Navy Recruits Research Articles

Opioid Prescription Reduction after Dentoalveolar Surgery-A Success Story in the Recruit Training Environment.

Given the public health toll exacted by the Opioid Crisis, it is important for providers in all disciplines to examine their opioid prescribing patterns to see where opioid reduction strategies can be effectively employed. Limiting the impact of the Opioid Crisis on active duty service members is a critical component of maintaining a ready fighting force. One avenue for reducing the potential for opioid diversion and abuse is developing and implementing non-opioid postsurgical pain management strategies that both provide adequate pain relief and also ensure an expedient return to full duty. Dentoalveolar surgeries performed by oral and maxillofacial surgeons to maintain operational dental readiness are a good example of common procedures necessitating post-procedural pain medications and convalescent days impacting availability for full duty. The providers at US Navy Recruit Training Command's oral surgery clinic undertook a process improvement initiative to reduce opioid prescriptions after dentoalveolar surgery. This change was accompanied by a concerted education effort aimed at both providers and patients on the benefits of avoiding opioids as well as the importance of strict adherence to a standardized medication dosing regimen for efficacious non-opioid pain control consisting of maximum doses of ibuprofen and acetaminophen taken every six hours. No increase in convalescent time off and no increase in postoperative visits related to pain control were noted. In our experience, eliminating routine post-procedure opioids for dentoalveolar surgery was a viable strategy for reducing the potential for opioid diversion and abuse among our patients with no negative impact on the operational and training tempo of the associated command.

Spectrum of Hematological Disorders in Young Navy Recruits

Introduction:Hematological disorders can vary from simple anemias to complicated malignancies. The aim of our study was to identify the spectrum of hematological disorders in young navy recruits that prompted a hematology oncology consult. We also aimed to obtain a sense of the recruitment process, screening tests performed and help prevent medical-hematological emergencies.Materials and Methods:A retrospective chart review was conducted at our hospital, Captain James a Lovell Federal Health Care Centre, North Chicago. Recruits who were referred to hematology and oncology clinic in the past one year(2015-2016) were included.Results:We reviewed a total of 122 patients, which included 84 males and 38 female recruits. The age range was 18 to 31. The most common reason for consult was microcytic anemia evaluation (30%), followed by normocytic anemia (21%) and coagulopathy evaluation (13%). Other reasons for consult included neutropenia, leukocytosis, microcytic anemia with neutropenia, normocytic anemia with neutropenia, thrombocytopenia, thrombocytosis, pancytopenia, splenomegaly, pancytopenia in association with splenomegaly, recurrent epistaxis, unusual bleeding, history of deep vein thrombosis and testicular tumor (Table 1).Microcytic anemia was secondary to Iron deficiency anemia(IDA) in 59% of recruits, either due to malnutrition and menorrhagia in females or gastritis with blood loss in males. Other causes of microcytic anemia were E-Alpha thalassemia, alpha thalassemia minima alone or in combination with IDA, beta thalassemia trait, sickle cell trait in association with IDA and alpha thalassemia minima. The most common cause of normocytic anemia was Anemia of Chronic disease in association with Vitamin D deficiency (15%). Other causes are mentioned in table 1. Coagulopathy was mostly secondary to viral syndrome causing abnormal liver function tests/LFT (75%). Coagulopathy due to mild hemophilia was identified in 3 patients. Thrombocytopenia occurred because of ITP (Immune Thrombocytopenia) or viral syndrome in most patients.Navy recruits are routinely screened for sickle cell disease and G6PD deficiency, but are not screened for anemia or coagulation abnormalities. Most recruits in our study presented with severe anemia or bleeding after dental extraction (especially hemophiliacs and thrombocytopenic patients) which disrupted recruit training. Few recruits were also separated depending on severity of hematological illness. In our retrospective study, even mild hemophiliacs had abnormal PTT. Hence, if complete blood count(CBC) and prothrombin time/partial thromboplastin time (PT/PTT) testing were included as a part of screening during recruit enrollment, many hematological disorders can be diagnosed early and complications can be prevented. Early diagnosis will also help identify recruits with severe and disabling hematological disorders, thereby preventing their admission to boot camp and avoiding unnecessary training expense. Good testicular exam is also recommended as part of initial screening as one of our patients was diagnosed with testicular tumor.Conclusion:Young navy recruits are a unique group of people, many of whom have minimal medical and dental care because of poor socio-economic status at home. Demanding physical activity in presence of underlying anemia, or dental extraction in presence of bleeding disorders or platelet abnormalities cause medical-hematologic emergencies. Simple screening tests such as CBC, PT/PTT and testicular exam can help identify hematological disorders early and prevent complications. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Effectiveness of Acceptance and Commitment Therapy in Increasing Resilience and Reducing Attrition of Injured US Navy Recruits.

