US Civilian Research Articles

Trends in High Levels of Low-Density Lipoprotein Cholesterol in the United States, 1999-2006

Studies show that a large proportion of adults with high levels of low-density lipoprotein cholesterol (LDL-C) remain untreated or undertreated despite growing use of lipid-lowering medications. To investigate trends in screening prevalence, use of cholesterol-lowering medications, and LDL-C levels across 4 study cycles (1999-2000, 2001-2002, 2003-2004, and 2005-2006). The National Health and Nutrition Examination Survey (NHANES) is a cross-sectional, stratified, multistage probability sample survey of the US civilian, noninstitutionalized population. After we restricted the study sample to fasting participants aged 20 years or older (n = 8018) and excluded pregnant women (n = 464) and participants with missing data (n = 510), our study sample consisted of 7044 participants. High LDL-C levels, defined as levels above the specific goal for each risk category outlined in guidelines from the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). All presented results are weighted and age-standardized to 2000 standard population estimates. Prevalence of high LDL-C levels among persons aged 20 years or older decreased from 31.5% in 1999-2000 to 21.2% in 2005-2006 (P < .001 for linear trend) but varied by risk category. By the 2005-2006 study cycle, prevalence of high LDL-C was 58.9%, 30.2%, and 11.0% for high-, intermediate-, and low-risk categories, respectively. Self-reported use of lipid-lowering medications increased from 8.0% to 13.4% (P < .001 for linear trend), but screening rates did not change significantly, remaining less than 70% (P = .16 for linear trend) during the study periods. Among the NHANES population aged 20 years or older, the prevalence of high LDL-C levels decreased from 1999-2000 to 2005-2006. In the most recent period, the prevalence was 21.2%.

Food label use and awareness of nutritional information and recommendations among persons with chronic disease

BackgroundBecause of the relation between chronic disease and poor nutritional habits, the use of food labels and adherence to dietary recommendations are important for chronic disease populations. We explored whether persons with chronic disease read nutrient information on food labels and whether they were aware of dietary guidelines. ObjectiveThis study aimed to assess dietary information use among persons with chronic disease by using a nationally representative sample of the US population. DesignA total of 5603 respondents aged ≥17 y from the 2005–2006 National Health and Nutrition Examination Survey participated in the study. This representative sample of US civilians were asked 17 questions regarding their awareness of federal nutrition information and their food label use and were given two 24-h recall dietary interviews. Participants were classified into 5 disease categories: 1) hypertension, 2) hypercholesterolemia, 3) diabetes/at risk of diabetes, 4) overweight, and 5) heart disease. ResultsSubjects with chronic diseases were more aware of nutritional recommendations, checked more often for specific nutrients, and used nutrition information on food labels more often than did participants without such diseases. Label use behavior was inconsistently associated with dietary guideline compliance. ConclusionsPeople with chronic disease generally reported better nutrition awareness and food label use and checking behaviors compared with those without chronic disease, but this did not translate into unequivocally better eating behaviors. New strategies are needed to improve the actual nutritional behaviors of persons with chronic disease.

Trends in Medical Care Expenditures of US Adults with Arthritis and Other Rheumatic Conditions 1997 to 2005

To examine trends in annual medical expenditures from 1997 to 2005 among adults with arthritis and other rheumatic conditions (denoted Arthritis group). We analyzed annual medical expenditures (2005 US dollars) among adults with Arthritis using the Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the US civilian, noninstitutionalized population. Expenditures were stratified by Arthritis and comorbidity status. The Arthritis population increased by 22% (36.8 to 44.9 million) during this period, attributable entirely to the subpopulation with at least one comorbid condition (31.8 to 40.3 million). The overall, inflation-adjusted annual mean medical expenditures for adults with Arthritis increased from $6,848 in 1997 to $7,854 in 2005. In 1997, inpatient care was the most expensive component of overall expenditures (mean $2,702), but beginning in 2001, mean inpatient and ambulatory expenditures were almost identical. Mean prescription expenditures increased nearly every year, almost doubling from $970 in 1997 to $1,811 in 2005. Aggregate total expenditures for the Arthritis population increased markedly during this period, from $252.0 to $353.0 billion (+40%). Most of this increase was attributable to the population increase in the Arthritis and comorbid condition subgroup. Mean annual ambulatory and prescription expenditures for adults with Arthritis increased far above the rate of medical inflation, offsetting a relative decline in inpatient expenditures. Increases in overall mean and aggregate total expenditures are attributable to the increasing number of adults with Arthritis and at least one comorbid chronic condition. Projected increases in this population suggest that these expenditures will continue to rise.

