Epidemiology of inflammatory bowel disease among participants of the Millennium Cohort: incidence, deployment-related risk factors, and antecedent episodes of infectious gastroenteritis.

BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) are two pathotypes of inflammatory bowel disease (IBD) with unique pathology, risk factors and significant morbidity. AIM: To estimate incidence and identify IBD risk factors in a US military population, a healthy subset of the US population, using information from the Millennium Cohort Study. METHODS: Incident IBD was identified from medical encounters from 2001 to 2009 or by self-report. Our primary risk factor of interest, infectious gastroenteritis, was identified from medical encounters and self-reported post-deployment health assessments. Other potential risk factors were assessed using self-reported survey responses and military personnel files. Hazard ratios were estimated using Cox proportional hazards analysis. RESULTS: We estimated 23.2 and 21.9 diagnoses per 100 000 person-years, respectively, for CD and UC. For CD, significant risk factors included [adjusted hazard ratio (aHR), 95% confidence interval]: current smoking (aHR: 2.7, 1.4-5.1), two life stressors (aHR: 2.8, 1.4-5.6) and prior irritable bowel syndrome (aHR: 4.7, 1.5-15.2). There was no significant association with prior infectious gastroenteritis. There was an apparent dose-response relationship between UC risk and an increasing number of life stressors. In addition, antecedent infectious gastroenteritis was associated with almost a three-fold increase in UC risk (aHR: 2.9, 1.4-6.0). Moderate alcohol consumption (aHR: 0.4, 0.2-0.6) was associated with lower UC risk. CONCLUSIONS: Stressful conditions and the high risk of infectious gastroenteritis in deployment operations may play a role in the development of IBD in military populations. However, observed differences in risk factors for UC and CD warrant further investigation.

Prescription medication use aboard US submarines during periods underway.

Since January 1997, automated medical records from U.S. submarines have been stored in a centralized database as part of a descriptive epidemiology study. 200 medical encounter notes were randomly selected from 1,017 initial health visits during submarine underway periods between April 1996 and January 1998. Medication prescription appropriateness was assessed using a modified Medication Appropriateness Index (MAI) described in the literature. Seven diagnostic categories accounted for 51.4% of all diagnoses: acute upper respiratory infections (17.6%), superficial wounds (9.7%), elevated blood pressure without the diagnosis of hypertension (7.9%), sprain/strains (4.7%), skin infections (4.3%), eye disorders (3.6%), and ear disorders (3.6%). Prescribed medications were consistent with the care of minor health problems. Mean number of medications prescribed per encounter was 1.4 +/- 1.1 (S.D.). 84% of prescribed medications were assigned a modified MAI summary score of 0, indicating the prescription was appropriate in all aspects. However, anti-infective medication prescriptions demonstrated a significant proportion of non-zero summary scores suggesting some room for improvement in the prescribing practices for this specific medication category.

Accidents and injuries among U.S. Navy crewmembers during extended submarine patrols, 1997 to 1999.

Accidents and injuries, the most common cause of morbidity in military populations, result in a significant number of work days lost each year and account for 75% of all active duty deaths. Rates of accidents and injuries during U.S. Navy submarine deployments have not been evaluated previously. A database designed to monitor the health of submarine crew-members was used to examine the rates and causes of accidents among deployed crewmembers aboard 196 submarine patrols between 1997 and mid 1999. The most common category of injuries was open wounds, followed by sprains and strains, contusions, superficial injuries, burns, and others. Rates of accidents and injuries decreased with increasing age and duration of military service. Among submariners working in supply departments, the rates were more than two times those of crewmembers working in other departments. Based on these data, among a submarine crew of 100 men at sea for 100 days, approximately four to five accidents or injuries might be expected and would result in an average of about 2 days of light or no duty per injury. Rates of accidents and injuries were very low; however, focused safety training could reduce rates among younger and less experienced crewmembers as well as among those working in particular areas of the submarine.

A method for monitoring the health of US Navy submarine crewmembers during periods of isolation.

BACKGROUND: With the expansion of the manned space program, an essential consideration in planning is the medical support necessary for long-term missions. Information on analogous populations serving in isolated and/or contained environments may be useful in predicting health risks for astronauts. METHODS: The present study evaluates rates of health events that occur in a highly screened, healthy military population during periods of isolation. A centralized database was designed to collect medical encounter data from U.S. Navy submarines and contains demographic information, crew rosters for each patrol, medical encounter notes, accident reports, medical evacuation reports, vital signs and laboratory data. The population included in the present analysis is composed of crewmembers aboard 136 submarine patrols between January 1, 1997 and December 31, 1998. RESULTS: A total of 2,044 initial visits to medical staff and 973 re-visits for the same condition were recorded during these patrols. Potentially mission-impacting medical events reported among crewmembers were rare (i.e., among a crew of 10 individuals, only 1-2 medical events would be expected to occur during a 100 d-mission). The most common category of medical events was injury, followed by respiratory illnesses (URIs), skin problems (minor infections, ingrown toenail), symptoms and ill-defined conditions, digestive disorders, infectious conditions, sensory organ problems (ear and eye), and musculoskeletal conditions.

