The association between mental health and cigarette smoking in active duty military members

Previous research has shown an association between mental health status and cigarette smoking. This study examined four specific mental health predictors and the outcome variable any smoking, defined as smoking one or more cigarettes in the past 30 days. The population included active duty military members serving in the United States Army, Air Force, Navy and Marine Corps. The data was collected during the 2005 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel, a component of the Defense Lifestyle Assessment Program. The sample size included 13,603 subjects. This cross sectional prevalence study consisted of descriptive statistics, univariate analysis, and multivariate logistic regression analysis of the four mental health predictors and the any smoking outcome variable. Multivariate adjustment showed an association between the four mental health predictors and any smoking. This association is consistent with previous literature and can help guide public health officials in the development of smoking prevention and cessation programs.^

Physical activity levels and access to places to be physically active

The built environment is recognized as having an impact on health and physical activity. Ecological theories of physical activity suggest that enhancing access to places to be physically active may increase activity levels. Studies show that users of fitness facilities are more likely to be active than inactive and active people are more likely to report access to fitness facilities. The purpose of this study was to examine the ecologic relationship between density of fitness facilities and self-reported levels of physical activity in adults in selected Metropolitan Statistical Areas (MSAs) in the United States.^ The 2007 MSA Business Patterns and the 2007 Behavioral Risk Factor Surveillance System (BRFSS) were used to gather fitness facility and physical activity data for 141 MSAs in the United States. Pearson correlations were performed between fitness facility density (number of facilities/100,000 people) and six summary measures of physical activity prevalence. Regional analysis was done using the nine U.S. Standard Regions for Temperature and Precipitation. ^ Direct correlations between fitness facility density and the percent of those physically active (r=0.27, 95% CI 0.11, 0.42, p=0.0012), those meeting moderate-intensity activity guidelines, (r=0.23, 95% CI 0.07, 0.38, p=0.006), and those meeting vigorous-intensity activity guidelines (r=0.30, 95% CI 0.14, 0.44, p=0.003) were found. An inverse correlation was found between fitness facility density and the percent of people physically inactive (r=-0.45, 95% CI -0.57, -0.31), p<0.0001). Regional analysis showed the same trends across most regions.^ Access to fitness facilities, defined here as fitness facility density, is related to physical activity levels. Results suggest the potential importance of the influence of the built environment on physical activity behaviors. Public health officials and city planners should consider the possible positive effect that increasing the number of fitness facilities in communities would have on activity levels.^

The economic cost of type 2 diabetes attributable to physical inactivity in the United States and Texas in 2007

Type 2 diabetes has grown to epidemic proportions in the U.S., and its prevalence has been steadily increasing in Texas. The physical activity levels in the population have remained low despite it being one of the primary preventive strategies for type 2 diabetes. The objectives of this study were to estimate the direct medical costs of type 2 diabetes attributable to not meeting physical activity Guidelines and to physical inactivity in the U.S. and Texas in 2007. This was a cross sectional study that used physical activity prevalence data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) to estimate the population attributable risk percentage (PAR%) for type 2 diabetes. These data were combined with the prevalence and cost data of type 2 diabetes to estimate the cost of type 2 diabetes attributable to not meeting Guidelines and to inactivity in the U.S. and Texas in 2007.^ The cost of type 2 diabetes in the U.S. in 2007, attributable to not meeting physical activity Guidelines was estimated to be $13.29 billion, and that attributable to physical inactivity (no leisure time physical activity) was estimated to be $3.32 billion. Depending on various assumptions, these estimates ranged from $7.61 billion to $41.48 billion for not meeting Guidelines, and $1.90 billion to $13.20 billion for physical inactivity in the U.S. in 2007. The cost of type 2 diabetes in Texas in 2007 attributable to not meeting physical activity Guidelines was estimated to be $1.15 billion, and that attributable to physical inactivity (no leisure time physical activity) was estimated to be $325 million. Depending on various assumptions, these estimates ranged from $800 million to $3.47 billion for not meeting Guidelines, and $186 million to $1.28 billion for physical inactivity in Texas in 2007. These results illustrate how much money could be saved annually just in terms of type 2 diabetes cost in the U.S. and Texas, if the entire adult population was active enough to meet physical activity Guidelines. Physical activity promotion, particularly at the environmental and policy level should be a priority in the population. ^

