French Military Personnel Research Articles

Juvenile Spring Eruption: A Report on an Outbreak and 2 Sporadic Cases in French Military Personnel.

Juvenile spring eruption is a sun-related skin eruption primarily affecting boys or young adult males. The pathophysiology is unknown, but there appears to be a link with sun exposure in cold weather. It can cause small outbreaks, particularly in groups of children or young adults. The primary lesions can be pruritic erythema, with or without associated papules, vesicles, or bullae. They are notable for almost exclusively affecting the ears. Spontaneous healing occurs within a few days without leaving scars. We report an outbreak and 2 sporadic cases that occurred at the Valdahon military camp in France between 2021 and 2024 among military personnel.

Retrospective Observational Analysis of Computed Tomography Scans of Trauma Patients in Overseas Operations (SCANOPEX Study).

High-intensity conflicts are on Europe's doorstep. The French expertise in the medical management of frontline casualties in overseas operations is well established. However, in the management of severe trauma, we lack data on the injuries identified by body scanners in the field. Understanding the associations between injury mechanisms and radiological lesions would enable us to anticipate medical and surgical management. To study this possible link, we collected and interpreted scanogaphic data and analyzed them according to lesion mechanisms, following the algorithm MARCH used to implement the concept of Damage Control Resuscitation, which includes life-saving measures to ensure that the wounded reach medical-surgical facilities alive. This retrospective monocentric study collected data from body scanners performed in overseas operations between June 2011 and September 2023. Inclusion criteria were to be French military personnel and to have undergone a whole-body scanner in a theater of overseas operations. Exclusion criteria were to have died before the scan, to be foreign, non-military and a minor. Of 164 available files, 96 were eligible, 1 patient declared aged 70 years was excluded, and 95 files were retained. In our population, 18% of injured patients had a spinal fracture. Compared with road traffic accident casualties, improvised explosive device casualties were the most severely injured patients arriving alive at computed tomography, with a relative risk of Injury Severity Score > 8 of 2.29 [1.09-4.80] (P = .019). Improvised explosive device casualties had a relative risk of airway injuries of 2.57 [1.03-6.39] (P = .030), injuries leading to functional impairment of 3.21 [1.17-8.82] (P =.013), injuries leading to infection of 2.14 [1.21-3.76] (P = .0045), and injuries leading to shock of 3.21 [0.96-10.70] (P = .039). Deep metal splinters were only found in the improvised explosive device group. Preparing the medical corps to deal with war casualties is fundamental. Our study shows that it is essential to consider the mechanism of injury to understand the casualty better and predict potential injuries. In addition, the study of postmortem scans could greatly help analyze potentially avoidable deaths.

Concordance Study of Diagnoses and Therapeutic Management for Military Personnel Evacuated for Medico-psychological Reasons: From the Theater of Operations to the Military Training Hospital.

The evolving global landscape has led to increased involvement of the French armed forces, exposing military personnel to operational challenges that can affect their mental well-being. As a result, psychiatry has become the second most common reason for Medical Evacuation (MEDEVAC). In war zones where specialized medico-psychological consultations may not be readily available, medical officers play a vital role in providing initial care. Therefore, there is a growing emphasis on the precise evaluation of these practices. In this retrospective observational study, we analyzed MEDEVAC request files from the Operational Health Headquarters (Patient Medical Request sheets), Aeromedical Evacuation Mission Order sheets, and hospital records from the entire military hospital complex in the Île-de-France region for French military personnel who underwent low-priority MEDEVAC (P3) for medico-psychological reasons from a non-metropolitan area to metropolitan France. The study spanned from January 1, 2013, to December 31, 2016. The primary objective is to evaluate the concordance of diagnoses between general practitioners and psychiatrists. The secondary objective is a detailed description of the introduction of psychotropic drugs, especially benzodiazepines, by the medical officer in the field. In total, our study included 610 patients. Significant differences were observed between diagnoses made by military general practitioners and military psychiatrists, except for "psychotic disorders" and "other diagnoses" categories. During hospitalization, benzodiazepines were prescribed to 26.5% of repatriated patients, antidepressants to 12.7%, hypnotics to 17.6%, neuroleptics to 24.23%, and hydroxyzine to 18.8%. Upon discharge, benzodiazepines were prescribed to 23.5% of patients, antidepressants to 17.8%, hypnotics to 9.9%, neuroleptics to 28.9%, and hydroxyzine to 19.7%. The chi-squared test revealed significant differences in prescription between military operations and hospitalization for all molecules except hydroxyzine. Among patients diagnosed with Psychological Disorder Related to a Traumatic Event (TPRET) (<1 and >1 month) by psychiatrists during hospitalization, 66.2% were prescribed benzodiazepines during operational theaters, 24.3% continued during hospitalization, and 16.8% received a prescription upon discharge.The duration of missions often hinders precise psychiatric diagnoses, leading medical officers to transmit clinical data for optimized specialized care at military training hospitals. Furthermore, significant differences in therapeutic administration between medical officers and psychiatrists, particularly in benzodiazepine prescriptions for patients with TPRET, highlight the importance of prioritizing psychotropic prescription modalities in the training of medical officers on mental disorders. Strengthening operational preparations in recent years could enable more practitioners to benefit from these measures. We suggest several measures to enhance the transmission of medical information between medical officers and military psychiatrists. First, optimizing the drafting of Patient Movement Requests could involve implementing pre-filled drop-down menus or providing an adapted bilingual lexicon, facilitating the optimal transmission of clinical information for repatriated patients. Second, strengthening the training of medical officers before deployment and sharing the "Emergency Psy Kit," a comprehensive support tool developed by French military psychiatrists, would further enhance the tool kit available to field practitioners for judiciously prescribing psychiatric drugs.