US Navy recruits who have injuries preventing them from participating in intense physical conditioning are pulled out of boot camp training and receive treatment that includes daily physical therapy, pain medications, and psychoeducational groups. Graduation from boot camp for these recruits requires not only recovering from their injuries but also passing a required Physical Fitness Assessment consisting of a timed 1.5-mile run, curl-ups, and push-ups. About 50-60% of these recruits will eventually be separated out and sent home. The purpose of this study is to examine the effectiveness of an Acceptance and Commitment Therapy (ACT)-based program called Mindfulness for Pain and Performance Enhancement (MPPE). This treatment program was designed to help recruits effectively handle pain and assist them in improving their physical performance in the service of recovery, boot camp completion, and entrance into the Navy. This study was approved by the Edward Hines VA Hospital/Captain James A. Lovell Federal Health Care Center Institutional Review Board and the Naval Services Training Command. Treatment was voluntary and a total of 373 recruits enrolled in one of the 32 cycles of MPPE administered. Attrition was 35.1% (131 recruits). The control group comprised 310 recruits who did not enroll in MPPE. Recruits continued to receive standard treatment services (e.g., physical therapy, medical interventions, and psychoeducational groups) while participating in MPPE. Chi-square tests and one-way analysis of variance were used to analyze comparisons among treatment, control, and attrition groups on demographic, clinical, and boot camp training variables. Paired sample t-tests and Cohen's d effect sizes were computed to assess change on treatment outcome measures. Logistic regression was performed to identify demographic, clinical, and boot camp training variables predictive of graduation. All of the pre- to post-treatment outcome measures were significant and Cohen's d effect sizes ranged from 0.41 to 0.84. Effect size changes were small for anxiety and experiential avoidance; moderate for pain acceptance, mindfulness, cognitive inflexibility, and depression; and large for pain reduction. Treatment completers graduated at a higher rate (58.3%) than attrites (34.4%) or controls (45.5%). Based on a logistic regression model, variables predictive of graduation included MPPE completion, age, and reported pain rating. MPPE is a six-session, 2-wk-long Acceptance and Commitment Therapy-based approach to pain and physical performance that was added to existing treatment services. Results supported the use of this program for helping recruits recover from injuries and successfully pass physical training requirements for graduation. Recruits were not randomly assigned to treatment, thus limiting the interpretation of outcomes. Incorporating this treatment earlier in boot camp training and making it available to more recruits (i.e., not only injured recruits) may further reduce attrition and contribute to greater resiliency of sailors within the US Navy fleet.

