Routine chlorhexidine gluconate use onboard navy surface vessels to reduce infection: A cluster randomized controlled trial.

BACKGROUND: Hand disinfection with chlorhexidine gluconate (CHG) is commonly used for preventing the spread of infection in medical institutions and the community, but studies on its use in military settings have been inconclusive. We examined the effects of CHG on morbidity in Israeli Navy ships. METHODS: This was a controlled, cluster randomized study that took place at a major naval base in Israel. Ships were randomly selected into the study (347 sailors) and primary control (350 sailors) groups. Additional nonintervention control groups included other sailors serving on the base (n = 360) and logistics and support personnel (n = 859). CHG disinfection devices were installed on all ships in the study group, alongside soap and water. Morbidity was analyzed using a computerized patient record, subjective self-report questionnaires, and a sample of hand cultures. Compliance with hand hygiene was analyzed using a self-report hygiene attitudes questionnaire at the beginning of the trial and after 3 months. The study took place between May and September 2014. RESULTS: No significant differences were found between the groups in terms of sick days or light-duty days or in the number of acute gastrointestinal or respiratory cases. Sailors were found to have more skin infections than controls, but this was not significantly reduced by CHG. Hand cultures demonstrated that continuous use of CHG did not cause a reduction in colonization. There were no statistically significant differences in self-reported hygiene practices. CONCLUSIONS: CHG did not demonstrate any medical benefit over the use of soap and water onboard Israeli Navy ships.

Assessment of the Risk of Fractures Because of Service on Diesel Submarines: A Retrospective Cohort Study.

INTRODUCTION: Submariners are known to have decreased bone mass following periods of long submersion. We examined whether this produces a higher predilection to fractures. METHODS: This is a retrospective cohort study. Data were collected from the computerized medical records of 457 consecutive submariners (serving 1091.42 man-years). The control group included 3,219 consecutive sailors, (serving 5845.04 man-years). Groups were stratified according to age at induction, body mass index, place of birth, and status of service (i.e., compulsory versus professional). Analysis of fracture incidence and comparison of proportions between the groups was conducted using χ(2) tests and Fisher's exact test. The hazard ratio for fractures was performed using a survival analysis regression model for each group (Cox Proportional Hazard Model). RESULTS: Nineteen submariners (4.2%) and 94 sailors (2.9%) were shown to have fractures during their service (RR = 1.42, p = 0.15). A Cox proportional hazard model was employed. No statistically significant difference was found between the 2 groups (HR = 1.037, p = 0.89). No correlation was found between length of service and risk of fracture. Most fractures suffered by submariners occurred outside their work environment. CONCLUSIONS: Submariners are repeatedly exposed to prolonged submersions that are deleterious to bone strength. However, no statistically significant difference in the incidence of fractures was found between submariners and surface sailors. This is an important finding for the bone and occupational health of submariners in general.

Levetiracetam in children, adolescents and young adults with intractable epilepsy: efficacy, tolerability and effect on electroencephalogram--a pilot study.

Levetiracetam has been authorized for use in Israel as an add-on therapy for intractable epilepsy since May 2006. The aim of the present study was to document its effectiveness for this indication in children, adolescents, and young adults. The medical files of 78 patients aged 0.5-39 years (mean, 14.2 years) treated at our center for intractable epilepsy were reviewed. All received levetiracetam as add-on therapy following a failure to respond to at least 3 anti-epileptic drugs. Fifty-two patients (67%) had partial epilepsy and the remainder had primary generalized epilepsy. The epilepsy was symptomatic in 57%, cryptogenic in 27%, and idiopathic in 15%. Average age at first seizure was 4.1 years. In 45% of patients, the number of seizures was reduced by half with levetiracetam treatment; 11.5% of the cohort achieved complete remission. There was a statistically significant correlation between clinical seizure control and improvement in the electroencephalography findings (p = 0.0012). The drug was well tolerated, with a retention rate of 69% after one year. The most common adverse effects were irritability and impulsiveness, in 26.9% of patients. Severe behavioral side effects (psychosis, confusion) were experienced by 6.4%. In conclusion, levetiracetam is an effective and tolerable add-on agent for use in most epileptic children, adolescents, and young adults who fail to respond to at least 3 antiepileptic drugs and should be the treatment of choice in this setting. Despite the relatively high rate of behavioral side effects in this study, the retention rate at one year was high.