Obesity and Overweight: First Comprehensive Overview in the French Armed Forces.

The global rise in obesity is well-established, with significant health implications. This study aims to comprehensively assess overweight and obesity prevalence within the French Armed Forces. Using data from the Unique Medical-Military Software (UMMS) in 2018, a cross-sectional study was conducted on active French Military personnel aged 18 and above, who underwent periodic medical examinations (PME) in 2017. Body Mass Index (BMI) served as the main criterion for overweight and obesity classification. A representative sample was obtained through random sampling. The sample included 17,082 individuals, revealing an average age of 33.5 years, with 36.1% classified as overweight and 9.6% as obese. The mean BMI of women was significantly lower than that of men (23.9 vs 25.3 kg/m2-P < .001). Results indicated that 22.4% of women vs 38.5% of men were overweight (P < .001). For obesity, the difference was not significant (8.8% of women vs 9.8% of men-P = .138). BMI increased with age, and non-commissioned officers (NCOs) showed the highest prevalence of obesity. Gendarmes exhibited the highest BMI and overweight rates (50.1%) among military branches. While obesity is less prevalent in the French Armed Forces compared to the general population, the study emphasizes the equivalent prevalence of overweight. We confirm here that the global epidemic of obesity and overweight affects all armed forces. France seems less affected than other Western armies. Targeting specific groups, such as NCOs and the national gendarmerie, is crucial for prevention.

‘Hidden’ anger as a risk factor for operational health: An exploratory approach among French military personnel

ABSTRACT Military personnel are repeatedly exposed to multiple stressors, and are sometimes characterized by high levels of anger. Evidence suggests that this anger can become dysfunctional, and impact the health status of populations chronically exposed to stress. In particular, rumination (understood as perseverative thoughts about a past event), provides a theoretical framework for investigating how anger may impact stress regulation abilities in military personnel declared fit for deployment. This exploratory study aimed therefore to examine the impact of the anger profile on psychological suffering in terms of burnout and post-traumatic stress disorder (PTSD), along with the reactivity of the autonomic nervous system, measured as cardiac variability. One hundred and seventeen French soldiers were tested before deployment to Operation BARKHANE. Anger rumination, burnout, and PTSD symptoms were assessed using questionnaires, and cardiac variability was measured as the questionnaires were completed. The results revealed two profiles related to anger trait and anger rumination. Burnout and PTSD scores were higher among military personnel with high levels of anger trait and rumination, and this group also had lower parasympathetic activity and flexibility after completing the questionnaires. These results suggest that there may be a link between an angry profile and psychological suffering, notably burnout and PTSD. Rumination could be involved in this link, as it is associated with poor adaptation to stress in a military context. Prospective researches including post-deployment will establish whether this ruminative response can account for the relationship between problematic anger, stress regulatory capacities and psychological health in military populations.

Return to Sport and Duty in French Military Personnel After Medial Opening Wedge High Tibial Osteotomy.

