Active Duty Soldiers Research Articles

Ileoanal pouch in the active duty population: effect on military career.

Patients undergoing proctocolectomy with an ileal pouch-anal anastomosis (IPAA) are reported to have an improvement in lifestyle and are able to return to their previous occupation. We questioned whether this was also true of active duty military personnel who require this operation. The rigors of military service are unlike that of most civilian occupations. Soldiers must maintain a physical fitness regimen and remain eligible to deploy overseas. We reviewed our experience with IPAA to determine whether our active duty patients could return to full duty. The charts of all patients undergoing IPAA since October 1990 were reviewed, and each patient was interviewed by telephone to elicit late complications not noted in their medical records and to inquire about their present bowel function. Patients were classified as active duty or nonactive duty. Active duty patients were queried as to whether they have remained on active duty, have required a permanent profile, have been promoted, or have been deployed overseas. If a military medical evaluation board had determined whether they were fit for duty, the findings of the board were reviewed. Thirty-four patients underwent an IPAA; 15 were active duty. Mean follow-up was 24 months. Indication for IPAA was ulcerative colitis in 76 percent of patients and familial adenomatous polyposis in 24 percent. J-Pouch was created in 88 percent of patients. Mean bowel movement frequency was seven per day, and 84 percent could defer a bowel movement for more than one hour. Leakage requiring a pad was reported by three patients (9 percent). Seven of 15 active duty patients (47 percent) remained on active duty, and 3 have been promoted. Of the eight patients who were evaluated by a medical evaluation board and were retired, only four were found unfit because of poor bowel function. Therefore, if it were not for other physical limitations, 11 of 15 (73 percent) active duty patients could have continued to serve. Barring other disqualifying illnesses, active duty soldiers can anticipate continuation of their military career following IPAA. Active duty soldiers, if motivated, can excel and maintain their status in the military.

Surviving the “Air Evac”: Medical and Logistical Issues of Evacuating Psychiatric Patients by Air from Korea to the United States

Active duty soldiers who need a physical evaluation board for incapacitating psychiatric symptoms may be evacuated by air to the United States. The Aeromedical Evacuation (air evac) process involves many overlapping organizations, including the Army, Air Force, command, medical, and flight personnel. There are often communication problems between the different systems. Which soldiers are returned to the United States, how they get there, whether to send a medical attendant, and which medications to use for the flight are discussed. The air evac process is in transition. We hope that this paper will facilitate cooperation between the different systems and improve patient care.

Expenditures on Family Dental Care by Active Duty Soldiers

Expenditures on family dental care by U.S. active duty soldiers were explored in this 1992 worldwide survey. Of 9,560 respondents (62% response rate), 7,187 claimed dependents and 5,569 provided reliable data. Mean annual expenditures and multinomial regression on a distribution of expenditures were calculated. Results show average family dental care expenditures were as follows: total sample, $135; childless couples, $59; couples with children, $154; and single parents, $120. Between 72 and 83% of families spent $0 on dental care. Excluding non-spenders, overall expenditures averaged as follows: total sample, $531; childless couples, $354; couples with children, $560; and single parents, $470. Regression results show that expenditures on family dental care by soldiers are influenced by different factors depending on family composition. Policy measures to encourage optimal dental care by families of active duty soldiers should focus on increasing insurance coverage and use.

Human Immunodeficiency Virus Type-1 Seroconversion Trends Among Young Adults Serving in the United States Army, 1985-1993

