Long-term health outcomes and medical effects of torture among US Navy prisoners of war in Vietnam.

OBJECTIVE: To characterize incidence of illnesses and injuries from 1979 to 1993 in former naval aviator prisoners of war (POWs) from the Vietnam War and a comparison group of naval aviators from the same war. DESIGN: Cohort analytic study. SETTING: A US Navy primary care clinic. PARTICIPANTS: Volunteer sample consisting of 70 former naval aviator POWs (white men, aged 47 to 69 years in 1993) and a comparison group of 55 naval aviators who served in Vietnam but were not POWs, matched on race, age, marital status, education, rank, year of entry into the navy, and pilot status. Subjects participated in an annual health screening program. This study reports data sampled on a biennial basis from subjects screening both in 1979 and 1993. MAIN OUTCOME MEASURE: Medically diagnosed incidence of illness and injury based on a standard protocol. RESULTS: POWs had higher incidence rates than the comparison group did of disorders of the peripheral nervous system (relative risk [RR], 8.4; 95% confidence interval [CI], 2.7-25.9; P<.001), joints (RR, 1.5; 95% CI, 1.2-2.0; P<.006), and back RR, 1.8; 5% CI, 1.0-3.0; P<.037). These findings also were statistically significant according to Kaplan-Meier survival analyses that included 131 (95%) of 138 POWs and 115 (83%) of the 138 members of the comparison group. Survival analyses revealed that, in addition to these disorders, POWs had higher hazard rates of peptic ulcer (P<.01). CONCLUSIONS: During captivity, ropes, ratchet handcuffs, leg irons, or stocks were used to put tightly constrictive pressure around the extremities of POWs as a means of torture, resulting in painful ischemia and subsequent neuropathies. Being a former POW was associated with increased cumulative incidence rates of chronic disorders of the peripheral nervous system, joints, and back and an increased hazard rate of peptic ulcer.

Perceptions of U.S. Navy medical reservists recalled for Operation Desert Storm.

Operations Desert Shield/Storm involved the recall of 9,700 Navy medical reservists. A demographically representative sample of 3,804 medical reservists (39%) responded to a survey between June and September 1991. The purpose was to identify major issues associated with the recall experience. Results indicated that reservists felt well prepared for their recall assignments; however, they did not strongly endorse the Reserve training program. Responses across operationally oriented issues were moderately positive. Reservists assigned to CONUS hospitals rated items more positively than those assigned to Marine Corps support, and officers were more positive than hospital corpsmen. Results are presented as a descriptive heuristic for policy considerations.

Physical fitness gains following simple environmental change.

Inactivity is the risk factor with potentially the greatest public health impact, according to the 1989 U.S. Preventive Services Task Force report. Our study reports changes in subjects' physical fitness level after simple changes aimed at enabling community members to adopt more easily active lifestyles. Simple environmental and social alterations occurred at a San Diego Naval air station. We administered to a cohort of active-duty personnel from within this community (n = 1,609) both a physical readiness test (PRT) and a lifestyle questionnaire at baseline and at one year. The PRT consisted of a 1.5-mile timed run, sit-ups, push-ups, and percentage body fat components, and the questionnaire addressed demographics, current exercise behavior, and attitudes toward exercise. We took similar measures within a comparison community cohort (n = 217) and within a Navy-wide sample cohort (n = 546). Both overall PRT category and 1.5-mile run time improved significantly (P less than .05) over time in the intervention community (0.3 category points and 18 seconds, respectively). The increase was significantly greater (P less than .01) than in either the control community or the Navy-wide sample. Subgroup analysis showed that, in the intervention community, 12.4% failed the overall fitness test in 1987, but only 5.1% failed in 1988. Similarly, the 1.5-mile run failures decreased from 8.4% to 4%. Reported leisure time kilocalorie expenditure showed no significant improvement. This simple program successfully improved fitness performance. The improvement was distributed throughout the community and included those who were substandard at baseline. Similar programs could easily be adopted in a variety of communities.