Conference report: Second conference of the Middle East and North Africa newborn screening initiative: Partnerships for sustainable newborn screening infrastructure and research opportunities

The second conference of the Middle East and North Africa newborn screening initiative: partnerships for sustainable newborn screening infrastructure and research opportunities was held in Cairo, Arab Republic of Egypt on April 12 to 14, 2008. Policy makers, health ministry representatives, health care providers, and experts from the region, Europe, Asia, and North America participated. The primary outcome was development of country plans of action to implement or expand newborn screening programs. Country representatives were grouped by current levels of national newborn screening activities based on a Needs Assessment Survey for national newborn screening programs and assisted by international technical experts. The Needs Assessment Survey provided information on the level of newborn screening in each country, strengths and barriers to implementation of newborn screening programs, and identified areas for research. Newborn screening programs require an integrated system of laboratories, health care providers, and educators, thus, the infrastructure put in place to screen for one condition should support expansion to other conditions. Congenital hypothyroidism was selected for initiating newborn screening programs because of its high prevalence, availability of screening methods, and cost-effective intervention. To this end, the conference provided technical sessions on screening and treatment of congenital hypothyroidism, performance standards, quality assurance, follow-up interventions, and patient management. In addition, presentations highlighted the value of integrating research into newborn screening programs as they are established and in evaluating outcomes. Research opportunities were identified at a postconference workshop sponsored by the US Civilian Research Development Foundation.

Assessing incidence and economic burden of genital warts with data from a US commercially insured population

ABSTRACTObjective: This study examined the incidence of and healthcare costs attributable to genital warts within a large US commercially insured, geographically dispersed population.Research design and methods: Using a retrospective cohort study design, this longitudinal analysis assessed administrative claims of integrated medical and pharmacy encounters from five Blue Cross Blue Shield health plans. Genital warts cases were identified using a methodology previously described by Insinga et al.Main outcome measures: Age- and gender-specific incidence of genital warts per 1000 person-years in 2004, and duration-of-episode attributable direct medical costs (2004 US dollars) and healthcare resource utilization of cases diagnosed in 2002. Overall outcome measures were age- and gender-adjusted to the 2004 US civilian population.Results: Genital warts incidence in 2004 was 1.2/1000 females and 1.1/1000 males. Incidence was highest among females aged 20–24 (4.6/1000) and males aged 25–29 (2.7/1000). Projected overall incidence was over 340 000 cases in 2004. Mean duration-of-episode per incident case in 2002 was 95.4 days (males 116.3 days; females 69.7 days). Mean ambulatory visits per episode were 1.5 for females and 1.9 for males, with <1 drug prescription/episode. Mean costs were $647/episode ($745 males; $528 females). The 2004 estimated economic burden was $760 per 1000 individuals in the general population with the total exceeding $220 million.Limitations: Only those genital warts cases that sought evaluation or for which the treating provider was covered by the health plan were captured in the study.Conclusions: Genital warts represent a significant health and cost burden in the US. Adoption of novel healthcare technologies such as vaccines along with traditional interventions such as physician education of signs and symptoms, condom use and abstinence or limiting number of sexual partners may significantly help reduce the burden of genital warts.