The direct measurement of the incidence of new infections with the human immunodeficiency virus type 1 (HIV-1) can be made among soldiers because of the routine and periodic nature of HIV-1 testing in the United States Army. Between November 1985 and October 1993, 978 HIV-1 seroconversions were seen among 1,061,768 soldiers, contributing over 3.6 million person-years of follow-up [seroconversion rate (95% confidence interval) = 0.27/1,000 person-years (0.25-0.29)]. A significant decreasing trend in HIV-1 seroconversion rates was seen over the analysis period. The rate of new infections declined significantly from the first interval, 1985-1987, (0.43/1,000 person-years) to the second interval, 1987-1988, (0.28/1,000 person-years), but stabilized at approximately 0.22/1,000 person-years after 1988, representing new infections in approximately 100-150 soldiers annually. The risk of seroconversion among active duty soldiers was significantly associated with racial/ethnic group, age, gender, and marital status. Surveillance of HIV-1 seroconversion rates in the U.S. Army continues to offer a unique opportunity to assess temporal trends in the evolving HIV-1 infection epidemic. Monitoring the rate of new HIV-1 infections allows for identification of subgroups in need of intervention, refocusing of intervention strategies, and evaluation of their effectiveness.

Satisfaction with Military Dental Care by Active Duty Soldiers

In Fall 1992, a random, worldwide sample of 5,474 enlisted personnel and 4,036 officers was surveyed on satisfaction with 28 attributes of Army dental care using self-administered questionnaires. Simple descriptive statistics for each attribute were derived, as was a composite overall satisfaction score using factor analysis. Composite scores were regressed on demographics, dental utilization, and access barriers to identify those factors that have an impact on a soldier's overall satisfaction with Army dental care. Results show above average satisfaction with most attributes of Army dental care except access attributes. Dental utilization and age exerted a positive impact on overall satisfaction; access barriers and assignment to a combat unit had a negative impact. The impact of race was mixed. Age had the strongest impact on overall satisfaction. Results suggest that improving satisfaction with Army dental care must come from improving access. This can be attained only by increasing dental manpower and resources.

Use of Inpatient Psychiatric Services on a U.S. Army Combat Support Post during Operations Desert Shield and Desert Storm: The Stress of Non-Deployment

We studied the utilization of inpatient psychiatric services during Operations Desert Shield and Desert Storm (the Persian Gulf War of 1990-1991) on a U.S. Army combat support post. Inpatient psychiatric admissions and dispositions for the post's catchment area were tallied before, during, and after Operations Desert Shield and Desert Storm. Subjects included active duty soldiers (deployed soldiers were not studied while they were away from the post), their families, and retirees. Overall, there was no increase in psychiatric hospitalizations for active duty soldiers, their family members, or retirees. However, coincident with the return of soldiers from Operations Desert Shield and Desert Storm, the psychiatric proportion of all hospitalizations increased in the subpopulation of soldiers not deployed who had served less than 1 year. These soldiers in training may be more susceptible to increased stress levels associated with the return of soldiers from war because of their inadequate group bonding.

Radial Keratotomy in the Soldier-Aviator

Radial keratotomy (RK) is an ophthalmological procedure that alters the shape of the cornea, making it "flatter," causing the desired shift to farsightedness. Complications can be minor and "normal" in the immediate post-operative period, or can include problems that occur in many eyes, that persist but do not decrease best corrected visual acuity, or may include events that potentially or actually threaten vision and may produce blindness. At best, only 50% of patients can expect to have 20/20 uncorrected vision 2-3 years after surgery. Diurnal fluctuations in vision (two-five Snellen lines) can persist years after RK. Perhaps 1% of patients may have a two-three Snellen line loss of best corrected vision or ghost images that interfere with clear vision. Disabling glare can disrupt daily activities. Eyes that have undergone RK are at increased risk of corneal rupture after blunt eye trauma. The visual demands of the active duty military, and more dramatically the military aviator, are incompatible with RK. Therefore, RK should not be performed on active duty soldiers, nor should enlistees be accepted if they have undergone the procedure.

