Career History Archival Medical and Personnel System.

The Career History Archival Medical and Personnel System is a database that provides information on cancer, chronic diseases, occupational and preventive medicine, epidemiological research, and the use of health care in the Navy and Marine Corps. It was created at the Naval Health Research Center for enlisted Navy personnel, and it is being expanded to encompass all military personnel. Its objective is to provide a comprehensive, chronologically ordered database of career and medical events in all active duty military service members and to track career and disease events in order from the date of entry to service to the date service ended. Events include the dates of beginning and ending of each specific military occupation, all assignments to a military units or ships, all hospitalized diseases, and other events. The database contains detailed epidemiological data on more than six million members of the military services. It is the largest known epidemiological database in the United States.

Health surveillance for asthma in the US Navy: experience of 9,185,484 person-years.

PURPOSE: To measure trends and demographic risk factors for hospitalization for asthma. METHODS: Time trends and demographic risk factors, for hospitalized asthma (1CD-9-CM Code 493) were analyzed by measuring age-specific and age-adjusted first hospitalization rates in a defined population of active-duty enlisted members of the US Navy worldwide during 1980-1999, consisting of 9,185,484 person-years. RESULTS: There were 3911 patients first hospitalized for asthma, including 2916 men and 995 women. The age-adjusted incidence rate of first hospitalization for asthma was three times higher in women than men, 110 per 100,000 person-years (95% confidence interval [CI], 104-117), compared with 35 per 100,000 person-years (95% CI, 33-37), respectively (p < 0.0001). The rate in black women was twice as high as in white women, 186 per 100,000 person-years, compared with 99 per 100,000 person-years, respectively (p < 0.001). The rate in black men was higher than in white men, 45 per 100,000, compared with 34 per 100,000 (p < 0.001). Age-adjusted rates in women doubled from 73 per 100,000 in 1980-1983 to 159 in 1997-1999 (p for trend < 0.01), while those in men remained stable. CONCLUSIONS: Age-adjusted incidence rates of first hospitalization for asthma were three times as high in women as in men, and doubled during the period between 1980 and 1999. The rates in black women were twice as high as in white women. The reasons are unknown.

The epidemiology of personality disorders in the U.S. Navy.

This study evaluated the incidence of first hospitalizations for personality disorders and their association with career outcomes for Navy enlisted personnel. Gender differences, rates for subtypes, and changes in hospital admission rates over time also were examined. Personnel who were first hospitalized with a personality disorder between 1980 and 1988 were followed through 1992 and were compared with a control group that did not manifest such pathology. Hospitalized personality disorder cases demonstrated pathology very early in their military careers, which was judged to have been present prior to enlistment in more than one-half of the cases. Women were more likely than men to have a first hospitalization for personality disorders. Rates in both men and women increased during the latter one-half of the 1980s and decreased during the early 1990s.

Infectious disease rates in the U.S. Navy, 1980 to 1995.

The effect of increasing numbers of women in the U.S. Navy, particularly those aboard Navy ships, on infectious disease risk is unknown. This study examines gender and other demographic differences among all U.S. Navy enlisted personnel in first hospitalizations for infectious diseases from 1980 through 1989 and identifies trends in incidence rates during the extended period from 1980 to 1995. All data were obtained from official personnel and medical records. First hospitalization rates were computed using the Epidemiological Interactive System. Varicella and other viruses and chlamydiae accounted for more than 20,000 hospitalizations among Navy enlisted personnel in the 1980s. In 7 of the 12 categories of common infectious diseases, women's rates were higher than those for men, particularly for viral meningitis, herpes simplex, syphilis, gonococcal disease, and candidiasis. An excess of certain common infectious diseases among women and nonwhite ethnic groups emphasizes the need for continuing education and surveillance in these populations.

Behavior and performance on long-duration spaceflights: evidence from analogue environments.

