PRETERM BIRTH AND OCCUPATIONAL PHYSICAL ACTIVITY: A CASE-CONTROL STUDY OF THE RELATIONSHIP BETWEEN LENGTH OF GESTATION AND THE PHYSICAL DEMAND OF U.S. ARMY MILITARY OCCUPATIONAL SPECIALTIES (UNITED STATES)

A case-control study has been conducted examining the relationship between preterm birth and occupational physical activity among U.S. Army enlisted gravidas from 1981 to 1984. The study includes 604 cases (37 or less weeks gestation) and 6,070 controls (greater than 37 weeks gestation) treated at U.S. Army medical treatment facilities worldwide. Occupational physical activity was measured using existing physical demand ratings of military occupational specialties.^ A statistically significant trend of preterm birth with increasing physical demand level was found (p = 0.0056). The relative risk point estimates for the two highest physical demand categories were statistically significant, RR's = 1.69 (p = 0.02) and 1.75 (p = 0.01), respectively. Six of eleven additional variables were also statistically significant predictors of preterm birth: age (less than 20), race (non-white), marital status (single, never married), paygrade (E1 - E3), length of military service (less than 2 years), and aptitude score (less than 100).^ Multivariate analyses using the logistic model resulted in three statistically significant risk factors for preterm birth: occupational physical demand; lower paygrade; and non-white race. Controlling for race and paygrade, the two highest physical demand categories were again statistically significant with relative risk point estimates of 1.56 and 1.70, respectively. The population attributable risk for military occupational physical demand was 26%, adjusted for paygrade and race; 17.5% of the preterm births were attributable to the two highest physical demand categories. ^

The association between mental health and hypertension in the 2005 Department of Defense Population Survey

Major objectives within Healthy People 2010 include improving hypertension and mental health management of the American population. Both mental health issues and hypertension exist in the military which may decrease the health status of military personnel and diminish the ability to complete assigned missions. Some cases may be incompatible with military service even with optimum treatment. In the interest of maintaining a fit fighting force, the Department of Defense regularly conducts a survey of health related behaviors among active duty military personnel. The 2005 DoD Survey was conducted to obtain information regarding health and behavioral readiness among active duty military personnel to assess progress toward selected Healthy People 2010 objectives. ^ This study is a cross-sectional prevalence design looking at the association of hypertension treatment with mental health issues (either treatment or perceived need for treatment) within the military population sampled in the 2005 DoD Survey. There were 16,946 military personnel in the final cross-sectional sample representing 1.3 million active duty service members. The question is whether there is a significant association between the self-reported occurrence of hypertension and the self-reported occurrence of mental health issues in the 2005 DoD Survey. In addition to these variables, this survey examined the contribution of various sociodemographic, occupational, and behavioral covariates. An analysis of the demographic composition of the study variables was followed by logistic analysis, comparing outcome variables with each of the independent variables. Following univariate regression analysis, multivariate regression was performed with adjustment (for those variables with an unadjusted alpha level less than or equal to 0.25). ^ All the mental health related indicators were associated with hypertension treatment. The same relationship was maintained after multivariate adjustment. The covariates remaining as significant (p < 0.05) in the final model included gender, age, race/ethnicity and obesity. There is a need to recognize and treat co-morbid medical diagnoses among mental health patients and to improve quality of life outcomes, whether in the military population or the general population. Optimum health of the individual can be facilitated through discovery of treatable cases, to minimize disruptions of military missions, and even allow for continued military service. ^