ANALYSIS OF CASUALTIES REFERRED TO ARMY PHYSICAL MEDICINE SERVICES DURING THE PERSIAN GULF CONFLICT

This study describes the casualties referred during the Persian Gulf War and underscores the valuable role of Army physical medicine and rehabilitation (PMR) services in evaluation and early rehabilitation of wartime casualties. Data regarding demographics, injury types, medical complications, complications of immobility and functional limitations were collected by military physiatrists at five Army Medical Centers with PMR services. Active duty soldiers injured in the Persian Gulf War who were referred totalled 222. Musculoskeletal injuries occurred in 57%, peripheral nerve injuries in 44%, penetrating wounds in 32%, fractures in 28%, brain injuries in 8%, amputations in 7%, burns in 6% and spinal cord injuries in 3%. The primary referral service was orthopedics (64%). Electrodiagnosis evaluations were performed for 41% of all referrals. Lower limb and upper limb contractures occurred in 10% and 9% of patients, respectively. Ambulatory impairments were seen in 48%. Nerve injuries were associated with penetrating wounds in 68%, with amputations in 67% and with fractures in 58%.

Decreases in invasive Haemophilus influenzae diseases in US Army children, 1984 through 1991

<h3>Objective.</h3> —To document trends in the incidence of invasive<i>Haemophilus influenzae</i>diseases in young children of US Army active duty soldiers following the publication of<i>H influenzae</i>type b immunization recommendations for young children between 1985 and 1990. <h3>Design.</h3> —A population-based surveillance of hospital discharge diagnoses for<i>H influenzae</i>invasive diseases. <h3>Setting.</h3> —Military and civilian medical treatment facilities around the world. <h3>Patients.</h3> —There was a mean population of nearly 200 000 US Army health care beneficiaries younger than 5 years of age each year of the study. <h3>Outcome Measures.</h3> —Annual total and age-specific incidences of the six most common<i>H influenzae</i>invasive diseases in this population (meningitis, epiglottitis, septicemia, pneumonia, cellulitis, and septic arthritis). <h3>Results.</h3> —The annual number of cases of<i>H influenzae</i>invasive diseases decreased from a high of 188 in 1986 to 43 in 1991. The incidence in the age group at highest risk for<i>H influenzae</i>disease, those 6 to 11 months of age, decreased from 355 per 100 000 children in 1986 to 116 per 100 000 in 1991 (<i>P</i>&lt;.0001 χ²for trend). The incidence for<i>H influenzae</i>meningitis declined from 59 per 100 000 children in 1986 to 6 per 100 000 in 1991 (<i>P</i>&lt;.0001, χ²for trend). <h3>Conclusions.</h3> —The decrease in<i>H influenzae</i>invasive diseases closely follows the dates of<i>H influenzae</i>type b vaccine licensure for use in progressively younger age groups. Some age groups, however, experienced a decline in disease rates even before becoming eligible for vaccination. (<i>JAMA</i>. 1993;269:227-231)

Decreases in Invasive Haemophilus influenzae Diseases in US Army Children, 1984 Through 1991

To document trends in the incidence of invasive Haemophilus influenzae diseases in young children of US Army active duty soldiers following the publication of H influenzae type b immunization recommendations for young children between 1985 and 1990. A population-based surveillance of hospital discharge diagnoses for H influenzae invasive diseases. Military and civilian medical treatment facilities around the world. There was a mean population of nearly 200,000 US Army health care beneficiaries younger than 5 years of age each year of the study. Annual total and age-specific incidences of the six most common H influenzae invasive diseases in this population (meningitis, epiglottitis, septicemia, pneumonia, cellulitis, and septic arthritis). The annual number of cases of H influenzae invasive diseases decreased from a high of 188 in 1986 to 43 in 1991. The incidence in the age group at highest risk for H influenzae disease, those 6 to 11 months of age, decreased from 355 per 100,000 children in 1986 to 116 per 100,000 in 1991 (P < .0001, chi 2 for trend). The incidence for H influenzae meningitis declined from 59 per 100,000 children in 1986 to 6 per 100,000 in 1991 (P < .0001, chi 2 for trend). The decrease in H influenzae invasive diseases closely follows the dates of H influenzae type b vaccine licensure for use in progressively younger age groups. Some age groups, however, experienced a decline in disease rates even before becoming eligible for vaccination.