MEASURING THE EFFECT OF ILLNESS ON THE EXPECTED REMAINING SERVICE TIME FOR THE ACTIVE DUTY ARMY: A LIFE TABLE APPROACH

A life table methodology was developed which estimates the expected remaining Army service time and the expected remaining Army sick time by years of service for the United States Army population. A measure of illness impact was defined as the ratio of expected remaining Army sick time to the expected remaining Army service time. The variances of the resulting estimators were developed on the basis of current data. The theory of partial and complete competing risks was considered for each type of decrement (death, administrative separation, and medical separation) and for the causes of sick time.^ The methodology was applied to world-wide U.S. Army data for calendar year 1978. A total of 669,493 enlisted personnel and 97,704 officers were reported on active duty as of 30 September 1978. During calendar year 1978, the Army Medical Department reported 114,647 inpatient discharges and 1,767,146 sick days. Although the methodology is completely general with respect to the definition of sick time, only sick time associated with an inpatient episode was considered in this study.^ Since the temporal measure was years of Army service, an age-adjusting process was applied to the life tables for comparative purposes. Analyses were conducted by rank (enlisted and officer), race and sex, and were based on the ratio of expected remaining Army sick time to expected remaining Army service time. Seventeen major diagnostic groups, classified by the Eighth Revision, International Classification of Diseases, Adapted for Use In The United States, were ranked according to their cumulative (across years of service) contribution to expected remaining sick time.^ The study results indicated that enlisted personnel tend to have more expected hospital-associated sick time relative to their expected Army service time than officers. Non-white officers generally have more expected sick time relative to their expected Army service time than white officers. This racial differential was not supported within the enlisted population. Females tend to have more expected sick time relative to their expected Army service time than males. This tendency remained after diagnostic groups 580-629 (Genitourinary System) and 630-678 (Pregnancy and Childbirth) were removed. Problems associated with the circulatory system, digestive system and musculoskeletal system were among the three leading causes of cumulative sick time across years of service. ^

Prevalence and determinants of hepatitis B co-infection among a United States Veterans Administration cohort with hepatitis C

Background and aim. Hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection is associated with increased risk of cirrhosis, decompensation, hepatocellular carcinoma, and death. Yet, there is sparse epidemiologic data on co-infection in the United States. Therefore, the aim of this study was to determine the prevalence and determinants of HBV co-infection in a large United States population of HCV patients. ^ Methods. The National Veterans Affairs HCV Clinical Case Registry was used to identify patients tested for HCV during 1997–2005. HCV exposure was defined as two positive HCV tests (antibody, RNA or genotype) or one positive test combined with an ICD-9 code for HCV. HCV infection was defined as only a positive HCV RNA or genotype. HBV exposure was defined as a positive test for hepatitis B core antibodies, hepatitis B surface antigen, HBV DNA, hepatitis Be antigen, or hepatitis Be antibody. HBV infection was defined as only a positive test for hepatitis B surface antigen, HBV DNA, or hepatitis Be antigen within one year before or after the HCV index date. The prevalence of exposure to HBV in patients with HCV exposure and the prevalence of HBV infection in patients with HCV infection were determined. Multivariable logistic regression was used to identify demographic and clinical determinants of co-infection. ^ Results. Among 168,239 patients with HCV exposure, 58,415 patients had HBV exposure for a prevalence of 34.7% (95% CI 34.5–35.0). Among 102,971 patients with HCV infection, 1,431 patients had HBV co-infection for a prevalence of 1.4% (95% CI 1.3–1.5). The independent determinants for an increased risk of HBV co-infection were male sex, positive HIV status, a history of hemophilia, sickle cell anemia or thalassemia, history of blood transfusion, cocaine and other drug use. Age >50 years and Hispanic ethnicity were associated with a decreased risk of HBV co-infection. ^ Conclusions. This is the largest cohort study in the United States on the prevalence of HBV co-infection. Among veterans with HCV, exposure to HBV is common (∼35%), but HBV co-infection is relatively low (1.4%). There is an increased risk of co-infection with younger age, male sex, HIV, and drug use, with decreased risk in Hispanics.^