Medial opening wedge high tibial osteotomy (MOWHTO) is a surgical option for medial femorotibial osteoarthritis, which preserves articular cartilage by correcting the extra-articular deformities of the lower limbs that cause osteoarthritis. This is an increasingly popular treatment in a population with high functional demand, such as the French military population. The aim of this study was to evaluate the rate of return to work and military activities at 6 months postsurgery and at last follow-up in this military population following MOWHTO.The hypothesis of this study was that MOWHTO enabled a majority of service members to return to the same level of activity within 6 months of surgery. This was a retrospective, multicenter study including all French military personnel operated on for MOWHTO alone for osteoarthritis of medial compartment between 2008 and 2018 in different Military Teaching Hospitals. We excluded civilian patients. For each patient, a questionnaire was used to collect epidemiological, professional, sports, and functional data. The primary endpoint was the rate of return to work at 6 months postsurgery. We also studied the recovery of sports activities and functional results at a 6.6-year follow-up by standardized questionnaires (Tegner activity scale, Lysholm, IKDC subjective (International Knee Documentation Commitee)). Twenty-four MOWHTOs were performed during this period in a cohort of 22 French military personnel. Return to work at 6 months was possible in 20/24 cases (83.3%). Of the four patients who did not return to work at 6 months, two changed their activities, while the other two returned to their jobs after 6 months. The rate of resumption of sporting activities at an equal or higher level was 50% (11/22). There was no difference between pre- and postoperative Tegner Activity Scale scores at the longest follow-up (P = .08). The mean postoperative Lysholm scores were 73.5 (standard deviation 17.8) and IKDC 59 (standard deviation 8.7). No intraoperative complications were found, and one case of postoperative infection was found. A total of 83% of the operated soldiers were able to return to their professional activities in less than 6 months. We observed a functional improvement at the last follow-up. Comparing these results with data from civilian populations, the rate of occupational recovery is comparable. However, the return to sport is much better in the series of nonmilitary patients with approximately 90% return to work and sport in the year following surgery. MOWHTO improves the functional results of the knee, enabling a return to work and sport in most cases in young, active populations such as the French military.

Retrospective analysis of tranexamic acid administration in French war-wounded between October 2016 and September 2020

IntroductionSince 2013, the French Army Health Service, in agreement with international experts, has recommended the administration of 1 g of tranexamic acid (TXA) in trauma patients in haemorrhagic shock or...

Trends in psychotropic drug consumption among French military personnel during the COVID-19 epidemic

BackgroundThe coronavirus disease (COVID-19) pandemic may have had significant mental health consequences for military personnel, which is a population already exposed to psychological stress. To assess the potential impact of the COVID-19 pandemic, we analyzed the dispensing of three classes of psychotropic drugs (anxiolytics, hypnotics, and antidepressants) among French military personnel.MethodsA retrospective analysis was conducted using the individualized medico-administrative data of persons insured by the National Military Social Security Fund from the National Health Data System. All active French military personnel aged 18–64 who received outpatient care and to whom drugs were dispensed between January 1, 2019, and April 30, 2021, were included from the French national health database. Rate ratios of dispensed anxiolytics, hypnotics and antidepressants (based on drug reimbursement) were estimated from negative binomial regressions before and after the start of the COVID-19 pandemic.ResultsThree hundred eighty-one thousand seven hundred eleven individuals were included. Overall, 45,148 military personnel were reimbursed for anxiolytics, 10,637 for hypnotics, and 4328 for antidepressants. Drugs were dispensed at a higher rate in 2020 and 2021 than in 2019. There was a notable peak at the beginning of the first lockdown followed by a decrease limited to the duration of the first lockdown. During the first lockdown only, there were temporary phenomena including a brief increase in drug dispensing during the first week followed by a decrease during the rest of lockdown, possibly corresponding to a stocking-up effect. For the study period overall, while there was a significant downward trend in psychotropic drug dispensing before the occurrence of COVID-19 (p < 0.001), the pandemic period was associated with an increase in dispensed anxiolytics (rate ratio, 1.03; 95% CI, 1.02–1.04, p < 0.05), hypnotics (rate ratio, 1.13; 95% CI, 1.11–1.16, p < 0.001) and antidepressants (rate ratio, 1.12; 95% CI, 1.10–1.13, p < 0.001) in the military population.ConclusionsThe COVID-19 pandemic has probably had a significant impact on the mental health of French military personnel, as suggested by the trends in dispensed psychotropic drugs. The implementation of mental health prevention measures should be investigated for this population.

