Some military organizations in the U.S. Indo-Pacific Command (INDOPACOM) give returning soldiers presumptive treatment for filariasis. As there have been few clinical cases in recent decades, the historical basis for this chemotherapy was reviewed. During the Second World War, U.S. Marines stationed on Polynesian islands such as Tonga, Samoa, and Fiji experienced clinical lymphatic filariasis. Although thousands of both U.S. and Australian soldiers served in New Guinea, few, if any, cases of lymphatic filariasis were ascribed to Melanesia. While the French Army reported dozens of cases of filariasis among its service members during the 1950s Vietnam conflict, the U.S. military experienced only a few cases among the nearly 2 million service members who served in Vietnam in the 1960s. Australian soldiers deployed to Timor Leste in the 21st century showed rare seroconversions to filaria but no clinical disease. Following mass drug administration to eliminate lymphatic filaria in the INDOPACOM region, exposure in deployed soldiers rarely occurs and preventive chemotherapy should cease.
{"title":"Lymphatic filariasis in soldiers exposed in INDOPACOM.","authors":"G Dennis Shanks, James K Smith","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Some military organizations in the U.S. Indo-Pacific Command (INDOPACOM) give returning soldiers presumptive treatment for filariasis. As there have been few clinical cases in recent decades, the historical basis for this chemotherapy was reviewed. During the Second World War, U.S. Marines stationed on Polynesian islands such as Tonga, Samoa, and Fiji experienced clinical lymphatic filariasis. Although thousands of both U.S. and Australian soldiers served in New Guinea, few, if any, cases of lymphatic filariasis were ascribed to Melanesia. While the French Army reported dozens of cases of filariasis among its service members during the 1950s Vietnam conflict, the U.S. military experienced only a few cases among the nearly 2 million service members who served in Vietnam in the 1960s. Australian soldiers deployed to Timor Leste in the 21st century showed rare seroconversions to filaria but no clinical disease. Following mass drug administration to eliminate lymphatic filaria in the INDOPACOM region, exposure in deployed soldiers rarely occurs and preventive chemotherapy should cease.</p>","PeriodicalId":38856,"journal":{"name":"MSMR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11413130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patricia A Vu, Shauna L Stahlman, Michael T Fan, Natalie Y Wells
Women, who comprise approximately 18% of the U.S. Armed Forces, suffer disproportionately higher rates of musculoskeletal injuries among active component service members. Using a retrospective study design, this study calculated incidence rates and rate ratios for acute hip fractures and hip stress fractures from January 1, 2018 through September 30, 2022 among female and male active component U.S. military members. Women who were younger than age 20 years, in recruit training, serving in the Army or Marine Corps, engaged in combat-related occupations, and with body mass indexes in the underweight or normal weight categories had the highest rates of both types of fractures. Women who had progressed beyond the recruit training phase had a higher female-to-male rate ratios of hip stress fractures than recruits. Despite an overall decline during the surveillance period, rates of acute hip fracture and hip stress fracture were higher among women than men. Changes in training and fitness policies may have contributed to the hip fracture rate declines among women. Continued efforts are needed to further reduce injuries among women.
{"title":"Incidence and risk factors for hip fractures among U.S. Armed Forces active component women compared to men, 2018-2022.","authors":"Patricia A Vu, Shauna L Stahlman, Michael T Fan, Natalie Y Wells","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Women, who comprise approximately 18% of the U.S. Armed Forces, suffer disproportionately higher rates of musculoskeletal injuries among active component service members. Using a retrospective study design, this study calculated incidence rates and rate ratios for acute hip fractures and hip stress fractures from January 1, 2018 through September 30, 2022 among female and male active component U.S. military members. Women who were younger than age 20 years, in recruit training, serving in the Army or Marine Corps, engaged in combat-related occupations, and with body mass indexes in the underweight or normal weight categories had the highest rates of both types of fractures. Women who had progressed beyond the recruit training phase had a higher female-to-male rate ratios of hip stress fractures than recruits. Despite an overall decline during the surveillance period, rates of acute hip fracture and hip stress fracture were higher among women than men. Changes in training and fitness policies may have contributed to the hip fracture rate declines among women. Continued efforts are needed to further reduce injuries among women.</p>","PeriodicalId":38856,"journal":{"name":"MSMR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11413133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher Moller, Ken Lilley, Fiona McCallum, G Dennis Shanks
Australian Defence Force (ADF) personnel train and operate in malarious regions that include neighboring countries with high burden and species with latent hepatic parasites.1 We summarized longitudinal malaria case data, following a prior 10-year period review to 2007.2 Malaria case entries within the ADF Malaria and Infectious Diseases Institute (ADFMIDI)-managed Central Malaria Register (CMR) were examined. Data from cases confirmed between January 1, 2008 through December 31, 2022 were analyzed. Sixty ADF members were diagnosed with malaria, including 1 with a mixed Plasmodium falciparum and P. vivax infection. Of 61 malaria infections, 69% (42 of 61) were P. vivax. P. vivax infection resulted in delayed initial case presentation (more than 4 weeks after exposure) in at least 36% (15 of 42) of cases, and 5 personnel experienced further relapse. Most P. vivax infections were acquired in the U.S. Indo-Pacific Command (INDOPACOM) and P. falciparum in the U.S. Africa Command (AFRICOM) regions. The ADF experienced ongoing reduced malaria case incidence following high rates in the early 2000s. Maintenance of prophylactic vigilance, both for eradicating dormant hypnozoites and preventing P. vivax relapse, remains important, however.
