Latent tuberculosis infection among sailors and civilians aboard U.S.S. Ronald Reagan--United States, January-July 2006.
(41/128)
Crews aboard ships live and work in crowded, enclosed spaces. Historically, large tuberculosis (TB) outbreaks and extensive transmission of Mycobacterium tuberculosis have occurred on U.S. Navy ships. On July 13, 2006, smear- and culture-positive, cavitary, pulmonary TB was diagnosed in a sailor aboard the aircraft carrier U.S.S. Ronald Reagan; the patient, aged 32 years, had a negative human immunodeficiency virus test. The M. tuberculosis strain cultured was susceptible to all first-line TB medications. The sailor was born in the Philippines, had latent tuberculosis infection (LTBI) diagnosed in 1995 shortly after enlisting in the U.S. Navy, and completed the 6-month daily isoniazid course that was standard treatment at that time (current treatment standard is 9 months). This report describes the contact investigation conducted by the U.S. Navy and CDC and demonstrates the importance of timely diagnosis of TB, identification and treatment of new LTBI, and cooperation among local, state, and federal agencies during large contact investigations. (+info)
Committee for the Relief of Distressed Seamen: correspondence from the Admiralty in 1818-19.
(42/128)
The Seamen's Hospital Society, which was to become a great Victorian charity, with the object of caring for both the physical and spiritual health of seafarers (most merchant seamen) in the Port of London, was founded at a meeting on 8 March 1821. However, it is not widely known that it had a temporary predecessor--The Committee for the Relief of Distressed (Destitute) Seamen. Ready cooperation was received from the Admiralty in most of its affairs, but "disposal" of many of these "redundant" mariners proved to be a somewhat difficult matter. (+info)
Women's smoking history prior to entering the US Navy: a prospective predictor of performance.
(43/128)
OBJECTIVE: To examine whether women's tobacco use prior to entering the US Navy is predictive of subsequent career performance. A priori predictions were that smoking at entry into the Navy would be related to early attrition, poorer job performance, more disciplinary problems and lower likelihood of re-enlistment. METHODS: A prospective cohort analysis of 5487 women entering the US Navy between March 1996 and March 1997 was conducted. Navy attrition/retention and career performance measures, such as time in service, early attrition, type of discharge, misconduct, number of promotions, demotions and unauthorised absences, highest paygrade achieved, and re-enlistment were examined. RESULTS: Compared with never smokers, daily smokers at entry into the US Navy had subsequent career outcomes consistently indicating poorer job performance (eg, early attrition prior to serving a full-term enlistment, more likely to have a less-than-honourable discharge, more demotions and desertions, lower achieved paygrade and less likely to re-enlist). Other types of smokers consistently fell between never and daily smokers on career outcome measures. CONCLUSIONS: For women entering the US Navy, being a daily smoker is a prospective predictor of poorer performance in the Navy. Future research should evaluate the effectiveness of cessation intervention with smoker-enlistees prior to their entering the Navy, to assess the impact on subsequent career outcomes. (+info)
A pre-joining fitness test improves pass rates of Royal Navy recruits.
(44/128)
BACKGROUND: Military training represents a significant physical challenge. Low fitness levels are strongly associated with an increased risk of injury and training attrition. To increase pass rates for Royal Navy (RN) Phase I training, a pre-joining fitness test (PJFT) was introduced (2.4 km treadmill best effort run). The PJFT was designed to identify candidates with poor levels of aerobic fitness who may be prone to leave training prematurely. AIM: To examine the impact of the PJFT on training length and outcomes. METHODS: Time taken to run 2.4 km and training outcomes were measured before and after the introduction of the PJFT. Information was collected from RN Phase I training establishments and the network of careers offices between 2002 and 2005. Recruits were placed into quartile groups based on 2.4 km overground running performance. The no PJFT and PJFT groups and the 2.4-km run performance quartiles were compared for training outcomes and time spent in training. RESULTS: Training measures were available for 4818 recruits who entered training before the PJFT's introduction (no PJFT) and 3305 after its introduction (PJFT). The pass rate increased from 78 to 88% following the introduction of the PJFT (P < 0.01). The number of recruits applying for voluntary release decreased from 15% (no PJFT group) to 6% (PJFT group) (P < 0.05). CONCLUSION: The PJFT positively impacted on RN Phase 1 training pass rates. A greater number of recruits successfully completed training, fewer applied for voluntary release and the number and length of training extensions were reduced. (+info)
Peer responses to perceived stress in the Royal Navy.