Electro and Echocardiographic Profile of Young American Navy Recruits Presented with Syncope

Background: The etiology of syncope in young adults is poorly defined and most studies reveal benign etiologies. However, case reports suggest that exercise-related syncope, even in young patients, can be a harbinger of sudden cardiac death. We aim to determine the characteristics of young adults presenting with syncope in a diverse population of navy recruits. Methods: A retrospective chart review was performed on all Navy recruits who presented with a complaint of syncope to the Captain James A. Lovell Federal Health Care Center (JALFHCC) between June 1, 2006 and May 31, 2013. There was a total of 154 charts. Demographics and clinical data, along with Electrocardiogram (EKG), telemetry, and echocardiographic findings were recorded. Variables were compared between the subjects with abnormal cardiac profile and subjects with normal cardiac results. Results: The sample size of 154 included 95 males and 59 females. There were 13 (8.4%) subjects who were found to have concerned cardiac findings; 9 were males (9.5% of males) and 4 were females (6.8% of females). Compared to those without cardiac findings, there were no significant differences in age (20.2 ± 3.8 vs. 20.2 ± 2.5 years), body mass index (25.8 ± 2.8 vs. 24.7 ± 3.5), prior history of syncope (23 vs. 21%), or presence of exertional syncope (77 vs. 63%). Conclusion: A significant proportion of young American navy recruits have evidence of concerning electro and echocardiographic findings. We did not find any clinical profile predicting such findings although there was a statistically insignificant, but noticeable trend towards exertional syncope in those who had concerning cardiac abnormalities.

Effectiveness of foot orthoses for the prevention of lower limb overuse injuries in naval recruits: a randomised controlled trial

ObjectivesTo evaluate the effectiveness of prefabricated foot orthoses for the prevention of lower limb overuse injuries in naval recruits.MethodsThis study was a participant-blinded and assessor-blinded, parallel-group randomised controlled trial. Three-hundred...

Sink or Swim by Steve Watkins

Reviewed by: Sink or Swim by Steve Watkins Elizabeth Bush Watkins, Steve Sink or Swim. Scholastic, 2017 [272p] ISBN 978-1-338-05790-4 $16.99 Reviewed from galleys R Gr. 4-7 When the bombs drop on Pearl Harbor, seventeen-year-old Danny is off like a shot to the Navy recruiters, but before he gets to the war, the war gets to him as a German U-boat surfaces into his trawling net, drags him underwater, and leaves him severely injured. His younger brother Colton, who watches it all go down and brings his brother home, is enraged and now bent on fighting the Nazis. As Danny lingers in unconsciousness in their hometown's clinic, Colton grabs his brother's recruitment papers and passes himself off as a very young-looking teen to a Navy so desperate for recruits that they turn a blind eye to the thousands of minors who manage to enlist. Loosely inspired by the story of Calvin Graham, the youngest known American to serve in World War II, this gripping novel follows his basic training at Great Lakes, his subchaser training in Miami, and his deployment aboard a patrol craft, one of the nimble vessels in the "Donald Duck Navy" tasked with sighting U-boats and attacking wolf packs. Diligent research (explained in Watkins' closing notes) manifests in the authenticity of training strategies as well as the life-and-death maneuvers of the wolf packs and their Ally predators. Short chapters, generous font and leading, and a relatively modest page count make this an appealing selection for reticent readers, and nonstop action recommends it to real world thrill-seekers of all reading stripes. EB Copyright © 2017 Board of Trustees of the University of Illinois

Foot orthoses for the prevention of lower limb overuse injuries in naval recruits: study protocol for a randomised controlled trial.

BackgroundFoot orthoses are frequently used for the prevention of lower limb overuse injuries but evidence for their effectiveness is limited. The primary aim of this study is to determine if prefabricated foot orthoses reduce the incidence of lower limb overuse injuries in naval recruits undertaking 11 weeks of basic training.MethodsThis study is a participant and assessor blinded, parallel-group, randomised controlled trial. The trial will recruit participants undertaking 11 weeks of basic training at the Royal Australian Navy Recruit School, Cerberus, Victoria, Australia. Participants will be randomised to a control group (flat insole) or an intervention group (prefabricated foot orthosis). Over the 11 weeks of basic training, participants will document the presence and location of pain in weekly self-report diaries. The end-point for each participant will be the completion of 11 weeks of basic training. The primary outcome measure will be the combined incidence of four lower limb injuries (medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy, and plantar fasciitis/plantar heel pain) which are common among defence members. Secondary outcome measures include: (i) overall incidence of lower limb pain, (ii) severity of lower limb pain, (iii) time to injury, (iv) time to drop-out due to injury, (v) adverse events, (vi) number of lost training days, (vii) shoe comfort, and (viii) general health status. Data will be analysed using the intention-to-treat principle.DiscussionThis randomised controlled trial will evaluate the effectiveness of prefabricated foot orthoses for the prevention of common lower limb overuse injuries in naval recruits.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12615000024549.