Determinants of the delegation of healthcare aboard ships with women assigned.

The purpose of this study was to identify the potential determinants and distribution of shipboard patient delegation decisions. During a 1-month period, physicians aboard five U.S. Navy ships with women assigned estimated the minimum numbers of healthcare providers needed to diagnose and treat each patient (N = 2,725). Results indicated the following distribution of potential patient assignment: consultation 1.4%, medical officer 18.6%, physician assistant/nurse practitioner 8.7%, corpsman with additional OB/GYN training 2.2%, and corpsman 69.2%. Diagnosis was the best predictor of the indicated level of healthcare required. The patient's sex and pay grade were unrelated to the potential levels of care provided.

Self-selection in responding to a health risk appraisal: are we preaching to the choir?

Abstract The objectives of the present study were a) to examine behavioral and sociodemographic factors associated with voluntary response to a health risk appraisal (HRA), and b) to assess the effect of HRA feedback on subsequent preventive health behaviors and risk-taking behaviors. After collection of health behavior data from a larger sample participating in a Navy-wide health promotion evaluation, an HRA was mailed to a random subsample of 625 individuals. A total of 270 (43 %) people responded to the HRA and received printed feedback. Follow-up health behavior data were collected one year later from 93 of the 270 HRA respondents. These 93 individuals were then matched with a control group who did not receive an HRA but had provided health behavior data both times. Analyses revealed that HRA respondents were older, better educated, had higher health status, smoked less, consumed less alcohol, and used seat belts more often than nonrespondents. Separate analyses of HRA respondents and matched controls indicated that HRA participation had no significant effect on subsequent preventive health behaviors or risk-taking behaviors. Results suggest limitations of the HRA as an effective due to behavior change.

Patient and provider satisfaction in Navy family practice and non-family practice clinics.

Differences between family practice and non-family practice health care service delivery have been characterized in terms of patient satisfaction. As health care providers may often behave according to their conceptions of what is satisfying for patients, a clarification of the degree of congruence between patient self-reports and provider impressions is needed. Responses to four patient satisfaction scales were obtained from 136 providers and 1,735 patients in both family practice and non-family practice Navy clinics. Results of separate multiple discriminant analyses conducted between settings for both provider and patient groups indicated that providers emphasized trust and range of services as hallmarks of family-oriented care. Patients, alternatively, emphasized accessibility of services, whereas range of services was not relevant to differentiating between treatment modalities.

Patient satisfaction in adjacent family practice and non-family practice Navy outpatient clinics.

Patient satisfaction was assessed in adjacent family practice and non-family practice clinics at a Naval Regional Medical Center. Results indicated that patients in the family practice clinic (n = 341) were significantly more satisfied with care than those in the other primary care clinic (n = 390). Although older people and men were generally more satisfied with care, demographic factors did not differentially affect patient preferences for the family practice approach to ambulatory care.

Evidence from mutual masking for serial processing of tachistoscopic letter patterns.

This experiment deomonstrates serial processing of tachistoscopic patterns when all potential artifacts are eliminated. Two nonsense arrays of six letters were tachistoscopically exposed successively at the same positions. Ss identified more letters from the temporally first string on the left of fixation and more from the second on the right, indicating left-to-right serial processing. Variations among Ss in the location of the crossover in curves indicate individual differences in processing time. Therefore, this study demonstrates definitively that tachistoscopic performance at various positions can reflect a sequential left-to-right processing of information, possibly at different rates.

Serial processing shown by mutual masking of icons.

In a procedure called mutual masking, two compound words were tachistoscopically exposed successively at the same location. Perceptual accuracy for both words was examined. With fixation at the center of the arrays, Ss often identified the component at the left within the temporally first word and at the right within the second. These results imply a left-to-right serial processing. With fixation on begining or end component, Ss tended to identify the component away from fixation of the first word and the fixated part of the second. This implies scanning from periphery toward fixation. Therefore, sequential processing of iconic information was obtained, with direction of processing determined by specific conditions.