ABSTRACT
To help understand suicide among soldiers, we compared suicide events between active duty U.S. Army versus civilian decedents to identify differences and inform military prevention efforts. We linked 141 Army suicide records from 2005 to 2010 to National Violent Death Reporting System (NVDRS) data. We described the decedents' military background and compared their precipitators of death captured in NVDRS to those of demographically matched civilian suicide decedents. Both groups commonly had mental health and intimate partner precipitating circumstances, but soldier decedents less commonly disclosed suicide intent.
Subject(s)
Chronic Pain/epidemiology , Depression/epidemiology , Military Personnel/statistics & numerical data , Stress, Psychological/epidemiology , Substance-Related Disorders/epidemiology , Suicide/statistics & numerical data , Adolescent , Adult , Chronic Pain/psychology , Depression/psychology , Family Conflict/psychology , Female , Humans , Jurisprudence , Male , Middle Aged , Military Personnel/psychology , Precipitating Factors , Retrospective Studies , Stress, Psychological/psychology , Substance-Related Disorders/psychology , Suicide/psychology , United States , Young Adult , Suicide PreventionABSTRACT
OBJECTIVE: In April 2009, 2009 pandemic influenza A (H1N1) (hereafter, pH1N1) virus was identified in California, which caused widespread illness throughout the United States. We evaluated pH1N1 transmission among exposed healthcare personnel (HCP) and assessed the use and effectiveness of personal protective equipment (PPE) early in the outbreak. DESIGN: Cohort study. SETTING: Two hospitals and 1 outpatient clinic in Southern California during March 28-April 24, 2009. PARTICIPANTS: Sixty-three HCP exposed to 6 of the first 8 cases of laboratory-confirmed pH1N1 in the United States. METHODS: Baseline and follow-up questionnaires were used to collect demographic, epidemiologic, and clinical data. Paired serum samples were obtained to test for pH1N1-specific antibodies by microneutralization and hemagglutination-inhibition assays. Serology results were compared with HCP work setting, role, and self-reported PPE use. RESULTS: Possible healthcare-associated pH1N1 transmission was identified in 9 (14%) of 63 exposed HCP; 6 (67%) of 9 seropositive HCP had asymptomatic infection. The highest attack rates occurred among outpatient HCP (6/19 [32%]) and among allied health staff (eg, technicians; 8/33 [24%]). Use of mask or N95 respirator was associated with remaining seronegative (P = .047). Adherence to PPE recommendations for preventing transmission of influenza virus and other respiratory pathogens was inadequate, particularly in outpatient settings. CONCLUSIONS: pH1N1 transmission likely occurred in healthcare settings early in the pandemic associated with inadequate PPE use. Organizational support for a comprehensive approach to infectious hazards, including infection prevention training for inpatient- and outpatient-based HCP, is essential to improve HCP and patient safety.