Considering a relational model for depression in Navy recruits.

Key variables that have influenced depression in previous research were examined in this study including adult attachment, perceived social support, sense of belonging, conflict in relationships, and loneliness for their relationships in a relational model for depression with U.S. Navy recruits in basic training. This theory-testing analysis study was part of a larger cross-sectional cohort study that examined the factors associated with depression in Navy recruits. The sample for this study included 443 recruits. Structural equation modeling was used to test the fit of the theoretical model. The proposed model explained 49% of the variance in depressive symptoms with loneliness and sense of belonging as the strongest indicators of depression. The Navy should consider interventions that increase sense of belonging in high risk for depression recruits to decrease loneliness and depression and circumvent recruits not completing basic training. The assumption that recruits are in close quarters and contact with other people and therefore are not lonely and receive adequate social support is not supported. This article contributes to advancing the science of mental health in relation to depression by considering predictors that are amenable to intervention.

Fitness for Duty: Two Cases of Rare Hemoglobin Variants in U.S. Navy Recruits

There are many hemoglobin (Hb) variants that vary in prevalence as well as in clinical significance. Two young male military recruits were incidentally found to have two uncommon Hb variants. This led to an investigation of Hb Lepore-Boston and G-Waimanalo to determine if these U.S. Navy recruits were healthy enough to perform their designated duties. Literature search was conducted using PubMed/Medline. Keywords included "hemoglobinopathy," "hemoglobin variant," "Lepore-Boston," "G-Waimanalo." Results that included cases of Hb Lepore-Boston and G-Waimanalo literature were included. There are few reported cases of these Hb variants that have geographical patterns. It was discovered that Hb Lepore is a group of three variants, characterized by hybrid δβ chains, which expresses features of β-thalassemia trait in heterozygotes. Hb G-Waimanalo or α64(E13) Aspartic acid (Asp) → Asparagine (Asn) is a slow-moving α chain variant, which often results in a mild microcytic hypochromic anemia. Hb Lepore-Boston and G-Waimanalo are benign Hb variants that typically produce mild and asymptomatic anemia. With no clinical relevance in either of these rare Hb variants, the recruits were found qualified for both general duty and their specialty rates.

The Association of Self-Reported Measures With Poor Training Outcomes Among Male and Female U.S. Navy Recruits

This prospective study evaluated the association of self-reported health habits and behaviors in 2,930 Navy recruits with poor training outcomes, defined as graduating late or separating from training. Although 17% of the men and 21% of the women had a poor training outcome, results suggest that some self-reported measures were associated with poor training outcomes. Men who did not run or jog at least 1 month before basic training or had a previous lower limb injury without complete recovery and women reporting the same or less physical activity compared with their same-age counterparts were more likely to have a poor training outcome. An important first step in decreasing poor training outcomes is encouraging incoming recruits to participate in physical activity and taking steps to identify and rehabilitate recruits who are not completely healed from a lower limb musculoskeletal injury before reporting to basic training.