{"title":"Malaria in the Australian military, 2008-2022.","authors":"Christopher Moller, Ken Lilley, Fiona McCallum, G Dennis Shanks","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Australian Defence Force (ADF) personnel train and operate in malarious regions that include neighboring countries with high burden and species with latent hepatic parasites.1 We summarized longitudinal malaria case data, following a prior 10-year period review to 2007.2 Malaria case entries within the ADF Malaria and Infectious Diseases Institute (ADFMIDI)-managed Central Malaria Register (CMR) were examined. Data from cases confirmed between January 1, 2008 through December 31, 2022 were analyzed. Sixty ADF members were diagnosed with malaria, including 1 with a mixed Plasmodium falciparum and P. vivax infection. Of 61 malaria infections, 69% (42 of 61) were P. vivax. P. vivax infection resulted in delayed initial case presentation (more than 4 weeks after exposure) in at least 36% (15 of 42) of cases, and 5 personnel experienced further relapse. Most P. vivax infections were acquired in the U.S. Indo-Pacific Command (INDOPACOM) and P. falciparum in the U.S. Africa Command (AFRICOM) regions. The ADF experienced ongoing reduced malaria case incidence following high rates in the early 2000s. Maintenance of prophylactic vigilance, both for eradicating dormant hypnozoites and preventing P. vivax relapse, remains important, however.</p>","PeriodicalId":38856,"journal":{"name":"MSMR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11413131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Devin C Kelly, Michael Fan, Richard S Langton, Shauna L Stahlman
Vitamin D contains 2 related fat-soluble substances, D3 and D2, that are essential for bone health and overall well-being. The burden of vitamin D deficiency within the active component of the armed forces is unknown. This study describes trends of vitamin D deficiency diagnoses in the active component of the U.S. Armed Forces. Risk factors for vitamin D, such as military occupation, were examined to see if preventive measures and targeted vitamin D screening would be beneficial, as the United States Preventive Task Force does not recommend universal screening for vitamin D, nor does TRICARE cover screening for asymptomatic individuals. The surveillance period covered January 1, 2018 through December 31, 2022. The data were derived from the Defense Medical Surveillance System (DMSS). Vitamin D deficiency was measured using ICD-9-CM and ICD-10-CM diagnoses recorded in inpatient and outpatient medical encounters. Incidence rate and average annual prevalence were calculated. A logistic regression was performed to obtain adjusted odds ratios. The rates of vitamin D deficiency diagnoses among active component service members (ACSMs) remained steady during the study period, with an incidence rate of 16.4 per 1,000 person-years and an average annual prevalence of 2.2%. Female service members, those of older age groups, and indoor workers demonstrated higher rates of vitamin D deficiency. Previously described demographic risk factors such as indoor work and history of obesity or malabsorption syndrome were also associated in this study with vitamin D deficiency in ACSMs, although older age groups in this study were not associated with vitamin D deficiency. Pilots and air crew had the lowest rates of vitamin D deficiency, while health care workers had the highest, when evaluating by occupation.