Competency in health care management: a training model in epidemiologic methods for assessing and improving the quality of clinical practice through evidence-based decision making.

This article describes a training model that focuses on health care management by applying epidemiologic methods to assess and improve the quality of clinical practice. The model's uniqueness is its focus on integrating clinical evidence-based decision making with fundamental principles of resource management to achieve attainable, cost-effective, high-quality health outcomes. The target students are current and prospective clinical and administrative executives who must optimize decision making at the clinical and managerial levels of health care organizations.

Comparison of saccharides as osmotic impermeants during hypothermic lung graft preservation.

We have previously shown that the trisaccharide raffinose is largely responsible for the superior lung graft performance seen after storage in University of Wisconsin solution. To investigate the use of osmotic agents in perfusates for hypothermic lung graft storage, we compared saccharides of various molecular weights in an isolated rat lung model. Grafts were flushed with 1 of 6 preservation solutions (n=5 each group) containing either a monosaccharide (glucose [G] or fructose [F]), disaccharide (trehalose [T] or sucrose [S]), or trisaccharide (raffinose [R] or melezitose [M]. Grafts were stored for 6 hours at 4 degrees C, reperfused by a veno-venous circuit from an anesthetized support animal for 60 min, and ventilated with room air. The best graft function was seen when trisaccharides were used (PO2; R 126 +/- 3 mm Hg, M 129 +/- 3 mm Hg, blood flows: R 10.2 +/- 0.42 ml/min, M 10.3 +/- 0.22 ml/min). Disaccharides produced similar oxygenation (T 133 +/- 3 mm Hg, S 129 +/- 3 mm Hg) and flows (T 10.3 +/- 0.29 ml/min, S 9.7 +/- 0.4 ml/min) at 60 min, but initial flows were reduced. Monosaccharides produced the least satisfactory graft function, with impaired oxygenation (F 110 +/- 14 mm Hg, P<0.05; G 69 +/- 10 mm Hg, P<0.01) and blood flows (G 6.5 +/- 0.6 ml/min, F 9.1 +/- 0.6 ml/min, P<0.01 each). Only glucose-stored lungs demonstrated a significant decrease in compliance (P<0.01) and weight gain (P<0.01). The worst results were seen with glucose, which is the osmotic agent most commonly used for clinical lung storage. A solution containing a trisaccharide or disaccharide may be more appropriate for this purpose.

A midtrimester procedure, not without its risks... Saline abortion: a review of the experience at Kapiolani hospital.

PIP: The experience with 107 saline instillation abortions at Kapiolani Maternity and Gynecologic Hospital in Honolulu, during the first 7 months of 1972 is reviewed. 57.9% of the patients were primigravidas and 40.2% were multigravidas. Estimated length of gestation ranged from 14 to 23 weeks, with a mean of 17.7. 87/8% of the women were successfully aborted on the initial attempt, while technical difficulty with amniocentesis prevented the instillation of saline in 10.3%, and the method itself failed for 2. 30% of the primary attempts at abortion failed when gestation length was estimated at 15 to 16 weeks compared to a 7% failure rate at 17 to 18 weeks; no failures occurred at 19 weeks or more. Mean induction-abortion interval was 25.7 hours; gravidity appeared to exert little influence. 32.7% of the patients displayed postabortive complications which were defined by the following criteria: 1) failure of amniocentesis or failure to abort; 2) accidental intravascular injection of saline and immediate reaction consistent with this clinical syndrome; 3) fever, any recorded temperature of 100.6 degrees Farenheit or greater; 4) retained tissue; 5) hemorrhage, a decrease in hemoglobin of 2 gm or more. 14% of the women developed fever while failed abortion occurred for 12.1% and 10.3% displayed more than 1 complication. The highest complication rate (40%) occurred in 13-16 week gestation group; the lowest (29.6%) in the 17-20 weeks interval. A greater risk was found to exist for the very young patient (15 years and under) and the older patient (age 30 and over); complication rates were 50% and 40% respectively, compared to a rate of 25% for age 29. The group of patients having greater than 150 cc of amniotic fluid removed and greater than 150 cc of hypertonic saline instilled had the shortest interval to abortion. While complications encountered in this series of 107 patients were mainly minor, it should be noted that the incidence of these complications as well as the induction-abortion interval determine the length of hospitalization and consequently the cost of the procedure. Early abortion procedures reduce both cost and risk of complications.^ieng