The Role of Recruit Division Commanders in Graduation From U.S. Navy Recruit Training

We investigated the importance of the role of drill instructors (RDCs) on training and retention of new sailors (N = 34,000). Based on social support and group cohesion literatures, we hypothesized that social support from RDCs would influence completion rates of entry-level Navy training and retention intention of new sailors. We found that perceptions of social support from RDCs had a significant positive relationship with eventual graduation from basic training; encouragement to remain in the Navy was particularly strongly related to graduation when the source of the encouragement was RDCs. Further, those who attrited from training were especially likely to perceive RDCs as encouraging them to leave the Navy. We discuss the implications of our findings in terms of theory, research and practice.

The relationship between varicoceles and obesity in a young adult population

To determine whether a relationship between obesity and varicocele occurrence exists, the prevalence and severity of varicoceles related to obesity were investigated in a general population of young males. A total of 1050 young males attending the Navy Recruit Training Center were evaluated from their physical screening examinations. All subjects underwent history taking and physical examinations to evaluate for the presence and severity of varicocele. The anthropometric indexes including body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) were recorded. All subjects were categorized by quartiles according to each anthropometric index. Means were compared with the Student's t-test. Severity was compared by analysis of variance testing and frequency was analysed using the chi-square method. Statistical significance was considered at p <0.05. A total of 490 (46.67%) subjects had varicoceles. The means of BMI, WC and WHR of those without varicoceles was 23.99 +/- 3.82 kg/m(2), 83.20 +/- 9.97 cm and 0.85 +/- 0.05, respectively. These judged values were greater than those with varicoceles (22.02 +/- 3.18 kg/m(2), 79.19 +/- 9.01 cm and 0.83 +/- 0.05) (p < 0.001). In the univariate regression analysis, BMI, WC and WHR all had a significantly negative correlation with severity of varicocele (all p < 0.001). Analysis comparing varicocele frequency based on each grade per anthropometric index group was performed. The logistic regression revealed that the prevalence of grade II and III varicoceles showed a statistically inverse association with all three anthropometric indexes. The prevalence and severity of varicoceles inversely correlated with obesity. The present data support the explanation that obesity may result in a decreased nutcracker effect, which accounts for prevention of the renal vein compression by the adipose tissue.

Is Obesity Correlated With Sexual Function in Young Men?

The study investigated the correlation between obesity and sexual function in young men. It was a cross-sectional study in an unselected consecutive sample of military men aged less than 28 years old attending to the Navy Recruit Training Center. There were 772 subjects included in the study, excluding subjects with comorbidities and subjects who had not engaged in sexual intercourse. All men underwent a detailed health examination, including physical assessment and taking of medical history. Obesity was assessed by anthropometric means, including body mass index, waist circumference (WC), and waist-to-hip ratio. Subjects were categorized into 4 groups by increasing order according to each anthropometric indicator (quartile method). Clinical sexual function was evaluated with the International Index of Erectile Function-5 (IIEF-5) scale score. There was no statistical difference in IIEF-5 score between smoking and nonsmoking groups (t test, P = .422). According to analysis of variance, only the anthropometric indicator WC showed a statistically significant correlation with IIEF-5 severity (P = .032). A possible explanation was that the systemic effects of obesity and smoking would take place while combined with the process of aging.

Calcium and Vitamin D Supplementation Decreases Incidence of Stress Fractures in Female Navy Recruits

Calcium and Vitamin D Supplementation Decreases Incidence of Stress Fractures in Female Navy Recruits

Incidence Rates of Pelvic Inflammatory Disease Diagnoses Among Army and Navy Recruits: Potential Impacts of Chlamydia Screening Policies