Congenital Neutropenia: How Low?-Reply

In Reply.— We thank Tomases and Bessman for their comments. Tomases points out correctly that our subjects were not fully representative of the population as a whole, but consisted of healthy employees of the federal government (most of whom were active-duty soldiers). We purposely chose this group of subjects so that our data would reflect the normal range of values within the general population, without including any subjects whose abnormal hemogram values were related to serious illness. Bessman's comments are appreciated and may provide a plausible explanation for the mean corpuscular volume data that we observed. We were cautious in describing and interpreting these data because of relatively small numbers of subjects with values in the lower ranges. It also should be noted that the article's 1 abstract contained an inadvertent transposition of numbers in the hemoglobin data. The mean hemoglobin concentrations for white and black men were 153 and

A Brief Review of the Epidemiology of HIV in the U.S. Army

The Department of Defense has conducted extensive HIV testing for over 5 years. We summarize the epidemiology of the HIV infection in the total Army. While screening of civilian applicants effectively ensures seronegativity of enlistees, there are approximately 220 new HIV infections each year among active duty soldiers. High-risk demographic groups in the Army include single soldiers, males, those age 25-35, blacks, and Hispanics (including black and Hispanic females). While preventive efforts in the Army should reflect the higher risk experienced by these groups, all soldiers should be made aware of their susceptibility as the epidemic evolves to include more women and heterosexual men.

Comparison of Three Treatment Approaches for Grade I and II Ankle Sprains in Active Duty Soldiers

The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. Return to full occupational function is a primary concern for the injured, including those with ankle sprains. This study compared the effectiveness of three different types of treatment for Grade I and Grade II ankle sprains. The effectiveness was determined by how quickly the patient returned to full duty and if the patient had a recurrence of the injury within one month. A total of 184 subjects (60 in Groups 1 and 3; 64 in Group 2) participated in this study. The treatment groups were: 1) strapping with athletic tape for three days, 2) application of gel cast for three days, and 3) daily strapping for three days. All three groups underwent the same physical therapy program before and after strapping or wrapping. All treatment protocols resulted in a better than 50 percent return to full duty in less than 14 days, with Group 3 showing a return rate of 60 percent in three days or less. The study showed (using log linear analysis) a significant difference at the p < 0.01 level between Groups 1 and 3 and Groups 2 and 3. These results suggest that daily strapping can help reduce lost work time due to ankle sprains. J Orthop Sports Phys Ther 1992;15(1):19-23.

Guillain-Barré Syndrome and Influenza Vaccination in the US Army, 1980–1988

An increased incidence of Guillain-Barré syndrome (polyradiculoneuritis) occurred in individuals who received the A/New Jersey (swine) influenza vaccine in 1976-1977. A retrospective study encompassing the years 1980-1988 was conducted to determine if the US Army's mass influenza vaccination program has been associated with an increased incidence of Guillain-Barré syndrome in active duty soldiers during the study years. No temporally related increase in Guillain-Barré syndrome was found during the study years.

Trends of HIV seroconversion among young adults in the US Army, 1985 to 1989. US Army Retrovirus Research Group

Because soldiers in the US Army are recurrently tested for the presence of antibody to the human immunodeficiency virus (HIV), HIV seroconversion rates can be directly measured. From November 1985 through October 1989, 429 HIV seroconversions were detected among 718,780 soldiers who contributed 1,088,447 person-years of follow-up time (HIV seroconversion rate, 0.39 per 1000 person-years). Period-specific seroconversion rates declined significantly from 0.49 per 1000 person-years (November 1985 through October 1987) to 0.33 per 1000 person-years (November 1987 through October 1988) to 0.29 per 1000 person-years (November 1988 through October 1989). The HIV seroconversion risk among active-duty soldiers was significantly associated with race/ethnic group, age, gender, and marital status. Based on these trends, we estimate that approximately 220 soldiers (95% confidence interval, 160 to 297 soldiers) were infected with HIV during 1989 and 1990, with potentially fewer in future years.

