Inpatient psychiatric morbidity of HIV-infected soldiers.

To determine differences in inpatient psychiatric morbidity, a total of 573 soldiers seropositive for the human immunodeficiency virus (HIV) were matched with 2,266 seronegative soldiers by age, sex, race, marital status, military rank, length of active service, military occupation, and date of HIV test. An HIV-infected individual was seven times more likely to be hospitalized than an uninfected individual. The rate of total hospitalizations was 16 times higher for the HIV-infected soldiers. The median length of hospital stay was six days for the infected soldiers and four days for the control group. The incidence of psychosis, organic mental disorders, and adjustment disorder in the HIV-infected group was significantly higher.

HIV infection: military occupational sequelae.

The military experience of 573 soldiers found to be HIV seropositive and their 2,262 matched seronegative controls were compared to determine if differences exist. Examination of personnel records for study members showed an expected difference in assignment changes, with seropositives being moved significantly more often to other units in compliance with a regulation prohibiting their presence in special operations units and units located overseas. Otherwise, there was no statistically significant difference at the 0.05 level when comparing changes in education, military occupational specialty code, promotion, or demotion. Seropositive individuals were less likely to marry, but no more likely to divorce. Seropositives were more likely to be separated from active service and barred from reenlistment for medical reasons.

Risk factors for hepatitis B virus infection in US Army soldiers in Europe.

Cross-sectional and case-control studies were conducted in a US Army unit which had experienced a protracted outbreak of viral hepatitis. Serological, demographic, and exposure data were collected. The cross-sectional study found that there was no association between the prevalence of hepatitis B virus (HBV) infection and ethnicity, education, and rank. There was an association with age and duration of assignment to the unit. Having social contact with an identified hepatitis patient and the sharing of personal hygiene items with a case were significant risk factors for HBV infection. Through the use of anonymous questionnaires, the case-control study evaluated various behavioural factors. Univariate analysis indicated moderate but not significant increases in risk associated with a history of multiple sex partners and a history of disciplinary problems while in the military. Six drug-use related risk factors were significantly associated with HBV infection on univariate analysis. When evaluated with multivariate analysis, the only risk factor that was significantly associated with HBV infection was injection of drugs while assigned to the study unit. Two sources of misclassification bias were identified, both of which acted to underestimate the true risk associated with identified risk factors.

Occupational health program development.

A model occupational health program was developed for 300,000 U. S. Army employees in Europe. Despite the availability of both fiscal resources and personnel, those charged with developing the program discovered that the traditional approach to occupational health could not be applied directly. Complex command channels required a well-stated delineation of responsibilities. Compounding the problems inherent in demographic complexity were geographical dispersion and organizational complexity, a broad spectrum of potential industrial hazards, and diverse occupational health laws for multiple-employee groups, all of which resulted in the need for flexibility. Because of limited capabilities to provide technical and clinical services, all services required a maximum amount of tailoring. The model described here, called the functional approach to occupational health, was designed to address these requirements.

Failure to achieve predicted antibody responses with intradermal and intramuscular human diploid cell rabies vaccine.

In a study to compare the immunogenicity of human diploid cell rabies vaccine (HDCV) given by intramuscular or automatic intradermal jet injection, neither method of administration resulted in antibody levels predicted by previous studies. 49 days after starting a series of three 0.1 ml doses of HDCV given intradermally, 85 volunteers had a geometric mean titre (GMT) of neutralising antibody to rabies of 1:170. 9 concurrent control subjects who received 1.0 ml doses of vaccine intramuscularly had a GMT of only 1:269. Although standard potency testing did not demonstrate that the vaccine used was subpotent , these results strongly suggest that the immunogenicity of HDCV is substantially less than previously reported.