BACKGROUND: Analyses of data collected in Antarctica since 1963 were conducted to identify features of behavior and performance likely to occur during long-duration missions in space. METHODS: The influence of mission duration and station latitude on POMS mood scores was examined in 450 American men and women who wintered-over in Antarctica between 1991 and 1998. The influence of crewmember social characteristics, personality traits, interpersonal needs, and station environments on measures of behavior and performance at the end of the austral winter was examined in 657 American men who wintered-over between 1963 and 1974. Both data sets were used to examine the influence of crew social structure on individual performance. RESULTS: Seasonal variations in mood appear to be associated with the altered diurnal cycle and psychological segmentation of the mission. Concurrent measures of personality, interpersonal needs, and coping styles are better predictors of depressed mood and peer-supervisor performance evaluations than baseline measures because of the unique features of the station social and physical environments and the absence of resources typically used to cope with stress elsewhere. Individuals in crews with a clique structure report significantly more depression, anxiety, anger, fatigue and confusion than individuals in crews with a core-periphery structure. Depressed mood is inversely associated with severity of station physical environment, supporting the existence of a positive or "salutogenic" effect for individuals seeking challenging experiences in extreme environments. CONCLUSION: Behavior and performance on long-duration spaceflights is likely to be seasonal or cyclical, situational, social, and salutogenic.

Predictors of behavior and performance in extreme environments: the Antarctic space analogue program.

BACKGROUND: To determine which, if any, characteristics should be incorporated into a select-in approach to screening personnel for long-duration spaceflight, we examined the influence of crewmember social/ demographic characteristics, personality traits, interpersonal needs, and characteristics of station physical environments on performance measures in 657 American men who spent an austral winter in Antarctica between 1963 and 1974. METHODS: During screening, subjects completed a Personal History Questionnaire which obtained information on social and demographic characteristics, the Deep Freeze Opinion Survey which assessed 5 different personality traits, and the Fundamental Interpersonal Relations Orientation-Behavior (FIRO-B) Scale which measured 6 dimensions of interpersonal needs. Station environment included measures of crew size and severity of physical environment. Performance was assessed on the basis of combined peer-supervisor evaluations of overall performance, peer nominations of fellow crew-members who made ideal winter-over candidates, and self-reported depressive symptoms. RESULTS: Social/demographic characteristics, personality traits, interpersonal needs, and characteristics of station environments collectively accounted for 9-17% of the variance in performance measures. The following characteristics were significant independent predictors of more than one performance measure: military service, low levels of neuroticism, extraversion and conscientiousness, and a low desire for affection from others. CONCLUSIONS: These results represent an important first step in the development of select-in criteria for personnel on long-duration missions in space and other extreme environments. These criteria must take into consideration the characteristics of the environment and the limitations they place on meeting needs for interpersonal relations and task performance, as well as the characteristics of the individuals and groups who live and work in these environments.

Effects of alcohol rehabilitation treatment on health and performance of Navy enlisted men.

Changes in medical care utilization (rates of hospital admission and days hospitalized) and performance (rates of unauthorized absence and desertion) from pre- to posttreatment for alcohol abuse were determined for a group of career Navy enlisted men. Comparisons were made with two control groups matched with the abusers on year of entering the service and age at enlistment. Treatment favorably affected health and performance during the 2-year posttreatment period. While the alcohol abuse group showed no change in the mean number of hospital admissions from pre- to posttreatment, significant increases were reported for both control groups. Similarly, although rates of unauthorized absence and desertion increased significantly from pre- to posttreatment for alcohol abusers, the increases were proportionately less than those experienced by either control group.

Alcohol-related morbidity among older career navy men.

Hospital admission histories were compared for groups of Navy enlisted men identified as alcohol abusers or controls during the later years of their service careers. The alcohol abuse group had a higher mean number of hospital admissions per year and a higher mean number of days hospitalized per year than did the control group. Highest admission rates for both abusers and controls were reported in two major diagnostic categories, first, accidents, poisoning, and violence, and second, diseases of the digestive system. The rates for alcohol abusers exceeded those of controls in these and several additional diagnostic categories including mental disorders where the greatest disparity in rates of hospitalization was noted. The greatest differences in rates of specific illness between abusers and controls were observed for cirrhosis of the liver and diseases of the pancreas. Reasons for higher illness rates other than alcohol abuse were not apparent from available data.

A longitudinal study of health risks associated with alcohol abuse in young navy men.

Hospital admission histories were compared for groups of alcohol abusers and controls who entered the Navy in 1970 or 1971 and who reenlisted. The histories extended over a period of 6 to 8 years. The alcohol abuse group had a significantly higher mean number of hospital admissions and days hospitalized for conditions other than alcoholism than did the controls. Differences in frequencies of illnesses between the two groups were apparent during the first year in service and continued throughout the study period. Highest rates of illness in both groups were reported for accidents, poisonings, and violence; diseases of the respiratory system; infective and parasitic diseases, and diseases of the respiratory system; infective and parasitic diseases, and diseases of the digestive system. Mental diseases were a major cause of morbidity in the alcohol abuse group but not in the control group. Differences in illness rates were related to identification as alcohol abusers rather than to differences between abusers and controls in education, aptitude, or age at enlistment.

