Comprehensive systematic surveillance for adverse effects of anthrax vaccine adsorbed, US Armed Forces, 1998-2000.

Routine vaccinations of US military personnel with Anthrax Vaccine Adsorbed began in 1998. To systematically identify clinical diagnoses reported more frequently after vaccination than before, all military personnel were retrospectively assigned to pre- or post-vaccination cohorts. Cohort assignments were based on vaccination statuses each day of the 3-year surveillance period. For each cohort, rates of hospitalizations and ambulatory visits for 843 specific diagnoses were calculated using data in a public health surveillance system. Compared to the pre-vaccination cohort, the post-vaccination cohort had statistically higher rates of hospitalizations for 17 diagnoses, of ambulatory visits for 34 diagnoses, and in both clinical settings for one diagnosis (malaria). After accounting for systematic differences in coding/reporting and residual confounding, the number and nature of clinical diagnoses more frequent after anthrax vaccination than before were consistent with expectations due to random variation. This surveillance suggests that Anthrax Vaccine Adsorbed has few, if any, clinically significant adverse effects.

Mental disorders among U.S. military personnel in the 1990s: association with high levels of health care utilization and early military attrition.

OBJECTIVE: Epidemiological studies have shown that mental disorders are associated with reduced health-related quality of life, high levels of health care utilization, and work absenteeism. However, measurement of the burden of mental disorders by using population-based methods in large working populations, such as the U.S. military, has been limited. METHOD: Analysis of hospitalizations among all active-duty military personnel (16.4 million person-years) from 1990 to 1999 and ambulatory visits from 1996 to 1999 was conducted by using the Defense Medical Surveillance System. Rates of hospitalization, ambulatory visits, and attrition from military service were compared for persons with mental disorder diagnoses and those with diagnoses in 15 other ICD-9 disease categories. RESULTS: Mental disorders was the leading category of discharge diagnoses among men and the second leading category among women; 13% of all hospitalizations and 23% of all inpatient bed days were attributed to mental disorders. Six percent of the military population received ambulatory services for mental disorders annually in 1998 and 1999. Among a 1-year cohort of personnel, 47% of those hospitalized for the first time for a mental disorder left military service within 6 months. This attrition rate was significantly different from the rate of only 12% after hospitalization for any of the 15 other disease categories (range=11%-18%) (relative risk=4.04, 95% confidence interval=3.91-4.17). The difference remained significant after controlling for effects of age, gender, and duration of service. CONCLUSIONS: Mental disorders appear to represent the most important source of medical and occupational morbidity among active-duty U.S. military personnel. These findings provide new population-based evidence that mental disorders are common, disabling, and costly to society.

Prospective study of brief neuropsychological measures to assess crash risk in older primary care patients.

BACKGROUND: Practicing primary care physicians often encounter the difficult clinical situation of evaluating the older driver. We wanted to investigate the relation between self-reported driving behavior, neuropsychological measures, and crash risk to inform the development of a test battery that could predict unsafe driving behavior and was feasible for use by primary care physicians. METHODS: This study was a prospective follow-up of 107 drivers aged 65 years and older recruited from a primary care setting in 1995. Tests of attention, visual information processing, spatial orientation, and general mental status were administered at baseline. At baseline and after 2 years of follow-up, patients were asked about their driving history using the driving questionnaire. Risk for reported crashes in the follow-up period was assessed in relation to baseline driving history and measures of cognition. RESULTS: Baseline self-reports of driving habits and attitudes were associated with an increased risk of reporting a crash after 2 years of follow-up (relative risk ratio = 5.31; 95% confidence interval [CI], 0.63, 44.63). In addition, baseline tests of attention, visual information processing, and spatial orientation were associated with an increased risk of reporting motor vehicle crash at follow-up. For example, respondents with poor performance on the Trail Making Test-part A, were almost four times more likely to report a crash at follow-up (risk ratio = 3.15; 95% CI, 0.76, 13.07). CONCLUSION: Although our conclusions are tempered by small sample size, this preliminary study suggests that brief cognitive tests and simple questions about driving habits warrant further investigation as indicators of crash risk with potential utility for assessing older drivers in primary care.