U.S. Navy policy requires Chlamydia trachomatis screening of all women upon entry to recruit training in conjunction with an educational session, and yearly screening thereafter until age 25. Army policy directs only annual screening of asymptomatic women aged <25. Hence, screening of Army recruits may not occur for up to 12 months following accession. Using routinely collected surveillance data, the rates of outpatient pelvic inflammatory disease (PID) following accession into the Army or Navy were compared to assess the potential implications of these policies. The population at risk comprised active-component women aged <25 who accessioned to either the U.S. Army or Navy between January 1, 2001, and December 31, 2005. Subjects were followed up to 60 months from accession, either until a first outpatient PID diagnosis occurred or they departed from military service. Data were collected from 2001 to 2006 and analyzed in 2007. Multiple Poisson regression was used to assess the effects of potentially important covariates. Time-to-event analysis was employed to characterize risk over time. There were 1276 and 546 incident outpatient diagnoses of PID among 58,088 Army and 33,046 Navy accessions during 93,918 and 65,863 person-years of follow-up, respectively. The crude incident rate was 64% higher in the Army (13.6/1000 person-years) than the Navy (8.3/1000 person-years). Risk for the Army increased soon after accession, followed by a decline, while risk for the Navy remained comparatively uniform. PID rates were higher in the Army than Navy during the first years of active service. A comprehensive study to elucidate the source of this observed difference is warranted.

Calcium and Vitamin D Supplementation Decreases Incidence of Stress Fractures in Female Navy Recruits

Stress fractures (SFx) are one of the most common and debilitating overuse injuries seen in military recruits, and they are also problematic for nonmilitary athletic populations. The goal of this randomized double-blind, placebo-controlled study was to determine whether a calcium and vitamin D intervention could reduce the incidence of SFx in female recruits during basic training. We recruited 5201 female Navy recruit volunteers and randomized them to 2000 mg calcium and 800 IU vitamin D/d or placebo. SFx were ascertained when recruits reported to the Great Lakes clinic with symptoms. All SFx were confirmed with radiography or technetium scan according to the usual Navy protocol. A total of 309 subjects were diagnosed with a SFx resulting in an incidence of 5.9% per 8 wk. Using intention-to-treat analysis by including all enrolled subjects, we found that the calcium and vitamin D group had a 20% lower incidence of SFx than the control group (5.3% versus 6.6%, respectively, p = 0.0026 for Fisher's exact test). The per protocol analysis, including only the 3700 recruits who completed the study, found a 21% lower incidence of fractures in the supplemented versus the control group (6.8% versus 8.6%, respectively, p = 0.02 for Fisher's exact test). Generalizing the findings to the population of 14,416 women who entered basic training at the Great Lakes during the 24 mo of recruitment, calcium and vitamin D supplementation for the entire cohort would have prevented approximately 187 persons from fracturing. Such a decrease in SFx would be associated with a significant decrease in morbidity and financial costs.

Premilitary Adult Sexual Assault Victimization and Perpetration in a Navy Recruit Sample

Female (n = 5,226) and male (n = 5,969) U.S. Navy recruits completed a survey assessing their premilitary histories of adult sexual assault (SA), defined as attempted or completed rape since the age of 14. The survey was completed under anonymous or identified conditions. Overall, 39% of women reported premilitary SA victimization and 13% of men admitted premilitary SA perpetration. As predicted, rates were significantly higher in the anonymous than in the identified condition. For the sample of women as a whole, marital status, ethnicity, and family income were associated with SA victimization; for men, only marital status was associated with SA perpetration. Compared to previous college samples, Navy recruits were more likely to have previous SA experience. Given the negative consequences associated with SA victimization and perpetration, the present study reinforces the desirability of developing additional treatment, education, and prevention programs to reduce the occurrence of SA among military recruits.

STARS: Strategies to Assist Navy Recruits' Success

The purpose of the Strategies to Assist Navy Recruits' Success (STARS) project, a prospective cluster-randomized intervention trial, was to determine the effects of the BOOT Camp Survival Training for Navy Recruits-A Prescription (BOOT STRAP) mental health intervention on divisions of Navy recruits. A total of 1,199 recruits participated in the study. The intervention was provided weekly during basic training to an entire division. The percentage of recruits separated from the Navy who did not receive the intervention was almost twice as large as compared to the recruits who did receive intervention (10.33% vs. 5.17%; p < 0.05) during surge training. The intervention group recruits developed significantly higher group cohesion, higher scores on problem-solving coping strategies, and higher perceived social support, while reporting lower scores on anger expression coping strategies than the control group recruits. Potential cost savings per year on recruit training were estimated to be $18.6 million. Training facilitators and conducting the group intervention would cost an estimated $1.5 million per year. Building on previous research, the results of this study have the potential to decrease attrition, improve recruit performance levels, and provide a cost-effective method of enhancing recruit retention.