Occupational Exposure to Blood and Other Bodily Fluids at a Military Hospital in Iraq

Exposure to bloodborne pathogens, namely HIV, hepatitis B, and hepatitis C, remains a risk for healthcare workers. Given the austere and challenging environments in a combat zone, it is unclear to what extent blood and other bodily fluid occupational exposures pose a risk of infection for military healthcare workers deployed to a level III military treatment facility in support of Operation Iraqi Freedom. This is a retrospective review of electronic infection control records at the Air Force Theater Hospital in Iraq in which blood and other bodily fluid occupational exposure data were available: October 1, 2005 through May 31, 2006 and January 15, 2007 through April 30, 2007. During the first study period, there were 46 exposures for an average monthly exposure of 5.8 (range, 2-16 per month). The majority of exposures were percutaneous fingersticks (74%), whereas the remainder were splashes (17%) or not documented (9%). During the second study period, there were 19 exposures with percutaneous device and splash exposure encompassing 68% and 32% of cases, respectively. The majority of occurrences were in the intensive care unit (53%) and primarily among nurses (37%). Overall, there were 65 exposures per 1,000 persons during the year review. During the time periods evaluated, a substantial number of blood and other bodily fluid exposures occurred in a combat zone military healthcare facility. This finding is comparable to US civilian institutions. Maintaining programs for preventing, tracking, and implementing postexposure prophylaxis remain a worthy and achievable goal at every military treatment facility, regardless of the austerity of the environment.

Traumatic brain injury in the United States: an epidemiologic overview

A basic description of severity and frequency is needed for planning healthcare delivery for any disease process. In the case of traumatic brain injury, severity is typically categorized into mild, moderate, and severe with information from a combination of clinical observation and self-report methodologies. Recent US civilian epidemiological findings measuring the frequency of mortality and morbidity of traumatic brain injury are presented, including demographic and etiological breakdowns of the data. Falls, motor vehicle accidents, and being struck by objects are the major etiologies of traumatic brain injury. US civilian and Army hospitalization trends are discussed and compared. Features of traumatic brain injuries from Operation Iraqi Freedom and Operation Enduring Freedom are discussed.

Substance use disorder among older adults in the United States in 2020

This study aimed to project the number of people aged 50 years or older with substance use disorder (alcohol/illicit drug dependence or abuse) in the United States in 2020. Logistic regression models were applied to estimate parameters predicting past-year substance use disorder using the 2002-06 National Survey on Drug Use and Health data. We applied these parameters to the projected US 2020 population to estimate the number of adults aged 50 or older with substance use disorder in 2020. Non-institutionalized US residences. Representative sample of the US civilian, non-institutionalized population. Substance use disorder is classified based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Due to the large population size and high substance use rate of the baby-boom cohort, the number of adults aged 50 or older with substance use disorder is projected to double from 2.8 million (annual average) in 2002-06 to 5.7 million in 2020. Increases are projected for all examined gender, race/ethnicity and age groups. Our estimates provide critical information for policymakers to allocate resources and develop prevention and treatment approaches to address future needs of the US older adult population with substance use disorder.

Prevalence of Long-Term Disability From Traumatic Brain Injury in the Civilian Population of the United States, 2005

To estimate the prevalence of long-term disability associated with traumatic brain injury (TBI) in the civilian population of the United States. We first estimated how many people experienced long-term disability from TBI each year in the past 70 years. Then, accounting for the increased mortality among TBI survivors, we estimated their life expectancy and calculated how many were expected to be alive in 2005. An estimated 1.1% of the US civilian population or 3.17 million people (95% CI: 3.02-3.32 million) were living with a long-term disability from TBI at the beginning of 2005. Under less conservative assumptions about TBI's impact on lifespan, this estimate is 3.32 million (95% CI: 3.16-3.48 million). Substantial long-term disability occurs among the US civilians hospitalized with a TBI.