(45/128)
BACKGROUND: Various organizations, including the Armed Forces, regularly place their personnel into potentially traumatic environments. Exposure to such events can lead to the development of psychological distress and organizational inefficiencies. It follows that the Armed Forces need to consider how best to address and prevent trauma-related problems both from duty of care and organizational effectiveness viewpoints. AIM: To investigate how Royal Navy personnel report they would deal with distress including the possibility of Deliberate Self-Harm (DSH) in peers. METHODS: In total, 142 interview transcripts were examined to see how military personnel would respond to a vignette which was concerned with how they would help a distressed peer. Interviews were analysed using content analysis and inclusive inductive categorization. RESULTS: The majority of individuals would interact positively with a peer who appeared to be 'under stress', and refer them on if problems did not resolve. Most respondents reported they would take positive action regarding immediate management of DSH, referring to either medical or management staff. The majority thought that reporting ideas of DSH would impact upon the potential harmer's career. Lower ranked personnel were more likely to report a negative impact. CONCLUSIONS: The results are generally encouraging; the majority of those interviewed would actively involve themselves in the care of their peers and refer them on appropriately if the situation deteriorated. Most individuals interviewed saw DSH as a real, predominately medical problem that required immediate active intervention. However, many felt that help seeking could be detrimental to one's career within the services. (+info)
Development of underwater and hyperbaric medicine in Malaysia.
(46/128)
Underwater and Hyperbaric Medicine is a treatment modality gaining recognition in Malaysia. It uses the hyperbaric oxygen therapy (HBOT) approach where patients are placed in recompression chambers and subjected to oxygen therapy under pressure. In Malaysia it was introduced as early as the 1960's by the Royal Malaysian Navy to treat their divers for decompression illness (DCI), arterial gas embolism (AGE) and barotraumas. Other sectors in the armed forces, universities and private health centres began developing this approach too in the late 1990's, for similar purposes. In 1996, Underwater and Hyperbaric Medicine began gaining its popularity when the Institute of Underwater and Hyperbaric Medicine at the Armed Forces Hospital in Lumut started treating specific clinical diseases such as diabetic foot ulcers, osteomyelitis, and carbon monoxide poisoning and other diseases using HBOT. This paper discusses the development of this interesting treatment modality, giving a brief historical overview to its current development, as well as provides some thought for its future development in Malaysia. (+info)
Maritime health emergencies.
(47/128)
BACKGROUND: Commercial ships flying the US flag must conform to Coast Guard standards and have medical care available onboard. Consultation with a physician is required if medication is to be prescribed. AIM: To evaluate the epidemiology of medical contacts for US ships at sea. METHOD: Retrospective analysis of cases where shipboard caregivers made contact with US emergency medicine physicians for advice. RESULTS: There were 866 cases and 1720 contacts in 48 consecutive months of study. Eighty-eight per cent of cases were men with a mean age of 43.7 years (SD 13.7). Eighty-four per cent of cases were medical, 14% were injuries and 2% were purely psychiatric. Fifty-eight per cent of medical cases, 50% of psychiatric cases and 42% of injury cases were handled with a single contact. Injuries and psychiatric cases required a higher number of contacts per case compared with medical cases (P < 0.01). Five categories of illness accounted for 43% of medical cases (respiratory infections, abdominal problems, genitourinary complaints, rashes and dental issues). Psychiatric cases required the most medication, with 12% requiring four medications. The most common categories of medication given were pain relievers (non-steroidal anti-inflammatory drugs, opiates, heartburn relief) and antibiotics. CONCLUSIONS: Even with pre-screening of seafarers and the potential dangers of life at sea, the majority of cases requiring physician advice are not related to trauma. However, cases of injury or acute psychiatric problems required more physician interaction and medication than medical cases. (+info)
Detection of Mycobacterium tuberculosis infection in United States Navy recruits using the tuberculin skin test or whole-blood interferon-gamma release assays.
(48/128)
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. (+info)