维生素 D 含有两种相关的脂溶性物质 D3 和 D2,对骨骼健康和整体健康至关重要。武装部队现役人员缺乏维生素 D 的情况尚不清楚。本研究描述了美国武装部队现役人员维生素 D 缺乏症的诊断趋势。由于美国预防工作组并不建议普遍进行维生素 D 筛查,TRICARE 也不涵盖无症状人员的筛查,因此本研究对维生素 D 的风险因素(如军事职业)进行了研究,以了解预防措施和有针对性的维生素 D 筛查是否有益。监测期为 2018 年 1 月 1 日至 2022 年 12 月 31 日。数据来源于国防医疗监控系统(DMSS)。维生素 D 缺乏症通过住院和门诊病人就诊记录中的 ICD-9-CM 和 ICD-10-CM 诊断进行测量。计算了发病率和年平均患病率。通过逻辑回归得出调整后的几率比。在研究期间,现役军人(ACSMs)的维生素 D 缺乏诊断率保持稳定,发病率为每千人年 16.4 例,年平均患病率为 2.2%。女性现役军人、老年群体和室内工作者的维生素 D 缺乏率较高。之前描述过的人口风险因素,如室内工作和肥胖或吸收不良综合症病史,在本研究中也与美国海军陆战队员维生素 D 缺乏症有关,尽管在本研究中年龄较大的人群与维生素 D 缺乏症无关。在按职业进行评估时,飞行员和空乘人员的维生素 D 缺乏率最低,而医护人员的维生素 D 缺乏率最高。
{"title":"Vitamin D deficiency trends, risk factors, and occupational risk in active component service members of the U.S. Armed Forces, 2018-2022.","authors":"Devin C Kelly, Michael Fan, Richard S Langton, Shauna L Stahlman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Vitamin D contains 2 related fat-soluble substances, D3 and D2, that are essential for bone health and overall well-being. The burden of vitamin D deficiency within the active component of the armed forces is unknown. This study describes trends of vitamin D deficiency diagnoses in the active component of the U.S. Armed Forces. Risk factors for vitamin D, such as military occupation, were examined to see if preventive measures and targeted vitamin D screening would be beneficial, as the United States Preventive Task Force does not recommend universal screening for vitamin D, nor does TRICARE cover screening for asymptomatic individuals. The surveillance period covered January 1, 2018 through December 31, 2022. The data were derived from the Defense Medical Surveillance System (DMSS). Vitamin D deficiency was measured using ICD-9-CM and ICD-10-CM diagnoses recorded in inpatient and outpatient medical encounters. Incidence rate and average annual prevalence were calculated. A logistic regression was performed to obtain adjusted odds ratios. The rates of vitamin D deficiency diagnoses among active component service members (ACSMs) remained steady during the study period, with an incidence rate of 16.4 per 1,000 person-years and an average annual prevalence of 2.2%. Female service members, those of older age groups, and indoor workers demonstrated higher rates of vitamin D deficiency. Previously described demographic risk factors such as indoor work and history of obesity or malabsorption syndrome were also associated in this study with vitamin D deficiency in ACSMs, although older age groups in this study were not associated with vitamin D deficiency. Pilots and air crew had the lowest rates of vitamin D deficiency, while health care workers had the highest, when evaluating by occupation.</p>","PeriodicalId":38856,"journal":{"name":"MSMR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11413132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Illness and injury burdens among reserve component members of the U.S. Coast Guard, 2023.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38856,"journal":{"name":"MSMR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Trends in pharmacy prescriptions by therapeutic class among active component members of the U.S. Armed Forces, 2014-2023.","authors":"Kristen R Rossi, Edward A Sheriff, Scott Russell","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38856,"journal":{"name":"MSMR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This report summarizes the nature, numbers, and trends of conditions for which military members were medically evacuated from the U.S. Central Command (CENTCOM) or Africa Central Command (AFRICOM) operations during 2023, with historical comparisons to the previous 4 years. Mental health disorders and injuries were the most common diagnostic categories in 2023 among service members medically evacuated from U.S. Central Command (CENTCOM) and U.S. Africa Command (AFRICOM). In 2023, 724 service members were medically evacuated from CENTCOM and 225 were evacuated from AFRICOM, with hospitalization required for 197 (27.2%) and 50 (22.2%), respectively. Most service members who were medically evacuated from CENTCOM or AFRICOM were returned to full duty status following their post-evacuation hospitalizations or outpatient evaluations. In 2023, evacuations for both battle and non-battle injuries from U.S. CENTCOM increased, following a period of decline. The number of service members medically evacuated in 2023 from AFRICOM remained unchanged from the previous year.