Incidence of leptospirosis in the French armed forces from 2004 to 2018: Retrospective analysis

The French military personnel may be exposed to leptospirosis during their training or on duty on the field in continental France, and most of all, in intertropical areas in the French departments and in Africa. The aim of this study was to assess the incidence of leptospirosis from epidemiological surveillance and cases data from 2004 to 2018, and to propose tools to assess leptospirosis risk prior to any mission or leisure activity. A retrospective epidemiological study on leptospirosis cases among French Armed Forces was conducted. More data were collected for 2 clusters in Martinique, as most of leptospirosis cases among French military personnel were identified in Martinique. Eighty-eight cases of leptospirosis were reported, 15 cases in continental France and 73 cases in overseas (including 42 cases in the French West Indies). The global leptospirosis incidence rate in continental France was 0.3/100,000 person-years and in overseas 24/100,000 person-years with the higher incidence rate in Martinique (99/100,000 person-years) and in Mayotte (36.9/100,000 person-years). For the clusters in Martinique, between January and June 2009, 7 cases were declared; between 2016 and 2018, 16 cases were reported, high proportions of severe cardiac, renal and neurological forms (6/16) and hospitalizations (9/16). The occupational risk is real in French Armed Forces, particularly in malaria-free intertropical areas where chemoprophylaxis by doxycycline is not applied. Prevention can be optimized by the use of practical tools such as tables and cartographies, leading to a better leptospirosis risk assessment and application of preventive recommendations.

Hindfoot blast injuries caused by improvised explosive devices: long-term functional assessment in French military personnel.

The chosen treatment and long-term evaluation of hindfoot blast injuries are not well-represented in the literature. The first objective of this retrospective study was to evaluate functional outcomes in French service personnel who had sustained such injuries caused by improvised explosive devices. The second objective was to compare the results for patients who had amputations with those who did not. The hypothesis was that amputee recovered better function. Long-term functional evaluations were carried out using the American Orthopaedic Foot and Ankle Society scale (AOFAS), the Foot and Ankle Ability Measure (FAAM), and the Short Form 12 health survey (SF-12). Eight servicemen with ten hindfoot blast injuries were reviewed at a mean follow-up time of seven years. Primary management was always conservative although half of the patients required late amputation for chronic pain. The patients who underwent amputation reported significantly lower levels of pain than those who did not have an amputation, with higher FAAM and SF-12 scores. In this series, long-term functional results appear better in the amputated group.

Is the incidence of motor neuron disease higher in French military personnel?

Objective: Previous studies, mostly from the United States, showed an increased risk of motor neuron disease (MND) in military personnel. We compared MND incidence rates in French military personnel to that in the general population. Methods: Among persons covered between 2010 and 2016 by the Caisse Nationale Militaire de Sécurité Sociale (CNMSS, military personnel) and the Caisse Nationale d’Assurance Maladie des Travailleurs Salariés (CNAMTS, general population) aged ≥50 years, we identified incident MND cases and estimated populations at risk using national health insurance databases. We estimated relative risks (RRs) and 95% confidence intervals (CIs) separately for men and women using age-adjusted Poisson regression. Analyses were also stratified by 10-year age groups. We used the E-value approach and probabilistic bias analysis to assess robustness of the results regarding unmeasured confounding by smoking. Results: On average, 25 cases/year were newly diagnosed with MND among military personnel aged ≥50 years. The incidence rate was higher for male military personnel compared to the general population (RR = 1.16; 95% CI = 1.05–1.29) but was similar for women (RR = 1.02; 95% CI = 0.79–1.31). Although there were no significant interactions with age and sex, the association was mainly explained by men aged 70–79 years. The prevalence of ever-smoking should be at least 1.1-fold higher in male CNMSS compared to male CNAMTS members to make the association in male military personnel not significant. Conclusion: MND incidence was 16% higher in French male military personnel, in agreement with studies from other countries. Smoking may contribute to this finding. Further studies are needed to identify exposures that drive this association.

