed to improve the care of patients with chronic bronchitis and emphysema (COPD); 44 primary care physicians completed the course. The physicians were randomly assigned to experimental and control groups, with 3 of the 4 experimental groups assisting in the selection of topics for the programs and/or receiving feedback on tests given during the course. The course's impact was assessed using written tests to measure knowledge and simulated patient visits to observe physician performance. Experimental groups retained significantly greater amounts of information 9 months after completing the program and used more program material during patient visits than did the control group (p < 0.05). The test scores and patient visits of the 3 experimental groups involved in determining the audiovisual topics and/or receiving feedback were not significantly different from one another nor from the fourth experimental group.