Motivational determinants of illicit drug use: an assessment of underlying dimensions and their relationship to behavior.

Principal components analysis was used to delineate motivational patterns associated with illicit drug use in a population of U.S. Navy enlisted men (n = 867) undergoing drug rehabilitation. Patients indicated which of 31 reasons for drug use were associated with various drugs. Four components emerged from this analysis, labeled Insight-Seeking, Therapeutic Needs, Sentience, and Pleasure-Seeking. Higher order factor analysis revealed the presence of a general factor, labeled General Sensation-Seeking. Multiple regression procedures were used to relate the derived dimensions to actual drug use behavior. The significant relationships observed among the factor analytic patterns in predicting overall drug involvement were shown to lead to increased explanation concerning interrelationships among personality needs and social resources. The findings suggested a number of hypotheses pertaining to increased understanding of motivational patterns underlying initiation and continuation of illicit drug use.

A longitudinal study of neurosis in young men.

Because of the widely varying symptomatology seen in the neuroses, questions have been raised about whether they constitute a realistically defined category of illness. The authors followed 4074 Navy enlisted men diagnosed as neurotic between 1966 and 1969 and compared disposition decisions and posthospital outcomes for four major neurotic subtypes (anxiety, hysterical, depressive, and phobic-obsessive-compulsive). Neurotic patients as a group were also compared with patients in other diagnostic categories. Although posthospital outcomes were found to differ among the four neurotic subtypes, the differences were not large when compared with the differences between the neuroses as a group and other major diagnostic categories. Those findings suggest that the neuroses are a distinct group with regard to outcome, and that the use of this diagnostic category should not be abandoned without further study.

The clinical characteristics of personality disorder subtypes in Naval service.

The clinical importance of personality disorder subtypes was evaluated through an analysis of the demographic characteristics and outcomes for 11,549 navy enlisted men who received a primary diagnosis of a character and behavior disorder. Men with similar demographic characteristics serving in similar environments and demonstrating grossly similar clinical pictures received different diagnoses and dispositions in the various hospitals studied. Within any 1 hospital over the 4 study years, while demography of character and behavior disorder patients remained stable, diagnostic breakdowns and administrative and outcome characteristics varied markedly. The data are thus consistent with the hypothesis that diagnostic subtypes for personality disorders have limited clinical and prognostic meanings. The label may reflect the idiosyncratic preference of a particular physician at 1 point in time as much as the clinical picture or prognosis of the patient.

Transient situational disturbances: course and outcome.

The validity and usefulness of the diagnostic category transient situational disturbance were evaluated by studying the course and outcome for 2,078 hospitalized naval personnel. The condition was found to be less severe and disabling than other major psychiatric disorders in terms of chronicity, length of hospitalization, and disposition. Outcomes in terms of rehospitalization rates and work effectiveness also were relatively favorable. Based on three or more years of follow-up, a substantial proportion of patients originally diagnosed as having a transient situational disturbance subsequently manifested personality disorder problems. The results suggest that clearer criteria are needed to define situational disturbances operationally and to identify patients with underlying personality disorders.

Prediction of posttreatment effectiveness in Navy alcoholics.

Major predictors of the posttreatment effectiveness of 2195 alcoholics enlisted in the U.S. Navy were, for men 26 and over, abstinence during treatment, years of service and level of pay, and, for younger men, level of pay, not being demoted and not missing promotion to petty officer status.

Early identification of alcoholism in Navy psychiatric outpatients.

This study compares Navy outpatient alcoholics, inpatient alcoholics, and a general outpatient psychiatric population on a number of demographic and clinical variables. Compared to inpatients, the outpatient alcoholics were younger, more often married, and were more frequently given favorable discharges. Compared to nonalcoholic outpatients, the outpatients were older, had lower socioeconomic origins, and were more often given favorable discharges. The characteristics of outpatient alcoholics are discussed, and an attempt is made to lay the groundwork for early case finding and prevention of alcoholism in the service.