High acquisition rate of extended-spectrum β-lactamase-producing Enterobacteriaceae among French military personnel on mission abroad, without evidence of inter-individual transmission

ObjectivesAcquisition of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) by Europeans travelling individually in high-endemicity countries is common. However, how the different ESBL-E strains circulate in groups of travellers has not been studied. We investigated ESBL-E transmission within several groups of French military personnel serving overseas for 4–6 months. MethodsWe conducted a prospective study among French military personnel assigned to Afghanistan, French Guiana or Côte d’Ivoire for 4–6 months. Faecal samples provided by volunteers before leaving and after returning were screened for ESBL-E isolates. ESBL Escherichia coli from each military group was characterized by repetitive element palindromic polymerase chain reaction (rep-PCR) fingerprinting followed, in the Afghanistan group, by whole-genome sequencing (WGS) if similarity was ≥97%. ResultsAmong the 189 volunteers whose samples were negative before departure, 72 (38%) were positive after return. The highest acquisition rates were observed in the Afghanistan (29/33, 88%) and Côte d’Ivoire (39/80, 49%) groups. Acquisition rates on return from French Guiana were much lower (4/76, 5%). WGS of the 20 strains from the Afghanistan group that clustered by rep-PCR identified differences in sequence type, serotype, resistance genes and plasmid replicons. Moreover, single-nucleotide polymorphism (SNP) differences across acquired strains from a given cluster ranged from 30 to 3641, suggesting absence of direct transmission. ConclusionsESBL-E. coli acquisition was common among military personnel posted overseas. Many strains clustered by rep-PCR but differed by WGS and SNP analysis, suggesting acquisition from common external sources rather than direct person-to-person transmission.

Evolution of the prevalence of intestinal parasitic infections among the French armed forces in French Guiana.

Two cross-sectional studies were performed 2years apart in French military personnel deployed from France to French Guiana. In 2011, military medical centres in French Guiana reported 40 cases of intestinal parasitism in service members returning from illegal gold mining sites in the rainforest. In 2013, 48 out of 132 service members returning from French Guiana after a 4-month mission had eosinophilia and seven were infected with hookworm. A presumptive first-line treatment with albendazole could be the most pragmatic strategy.

Medical evacuation of French forces for dental emergencies: Operation Serval.

The objectives of this study were to (1) quantify the number of intratheater dental Medical evacuations (MEDEVACs) required for French Soldiers in Mali during Operation Serval and (2) determine a Soldier's time away from their unit because of MEDEVAC, dental treatment, and return to unit. Data concerning MEDEVACs occurring during Operation Serval were recorded by the Patient Evacuation Coordination Center. MEDEVACs resulting from oral/facial/dental conditions were evaluated for the period from February 15, 2013 to May 15, 2013. Fifty-four (15.7%) of the 338 MEDEVACs recorded were required to treat dental emergencies. Dental emergencies accounted for 54 (23.9%) of nonbattle injury MEDEVACs. Soldiers evacuated for dental problems were unavailable to their units an average of 10.5 days. French military personnel often require MEDEVAC to treat dental problems occurring in the theater of operation. Dental casualties requiring MEDEVAC are absent from their units for almost 2 weeks, which could drastically decrease their operational capacity and ability to complete their mission. Predeployment dental readiness and the presence of a dental surgeon in close proximity to deployed forces may reduce the number of MEDEVACs required and reduce the time away from the unit.

French surgical experience in the Role 3 Medical Treatment Facility of KaIA (Kabul International Airport, Afghanistan): The place of the orthopedic surgery

IntroductionIn 2009, the French took command of the Medical Hospital (MH) or Role 3 Hospital at KaIA (Kabul International Airport) within the framework of its role in the military mission Operation Pamir in Afghanistan. The goal of this study was to analyze the volume of orthopedic surgical activity for the last four years, to identify its specificities and to improve training of military orthopedic surgeons. HypothesisOrthopedic surgery is the most important activity in the field and surgeons must adapt to situations and injuries that are different from those encountered in France. Patients and methodsAll patients operated on between July 2009 and June 2013 were prospectively included in an electronic database. The analysis included the number of surgical acts and patients, the types of injuries and the surgical procedures. ResultsForty-three percent (n=1875) of 4318 procedures involved orthopedic surgery. Half of these were emergencies. French military personnel represented 17% of the patients, local civilians 47% and children 17%. Half of the procedures involved the soft tissues, 20% were for bone fixation and 10% for surgery of the hand. The rate of amputation was 6%. The diversity of the surgical acts was high ranging from emergency surgery to surgical reconstruction. DiscussionThe activity of this Role 3 facility is comparable to that of other Role 3 facilities in Afghanistan, with an important percentage of acts involving medical assistance to the local population and scheduled surgeries as well as primary and/or secondary management of the wounded. The diversity of surgical acts confirms the challenge of training military orthopedic surgeons within the context of the hyperspecialization of the civilian sector. Specific training has been organized in France by the École du Val de Grâce. Specific continuing education is also necessary. Level of evidenceIV (retrospective review).