Five-year routine cervical cancer screening rates and intervals in a US health plan

ABSTRACTObjective: Cervical cancer screening with liquid-based cytology or concurrent HPV screening may decrease positive predictive value and specificity of screening results. Following changes to leading guidelines for cervical cancer screening, policy-makers may benefit from more detailed statistics to improve management of routine screening intervals. This paper reports annual cervical cancer screening rates, intervals between routine screenings, population cost burden of routine screening, and concurrent HPV screening rates in the medical claims database of a large US health plan between 2000 and 2004.Research design and methods: Annual cervical cancer screening rates were reported for each calendar year between 2000 and 2004, plus intervals between routine screenings in a cohort enrolled for 5 years after a first routine screening. Interval estimates accounted for women not screened in the first year of the study period. Overall screening rates and intervals were adjusted to the US civilian female population, and costs were adjusted to 2004 dollars. This database research was exempt from IRB review.Results: Annual routine screening rates during the 5-year period ranged from 33.7 to 37.2 tests per 100 enrollees. Among females with routine screenings, 68.8% were re-screened within 3 years, and 26.8% were not re-screened within 5 years. Concurrent HPV screening was 1.9 tests per 1000 routine screenings in 2000, and 27.9 per 1000 in 2004. The cost of routine screening per 1000 females was %31 282.00 in 2000 and %38 515.07 in 2004.Conclusion: More than a quarter of women with evidence of a routine cervical cancer screening were not re-screened within 5 years, while 43.4% were re-screened within a year. Triennial screening rates reported here are not comparable to traditional 3-year screening rates, and screening intervals were not reported separately by conventional and liquid-based cytology. Reducing rates of women receiving annual routine screening may offset the cost burden of newer screening technologies, but must be managed carefully to avoid decreasing 3-year screening rates. Clinicians should reinforce with their patients the need for routine screening at least triennially.

US Civilian Smallpox Preparedness and Response Program, 2003

Variola virus, the cause of smallpox disease, has been deemed a possible bioterrorism agent. Since November 2001, federal, state, and local public health partners implemented activities to prepare for a possible smallpox outbreak. The Centers for Disease Control and Prevention (CDC) produced and delivered training and educational materials for smallpox preparedness in many formats, developed detailed smallpox vaccine information statements about vaccine contraindications and vaccination site care, and established mechanisms to monitor and respond to adverse events after smallpox vaccination. The last included enhancements to the Vaccine Adverse Event Reporting System, a pregnancy registry for inadvertently vaccinated pregnant women, and a Clinician Telephone Information Line to collect reports about adverse events. The civilian responder vaccination program was conducted with rigorous safety procedures, and few historically recognized adverse events were observed. However, myocarditis and/or pericarditis was newly recognized as an adverse event caused by the New York City Board of Health vaccinia vaccine strain. This smallpox preparedness program put into place a number of measures to advance the United States' readiness for a smallpox outbreak that have assisted in preparedness for other threats.

Complementary and alternative medicine use among US Navy and Marine Corps personnel

BackgroundRecently, numerous studies have revealed an increase in complementary and alternative medicine (CAM) use in US civilian populations. In contrast, few studies have examined CAM use within military populations, which have ready access to conventional medicine. Currently, the prevalence and impact of CAM use in US military populations remains unknown.MethodsTo investigate CAM use in US Navy and Marine Corps personnel, the authors surveyed a stratified random sample of 5,000 active duty and Reserve/National Guard members between December 2000 and July 2002. Chi-square tests and multivariable logistic regression were used to assess univariate associations and adjusted odds of CAM use in this population.Results and discussionOf 3,683 service members contacted, 1,446 (39.3%) returned a questionnaire and 1,305 gave complete demographic and survey data suitable for study. Among respondents, more than 37% reported using at least one CAM therapy during the past year. Herbal therapies were among the most commonly reported (15.9%). Most respondents (69.8%) reported their health as being very good or excellent. Modeling revealed that CAM use was most common among personnel who were women, white, and officers. Higher levels of recent physical pain and lower levels of satisfaction with conventional medical care were significantly associated with increased odds of reporting CAM use.ConclusionThese data suggest that CAM use is prevalent in the US military and consistent with patterns in other US civilian populations. Because there is much to be learned about CAM use along with allopathic therapy, US military medical professionals should record CAM therapies when collecting medical history data.