Detection of Mycobacterium tuberculosis Infection in United States Navy Recruits Using the Tuberculin Skin Test or Whole-Blood Interferon- Release Assays

Military personnel are at risk for acquiring Mycobacterium tuberculosis infection because of activities in close quarters and in regions with a high prevalence of tuberculosis (TB). Accurate tests are needed to avoid unnecessary treatment because of false-positive results and to avoid TB because of false-negative results and failure to diagnose and treat M. tuberculosis infection. We sought to estimate the specificity of the tuberculin skin test (TST) and 2 whole-blood interferon-gamma release assays (QuantiFERON-TB assay [QFT] and QuantiFERON-TB Gold assay [QFT-G]) and to identify factors associated with test discordance. A cross-sectional comparison study was performed in which 856 US Navy recruits were tested for M. tuberculosis infection using the TST, QFT, and QFT-G. Among the study subjects, 5.1% of TSTs resulted in an induration > or = 10 mm, and 2.9% of TSTs resulted in an induration > or = 15 mm. Eleven percent of QFT results and 0.6% of QFT-G results were positive. Assuming recruits at low risk for M. tuberculosis exposure were not infected, estimates of TST specificity were 99.1% (95% confidence interval [CI], 98.3%-99.9%) when a 15-mm cutoff value was used and 98.4% (95% CI, 97.3%-99.4%) when a 10-mm cutoff value was used. The estimated QFT specificity was 92.3% (95% CI, 90.0%-94.5%), and the estimated QFT-G specificity was 99.8% (95% CI, 99.5%-100%). Recruits who were born in countries with a high prevalence of TB were 26-40 times more likely to have discordant results involving a positive TST result and a negative QFT-G result than were recruits born in countries with a low prevalence of TB. Nineteen (50%) of 38 recruits with this type of discordant results had a TST induration > or = 15 mm. The QFT-G and TST are more specific than the QFT. No statistically significant difference in specificity between the QFT-G and TST was found using a 15-mm induration cutoff value. The discordant results observed among recruits with increased risk of M. tuberculosis infection may have been because of lower TST specificity or lower QFT-G sensitivity. Negative QFT-G results for recruits born in countries where TB is highly prevalent and whose TST induration was > or = 15 mm suggest that the QFT-G may be less sensitive than the TST. Additional studies are needed to determine the risk of TB when TST and QFT-G results are discordant.

Psychosocial Effects of the Boot Strap Intervention in Navy Recruits

The purpose of this prospective study was to investigate the effects of the Boot Camp Survival Training for Navy Re cruits--A Prescription (BOOT STRAP) intervention on stress depression, situational events, interpersonal factors, and recruit training performance. Divisions of Navy recruits were randomly selected and 801 recruits participated for the 9 weeks of their training. Recruits "at risk" for depression were randomly assigned to the intervention or nonintervention groups, and the remaining recruits served as the comparison group. The at-risk recruits who received the BOOT STRAP intervention significantly increased their sense of belonging, experienced less loneliness, used more problem-solving coping skills, and decreased insecure attachment by the end of recruit training. Percentages of recruits in the study success fully completing basic training were 84% of the comparison group, 86% of the intervention group, and only 74% of the nonintervention group. Results suggest that the BOOT STRAP intervention improves recruit functioning, strengthens train ing performance, helps reduce attrition, and may have impor tant implications for stress and depression interventions.