{"title":"Medical evacuations out of U.S. Central and Africa commands among the active and reserve components of the U.S. Armed Forces, 2023","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This report summarizes the nature, numbers, and trends of conditions for which military members were medically evacuated from the U.S. Central Command (CENTCOM) or Africa Central Command (AFRICOM) operations during 2023, with historical comparisons to the previous 4 years. Mental health disorders and injuries were the most common diagnostic categories in 2023 among service members medically evacuated from U.S. Central Command (CENTCOM) and U.S. Africa Command (AFRICOM). In 2023, 724 service members were medically evacuated from CENTCOM and 225 were evacuated from AFRICOM, with hospitalization required for 197 (27.2%) and 50 (22.2%), respectively. Most service members who were medically evacuated from CENTCOM or AFRICOM were returned to full duty status following their post-evacuation hospitalizations or outpatient evaluations. In 2023, evacuations for both battle and non-battle injuries from U.S. CENTCOM increased, following a period of decline. The number of service members medically evacuated in 2023 from AFRICOM remained unchanged from the previous year.</p>","PeriodicalId":38856,"journal":{"name":"MSMR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This report updates previous analyses of health care burden distributions among active and reserve component service members of the U.S. Armed Forces in deployed settings. Musculoskeletal disorders in combination with administrative and other health services (ICD-10 "Z" codes) accounted for more than half of all medical encounters in 2023 among service members deployed to the U.S. Central Command (CENTCOM) and Africa Command (AFRICOM). Three common injury conditions occurred among male and female service members deployed to U.S. CENTCOM and U.S. AFRICOM: other back problems, arm and shoulder injuries, and knee injuries.
{"title":"Morbidity burdens attributable to various illnesses and injuries among deployed active and reserve component service members of the U.S. Armed Forces, 2023.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This report updates previous analyses of health care burden distributions among active and reserve component service members of the U.S. Armed Forces in deployed settings. Musculoskeletal disorders in combination with administrative and other health services (ICD-10 \"Z\" codes) accounted for more than half of all medical encounters in 2023 among service members deployed to the U.S. Central Command (CENTCOM) and Africa Command (AFRICOM). Three common injury conditions occurred among male and female service members deployed to U.S. CENTCOM and U.S. AFRICOM: other back problems, arm and shoulder injuries, and knee injuries.</p>","PeriodicalId":38856,"journal":{"name":"MSMR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Military Health System (MHS) is a global, integrated health delivery system tasked with ensuring the medical readiness of the U.S. Armed Forces while fulfilling the individual health care needs of eligible military personnel and their dependents. The MHS network comprises military hospitals and clinics that ensure the medical readiness of the force, which are complemented by programs that enable beneficiary care in the private sector through the TRICARE insurance program. Mental health disorders accounted for the largest proportions of the morbidity and health care burdens that affected the pediatric and younger adult beneficiary age groups of nonservice member beneficiaries of the Military Health System in 2023. Among adults aged 45-64 years and adults aged 65 years and older, musculoskeletal diseases accounted for the most morbidity and health care burdens. With almost all health care for Medicare-eligible beneficiaries aged 65 years and older at private sector medical facilities, over 91% of health care encounters among non-service member beneficiaries (TRICARE-eligible and Medicare-eligible) occurred at non-military medical facilities.
{"title":"Absolute and relative morbidity burdens attributable to various illnesses and injuries among non-service member beneficiaries of the Military Health System, 2023.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The Military Health System (MHS) is a global, integrated health delivery system tasked with ensuring the medical readiness of the U.S. Armed Forces while fulfilling the individual health care needs of eligible military personnel and their dependents. The MHS network comprises military hospitals and clinics that ensure the medical readiness of the force, which are complemented by programs that enable beneficiary care in the private sector through the TRICARE insurance program. Mental health disorders accounted for the largest proportions of the morbidity and health care burdens that affected the pediatric and younger adult beneficiary age groups of nonservice member beneficiaries of the Military Health System in 2023. Among adults aged 45-64 years and adults aged 65 years and older, musculoskeletal diseases accounted for the most morbidity and health care burdens. With almost all health care for Medicare-eligible beneficiaries aged 65 years and older at private sector medical facilities, over 91% of health care encounters among non-service member beneficiaries (TRICARE-eligible and Medicare-eligible) occurred at non-military medical facilities.</p>","PeriodicalId":38856,"journal":{"name":"MSMR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Illness and injury burdens among reserve component members of the U.S. Armed Forces, 2023.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38856,"journal":{"name":"MSMR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}