Trends of HIV Seroconversion Among Young Adults in the US Army, 1985 to 1989

Because soldiers in the US Army are recurrently tested for the presence of antibody to the human immunodeficiency virus (HIV), HIV seroconversion rates can be directly measured. From November 1985 through October 1989,429 HIV seroconversions were detected among 718 780 soldiers who contributed 1 088 447 person-years of follow-up time (HIV seroconversion rate, 0.39 per 1000 person-years). Period-specific seroconversion rates declined significantly, from 0.49 per 1000 person-years (November 1985 through October 1987) to 0.33 per 1000 person-years (November 1987 through October 1988) to 0.29 per 1000 person-years (November 1988 through October 1989). The HIV seroconversion risk among active-duty soldiers was significantly associated with race/ ethnic group, age, gender, and marital status. Based on these trends, we estimate that approximately 220 soldiers (95% confidence interval, 160 to 297 soldiers) were infected with HIV during 1989 and 1990, with potentially fewer in future years. ( JAMA . 1991;265:1709-1714)

Bioelectrical Impedance in the Air Force Weight Management Program

Thousands of active-duty soldiers undergo weight evaluations each year and are subjected to disciplinary action if they fail to comply with established weight standards. This regulation consumes scarce available resources by requiring medical appointments. This study focuses on the use of bioelectrical impedance to determine body fat. It compared the physician's assistants with technicians for correlation of body fat percentage determinations. The correlation was r = .939 (p less than .0151) between the two groups. The use of technicians to determine body fat percentages using bioelectrical impedance appears to be a reasonable way to recover thousands of lost medical appointment slots.

Residual Subclinical Impairment in Patients Who Totally Recovered from Guillain-Barré Syndrome: Impact on Military Performance

Patients who have clinically recovered from Guillain-Barré syndrome (GBS) may exhibit a deficit during strenuous exercises that require maximal effort and muscular endurance. The Army Physical Fitness Test (APFT) is a quantitative tool that challenges neuromuscular endurance and unmasks a subclinical deficit in soldiers who have apparently recovered from GBS. The impact of this subclinical deficit on active duty soldiers and strategies for managing their poor performance on the APFT are discussed.

The Army's "Be All You Can Be" Campaign

This research examined the opinions of current soldiers regarding the most expensive campaign ever used by the U.S. Military: the Army's "Be All You Can Be" campaign. The campaign emphasizes the role of the army in providing instrumental and intrinsic rewards to soldiers. Although the campaign is aimed at potential enlistees, active duty soldiers attend to the same media channels and content and thus also receive high exposure to the advertisements. Results of focus group interviews with 87 male and 27 female soldiers indicate soldiers believe there is a wide gap between the promises of Army advertising and the actual performance of the Army in keeping its promises. This perception was expressed by many soldiers as disillusionment, frustration, and anger. The advertisements appear to damage soldier morale, commitment to the military, and reenlistment potential. For both ethical and pragmatic reasons it is suggested that future advertising should be designed with a concern for both effectiveness and honesty and that future advertisements should be concerned with increased sensitivity for the immediate and long-term effects on both the target audience of potential recruits and the unintended audience of active duty soldiers.

Mumps in the US Army 1980-86: should recruits be immunized?

The US Army's experience with mumps hospitalizations was examined for the years 1980 through 1986. One hundred fifty-two cases among active duty Army soldiers were identified. Mumps rates declined from 3.85 per 100,000 active duty soldiers per year in 1980 to 1.28 in 1985, but an outbreak during 1986 caused rates to jump to 6.65. Attack rates were found to decline dramatically with increasing age or length of military service, with 74 per cent of cases occurring in soldiers with three years or less of service. Rates for Blacks and Whites were similar, but were higher for other minorities. Complications reported were mild. A cost-benefit analysis, assuming all recruits were to be vaccinated, estimated average annual vaccination program costs of $286,789; this figure exceeds average annual reported hospitalized mumps disease costs of $61,525 by a factor of 4.7. Mumps attack rates would have to reach at least 15.0 per 100,000 per year before savings would equal recruit vaccination costs. Failure to show that a vaccine program would be cost-saving may be due to limitations in identifying cases or to the requirement that all recruits be immunized regardless of prior immune status. It is likely that a program to immunize susceptible individuals alone would show benefit.