Pancreatic cancer deaths in Texas veterans

Background/objective. Several studies have found an increased risk of pancreatic cancer in veterans deployed to Vietnam during the Vietnam War. Diabetes, a known risk factor for pancreatic cancer, has been designated as a service-connected illness in deployed Vietnam veterans. The majority of Vietnam veterans, now between the ages of 55 to 65, have not yet reached the ages of pancreatic cancer’s greatest prevalence, ages 65 to 79. This case-control study utilized 1998 electronic Texas death certificate data for white, black and Hispanic men to explore the question of whether military service was a risk factor for deaths due to pancreatic cancer among men who died in 1998.^ Methods. The primary study included men born between 1927 and 1953, and was a matched case-control study with two control groups; 431 pancreatic cancer cases were birth-year and race-matched one case to two non-neoplastic death controls and, for the second control group, were matched 1:1 with 431 accidental death controls. The exposure was military service, recorded as “yes”, “no” or “unknown” on the death certificate. Conditional logistic regression was used for the data analysis. Logistic regression was used in two additional unmatched analyses to examine the same exposure, military service, within different birth cohorts, again using pancreatic cancer cases with non-neoplastic and accidental death controls.^ Results. For pancreatic cancer cases matched to non-neoplastic controls, the association with military service showed an elevated odds ratio (OR) of 1.40 (95% confidence interval [CI] 1.10-1.79); matched to accidental death controls, a similar association with military service was detected [OR=1.40 (95% CI 1.04-1.89)]. The association was not seen in all time periods and was greatest for those within a birth cohort specific for Vietnam Era service. For men born between 1946 and 1950, OR=1.90 (95% CI 1.03-3.50) for comparison with non-neoplastic controls and OR=1.91 (95% CI 0.9995-3.64) for accidental death controls. ^ Conclusion. In Texas, for men aged 44-71, who died in 1998, military service was associated with an approximately 40% increased risk for pancreatic cancer. For men ages 48-52, military service was associated with an approximately 90% increased risk for pancreatic cancer.^

The Effectiveness of Court Mandated Intervention Versus Voluntary Services in Child Protective Services:

The general objective of this research was to compare the relative effectiveness of court mandated services versus a voluntary service plan in preventing in child maltreatment recidivism. Four-thirty-two children were selected at random from among children in a large California County who were receiving in-home services under a court mandate or a voluntary plan. Protective services files of study children were reviewed to derive study data. Type of plan did not make a difference on case outcome. Children were more likely to remain in the home at the end of the service delivery period in families that received voluntary plans. However, when other factors are controlled, the advantage of a voluntary plan disappears. Moreover, similar rates of recidivism were noted between both types of plans after the case was closed.

An assessment of differences in pediatric dental services provided for a Medicaid population when compared to a federally subsidized (military) clinic

Reimbursement for dental services performed for children receiving Medicaid is reimbursed per service while dental treatment for military dependents provided at a military installation is neither directly reimbursable to those providing the care nor billed to those receiving the care. The purpose of this study was to compare pediatric dental services provided for a Medicaid population to a federally subsidized military facility to compare treatment choices and subsequent costs of care. It was hypothesized that differences in dental procedures for Medicaid and military dependent children would exist based upon treatment philosophy and payment method. A total of 240 records were reviewed for this study, consisting of 120 Medicaid patients at the University of Texas Health Science Center at San Antonio (UTHSCSA) and 120 military dependents at Wilford Hall Medical Center (WHMC), Lackland Air Force Base, San Antonio. Demographic data and treatment information were abstracted for children receiving dental treatment under general anesthesia between 2002 and 2006. Data was analyzed using the Wilcoxon rank sum test, Kruskal-Wallis test, and Fisher's exact test. The Medicaid recipients treated at UTHSCSA were younger than patients at WHMC (40.2 vs. 49.8 months, p<.001). The university also treated significantly more Hispanic children than WHMC (78.3% vs. 30.0%, p<.001). Children at UTHSCSA had a mean of 9.5 decayed teeth and were treated with 2.3 composite fillings, 0 amalgam fillings, 5.6 stainless steel crowns, 1.1 pulp therapies, 1.6 extractions, and 1.0 sealant. Children at WHMC had a mean of 8.7 decayed teeth and were treated with 1.4 composite fillings, 0.9 amalgam fillings, 5.6 stainless steel crowns, 1.7 pulp therapies, 0.9 extractions, and 2.1 sealants. The means of decayed teeth, total fillings, and stainless steel crowns were not statistically different. UTHSCSA provided more composite fillings (p<.001), fewer amalgam fillings (p<.001), fewer pulp therapies (p <.001), more extractions (p=.01), and fewer sealants (p<.001) when compared to WHMC. Age and gender did not effect decay rates, but those of Hispanic ethnicity did experience more decay than non-Hispanics (9.5 vs. 8.6, p=.02). Based upon Texas Medicaid reimbursement rates from 2006, the cost for dental treatment at both sites was approximately $650 per child. The results of this study do not support the hypothesis that Medicaid providers provide less conservative therapies, which would be more costly, care when compared to a military treatment center. ^