Two Cases of Late Plasmodium ovale Presentation in Military Personnel

Only a few late cases of Plasmodium ovale presentation have been reported in literature. We describe two cases of late P. ovale presentation occurring in two French military personnel, 47 and 69 months, respectively, after a stay in Côte d'Ivoire and in the absence of new intercurrent malaria exposure.

FEATURE FILMS - Mahamat-Saleh Haroun. A Screaming Man. Original title: Un homme qui crie. 2010. Chad and France. French and Chadian Arabic, with English subtitles. 91 min. Film Movement and Pyramide International. $24.95.

Mahamat-Saleh Haroun. A Screaming Man. Original title: Un homme qui crie. 2010. Chad and France. French and Chadian Arabic, with English subtitles. 91 min. Film Movement and Pyramide International. $24.95.A Screaming Man, Mahamat-Saleh Haroun's fourth feature film after Bye Bye Africa (1999), Abouna (2002), and Daratt (2006), was widely shown and distributed after winning the Jury Prize at the 2010 Cannes Film Festival. Although Haroun has lived in France for thirty years, he chose to set all four films in his native Chad: If I stopped making them, you would never see images of Chad This view of the world, from this country where there aren't film-makers, is very important I think. So, I do it through solidarity and because I feel a responsibility not to leave this country invisible (in Alexandra Topping, Mahamat Saleh Haroun Brings Chad to the World, and Vice Versa, through Film, The Guardian, Feb. 25, 2013). The success of A Screaming Man led the government of Chad to fund a film for the first time, Haroun's Gris-Gris (2013) which, like Abouna and A Screaming Man, was shown in competition at Cannes. The Chadian government has also agreed to open a film school in N'Djamena, which will be run by the filmmaker Issa Serge Coelo.The main characters of Abouna and Daratt are children hurt by the absence of their fathers. The protagonist of A Screaming Man is a father whose presence ultimately destroys his son. Adam, a winner in his youth of the Central African Swimming Championships and still nicknamed Champion in his mid-fifties, has passed his expertise as a swim instructor and hotel pool supervisor on to his son, Abdel, only to see Abdel replace him when the N'Djamena hotel where they work is bought by a Chinese owner who downsizes the staff. Demoted to guard at the hotel gate, Adam experiences a twofold struggle. His identity, from competitive swimmer to maitre nageur, has been constructed around the swimming pool from which he has been evicted. And Abdel's willingness to accept their boss's offer to supplant him leads Adam in turn to betray his son, with far more dire consequences. Adam stops the payments to the army that have thus far spared Abdel from being drafted to fight in Chad's brutal and unending civil war, and the film remains ambiguous about whether this is an act of financial or psychological desperation. Abdel is wounded in the fighting and dies in the sidecar of his father's motorcycle after Adam sneaks him out of the barracks to take him home.A Screaming Man, an intimate portrait of an African family in the midst of an African civil war, avoids all stereotypes (both those derived from non-African sources and from Africa itself) of the African continent, its people, or its film. Haroun's Chad, for better or for worse, is neither remote nor isolated; Adam shares his swimming pool with his fellow employees, the new owner, Madame Wang, and a number of French tourists and military personnel. …

Adverse events following vaccination in the French armed forces: An overview of surveillance conducted from 2002 to 2010