Old World Leishmaniasis: An Emerging Infection among Deployed US Military and Civilian Workers

Many veterans of Operation Iraqi Freedom are now returning to the United States after potential exposure to leishmaniasis. In the past year, large numbers of leishmaniasis cases of a magnitude not encountered in the United States since World War II have challenged clinicians in both the military and the civilian sectors. Many Reserve and National Guard troops were deployed to Iraq and are now back in their communities. Hundreds of leishmaniasis cases, which were managed by a few practitioners initially, permitted further appreciation of the epidemiology and diagnostic and treatment options for Old World leishmaniasis. We describe the current situation, with on-the-ground experience, complimented by a literature review, and we provide a practical list of options for the clinician likely to encounter this parasitic infection in the coming months and years.

Prevalence of Cigarette Use Among 14 Racial/Ethnic Populations

Prevalence of Cigarette Use Among 14 Racial/Ethnic Populations

US-Russian Civilian Research and Development Fund Project: An origin of microdiamonds in metamorphic rocks of the Kokchetav Massif, Northern Kazakhstan

The Kokchetav Massif of northern Kazakhstan is a typelocality of occurrence of microdiamonds in ultrahighpressure metamorphic rocks. It records continental subduction and exhumation from depths greater than 120 km and provides unparalleled insights into mantle dynamics, global material recycling and the processes responsible for the genesis and destruction of continent. Through the support of a US Civilian Development and Research Fund, a group of Russian, US, Taiwanese and Kazakhstan geologists visited the reconstructed 800-m underground gallery to conduct field survey and sample collections. This gallery provides a useful geologic laboratory for international community to undertake similar geotectonic or different ecological and environmental studies.

Troubled Waters: The United States-United Nations Relationship

In explaining the difficulties between the United Nations and United States, this article emphasizes four factors. First, American political culture reifies American exceptionalism and commitment to sovereignty. Second, the emergence of complex peacekeeping and peace enforcement has brought US military and civilians into a direct role that complicates the country's relationship with the UN. Third, US domestic politics has a key effect on the relationship. Fourth, the US position as unrivaled hegemon has enabled it to use and manage the Security Council to its advantage, or to thwart the body altogether. The article's prognosis is that the US will continue to oscillate between supporting the UN and taking actions which simultaneously undermine its very existence.

Recipients of Highest US Civilian Honor Include Teller

Recipients of Highest US Civilian Honor Include Teller

Disaster medicine and the emergency medicine resident

Disaster medicine and the emergency medicine resident

Which Courts Should Try Persons Accused of Terrorism?

The article considers the advantages and disadvantages of trying terrorists before regular US civilian courts, before military tribunals, before courts outside the United States or before an international tribunal While civilian courts have problems with maintaining security and handling classified information, they possess a high degree of legitimacy. Military tribunals can be efficient in some ways, but their constitutional basis is questionable, depending largely on whether there is a ‘war’ going on. Foreign courts will occasionally have jurisdiction over persons captured in their territory, but some of them follow procedures that discredit them in the eyes of advanced states. The chances of an international criminal tribunal suitable for terrorist cases coming into existence in the near future do not seem good. The article concludes that, in most cases, the regular US courts will be preferable.

Association of edentulism and diet and nutrition in US adults.

Dental status and its relationship to diet and nutritional status have been little explored. In this study of a representative sample of the US civilian, non-institutionalized population (NHANES III), we predicted that the intake of nutritious foods, dietary fiber, and levels of biochemical analytes would be lower, even after adjusting for potential social and behavioral factors, among those who were edentulous and wore complete dentures than for those who had all their natural teeth. Multivariate analyses indicated that intake of carrots and tossed salads among denture-wearers was, respectively, 2.1 and 1.5 times less than for the fully dentate (p < 0.0001), and dietary fiber intake was 1.2 times less (p < 0.05). Serum levels of beta carotene (9.8 microg/dL), folate (4.7 ng/dL), and vitamin C (0.87 mg/dL) were also lower among denture-wearers (p < 0.05). Intakes of some nutrient-rich foods and beta carotene, folate, and vitamin C serum levels were significantly lower in denture-wearers.