The identification and prevalence of veterinary clinical events in U.S. military working dogs deployed to Iraq between March 20, 2003, and December 31, 2007

Objective. The purpose of this study was to identify the medical issues experienced by Military Working Dogs during their period of deployment in Iraq.^ Design. This study was a retrospective cross-sectional survey based on database and medical record abstraction.^ Population. Military Working Dogs (MWDs) that were deployed to Iraq at any time between 20 March 2003 and 31 December 2007 were the inclusive population of interest. Seven hundred ninety-five (795) MWDs were identified as having been deployed to Iraq during the inclusive dates. Four hundred ninety-six (496) MWDs were identified that had medical events during the deployment period. ^ Procedures. Eligible MWDs were identified through several sources, to include database query, medical record abstraction questionnaire, and medical record abstraction. Demographic information collected for each MWD included tattoo, name, age, gender, breed, Branch of Service, and duty certification. Information on each veterinary/medical clinical event (VCE) was collected. This information was coded, and data entered into a database for organization. Frequency and prevalence information were determined for each category of VCE.^ Results. The top four VCEs experienced by MWDs while deployed in Iraq were gastrohepatic, dermatologic, traumatic injury, and appendicular musculoskeletal issues.^ Conclusions. Training, equipment, and supplies for veterinary personnel who care for the deployed MWDs should be tailored accordingly to suit the identified medical needs of the MWDs. ^

Smokeless tobacco use in 2005 US Military population

U.S. Military personnel are more likely to use smokeless tobacco than civilians. The purpose of this study was to describe the relationship between smokeless tobacco use and sociodemographic, behavioral, and occupational variables, using data from the 2005 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel. The DoD survey was comprised of representative active duty U.S. military members (N=16,146). In adjusted multivariate logistic regression models, this study found smokeless tobacco use to be more prevalent in younger age, males, whites, and enlisted-rank members. By service, higher rates were reported among members of the Army and Marine Corps than among the Air Force and Navy members. Smokeless tobacco use among those who also smoke or drink heavily was also much higher than among those who did not report smoking or heavy alcohol use. Results also showed increased prevalence of smokeless tobacco use among those who reported moderate or high impulsive behavior and among those who recently deployed. These findings contribute to improving the understanding of factors related to smokeless tobacco use in the military and may help design strategies to reduce the use of this potentially toxic substance and improve health for military members.^

Volunteering: Demographic characteristics, motives and potential benefits from service

Volunteering is intricately woven into the fabric of our society. In 2009 alone, approximately 63.4 million Americans participated in volunteer activities, collectively donating over 8.1 billion service-hours (Corporation for National and Community Service [CNCS], 2010). Each service-hour is determined by the U.S. Bureau of Labor Statistics (2010) to be valued at $20.85/hr which translates to a national savings of $169 billion. Thus, we can clearly observe the significance of volunteer contribution to the overall benefit of society. In addition, there is now evidence that voluntary service may also benefit the actual volunteer, especially individuals who are 65+ years. As we reach 2020 this elderly class, composed of nearly 13 million (CNCS, 2010) Americans, will be of much consequence. Their potential to contribute in community-related efforts may save the U.S. billions in labor costs, and may also help reduce healthcare-related expenditures if volunteering proves to be a protective factor. In this literature review, we set out to explore the potential relationship between volunteer participation and increased mental and physical wellness. We also examined volunteer demographic characteristics and common motives for engaging in service-related activities. Analysis showed that volunteer work often combined low-impact physical activity and mental satisfaction from serving others, resulting in overall health benefit. Demographic characteristics displayed were consistent with previous studies and found that a majority of volunteers were female, White, married status, having received college degree or higher, employed, middle-high SES. In addition, age was seen to be a key characteristic in forecasting volunteer motivation and self-reported perceived health benefits.^