French military personnel are subject to a compulsory vaccination schedule. The aim of this study was to describe vaccine adverse events (VAE) reported from 2002 to 2010 in armed forces. VAE are routinely surveyed by the military Centre for epidemiology and public health. For each case, military practitioners fill a notification form, providing patient characteristics, clinical information and vaccines administered. For this study, VAE following influenza A(H1N1)pdm09 vaccination were excluded. Among the 473 cases retained, 442 (93%) corresponded to non-severe VAE,including local, regional and systemic events, while 31 corresponded to severe VAE, with two leading to significant disability. The global VAE reporting rate (RR) was 14.0 per 100,000 injections. While stationary from 2002 to 2008, the RR increased from 2009. The most important observations were a marked increase of VAE attributed to Bacillus Calmette-Guérin (BCG) vaccine from 2005 to 2008, a high RR observed with the inactivated diphtheria-tetanus (toxoids)-poliovirus vaccine combined with acellular pertussis vaccine (dTap-IPV) from 2008 and an increase in RR for seasonal influenza vaccine VAE in 2009. Our RR for severe VAE (1.1 VAEper 100,000) appears comparable with rates observed among United States civilians and military personnel. The increase observed from 2009 could be partly explained by the influenza A(H1N1)pdm09 pandemic which increased practitioner awareness towards VAE. In conclusion, the tolerance of the vaccines used in French armed forces appears acceptable.

Reinventions of a spa town: the unique case of Vichy

Vichy appeared first as a Roman village, disappeared with the Empire, and was reborn as a medieval fortified town. Following the Middle Ages and the wars of religion, Vichy emerged in the seventeenth and eighteenth centuries as a spa centre. Urban modernisation during the Second Empire and Belle Époque, together with the promotion of hydrotherapy by business and medical interests, propelled it into prominence as an international spa tourist destination. Visitors during the late nineteenth and first half of the twentieth centuries were often French military and civilian personnel from the colonies. Following France's defeat by the Germans in 1940, Vichy became the seat of the collaborationist government of Marshal Philippe Pétain. Since the war, the town has had to overcome a stigma it acquired for its wartime role. More critical to its spa tourism trade, however, was the end of the Empire, which together with a discrediting of water cures among the medical establishment, virtually dried up spa traffic to Vichy. Town leaders have worked since to reorient its tourist trade by creating sports and convention centres. Most importantly, Vichy continues to export large quantities of the mineral water associated with its name.

Remboursement des médicaments de substitution aux opiacés chez les militaires en 2007

The use of psychoactive drugs by militaries is not compatible with the analytical skills and self-control required by their jobs. Military physicians take this problem into consideration by organising systematic drugs screening in the French forces. However, for technical reasons, opiates are not concerned by this screening with the agreement of the people concerned. The estimated number of militaries who use an opiate substitute may be an approach of heroin consumption in the French forces. This study describes buprenorphine and methadone reimbursements made during 2007 by the national military healthcare centre to French militaries. Each French soldier is affiliated to a special health insurance. The national military healthcare centre has in its information system, all the data concerning drug reimbursement made to French military personnel. This is a retrospective study of buprenorphine and methadone reimbursements made during 2007 by the military healthcare centre, to militaries from the three sectors of the French forces, and from the gendarmerie and joint forces. Only one reimbursement of one of these two drugs during this period allowed the patient to be included in our study. Daily drug dose and treatment steadiness profile have been calculated according to the criteria of the French monitoring centre for drugs and drug addiction. The criteria of the National guidelines against frauds have been used to identify misuse of these drugs. Doctors' shopping behaviour has also been studied. Finally, the nature of the prescriber and the consumption of other drugs in combination with opiate substitute have been analysed. One hundred and eighty-one military consumers of opiate substitute drugs (167 men and 14 women) participated. This sample included people from the three sectors of the French forces as well as from the gendarmerie and from the joint forces. The average age of the consumers was 26.6 years (20-42 years). The average length of service was 6.1 years (maximum 22 years service). One hundred and fifty-nine militaries had been delivered buprenorphine, 15 had been delivered methadone and seven had been delivered both. The prevalence of opiate substitute drug consumption by the militaries (52 per 100,000) is lower than in general population. According to the criteria of the National Healthcare Insurance, this population is not affected by abuse or fraud behaviour. Doctors' shopping behaviour is unusual. Opiate substitutes are prescribed by general physicians in 88% of issues. Only one prescriber was a military physician. An analysis of reimbursement of some drugs associated with opiate substitute has been made. The sampled military consume more psychoactive drugs (anxiolytics, antidepressants, hypnotics) than the French population under opiate substitution. In our observation, the military physician is almost always excluded the process of substitution. His/her different responsibilities of care, but also in determining the working aptitude, lead to dissimulation behaviour by the militaries. The difficulty for military physicians is to identify such consumption. They have to evaluate the capacity to work through a physical and psychological examination.