Dengue transmission risk maps of the continental United States

Dengue fever is a strictly human and non-human primate disease characterized by a high fever, thrombocytopenia, retro-orbital pain, and severe joint and muscle pain. Over 40% of the world population is at risk. Recent re-emergence of dengue outbreaks in Texas and Florida following the re-introduction of competent Aedes mosquito vectors in the United States have raised growing concerns about the potential for increased occurrences of dengue fever outbreaks throughout the southern United States. Current deficiencies in vector control, active surveillance and awareness among medical practitioners may contribute to a delay in recognizing and controlling a dengue virus outbreak. Previous studies have shown links between low-income census tracts, high population density, and dengue fever within the United States. Areas of low-income and high population density that correlate with the distribution of Aedes mosquitoes result in higher potential for outbreaks. In this retrospective ecologic study, nine maps were generated to model U.S. census tracts’ potential to sustain dengue virus transmission if the virus was introduced into the area. Variables in the model included presence of a competent vector in the county and census tract percent poverty and population density. Thirty states, 1,188 counties, and 34,705 census tracts were included in the analysis. Among counties with Aedes mosquito infestation, the census tracts were ranked high, medium, and low risk potential for sustained transmission of the virus. High risk census tracts were identified as areas having the vector, ≥20% poverty, and ≥500 persons per square mile. Census tracts with either ≥20% poverty or ≥500 persons per square mile and have the vector present are considered moderate risk. Census tracts that have the vector present but have <20% poverty and <500 persons per square mile are considered low risk. Furthermore, counties were characterized as moderate risk if 50% or more of the census tracts in that county were rated high or moderate risk, and high risk if 25% or greater were rated high risk. Extreme risk counties, which were primarily concentrated in Texas and Mississippi, were considered having 50% or greater of the census tracts ranked as high risk. Mapping of geographic areas with potential to sustain dengue virus transmission will support surveillance efforts and assist medical personnel in recognizing potential cases. ^

Grain size distribution in surface sediments samples of the continental shelf and slope of southeast Greenland

During "Meteor" Cruise 6/1966 in the northwest Atlantic a systematic survey of the bottom topography of the southeast Greenland continental margin was undertaken. Eighty-seven profiles transverse to the shelf edge at distances of 3-4 nautical miles and two longitudinal profiles parallel to the coast were carried out with the ELAC Narrow Beam Echo-Sounder giving a reliable record of even steep slopes. On the basis of the echo soundings the topography and morphology of the continental shelf and slope are evaluated. A detailed bathymetric chart and a serial profile chart were designed as working material for the morphological research. These maps along with the original echograms are morphometrically evaluated. The analysis of the sea bottom features is the basis of a subsequent morphogenetical interpretation, verified and extended by means of interpretation of magnetic data and sediment analysis (grain size, roundness, lithology). The results of the research are expressed in a geomorphological map. The primary findings can be summarized as follows: 1) The southeast Greenland shelf by its bottom topography can be clearly designated as a glacially formed area. The glacial features of the shelf can be classified into two zones nearly parallel to the coast: glacial erosion forms on the inner shelf and glacial accumulation forms on the outer shelf. The inner shelf is characterized by the rugged and hummocky topography of ice scoured plains with clear west/east slope asymmetry. On the outer shelf three types of glacial accumulation forms can be recognized: ice margin deposits with clearly expressed terminal moraines, glacial till plains and glaciomarine outwash fans. Both zones of the shelf can be subdivided into two levels of relief. The ice scoured plains, with average depths of 240 meters (m), are dissected to a maximum depth of 1060 m (Gyldenloves Trough) by trough valleys, which are the prolongations of the Greenland fjords. The banks of the outer shelf, with an average depth of 180 m, surround glacial basins with a maximum depth of 670 meters. 2) The sediments of the continental shelf can be classified as glacial due to their grain size distribution and the degree of roundness of the gravel particles. The ice margin deposits on the outer shelf can be recognized by their high percentage of gravels. On the inner shelf a rock surface is suggested, intermittently covered by glacial deposits. In the shelf troughs fine-grained sediments occur mixed with gravels. 3) Topography and sediments show that the southeast Greenland shelf was covered by an ice sheet resting on the sea floor during the Pleistocene ice-age. The large end moraines along the shelf edge probably indicate the maximum extent of the Wurm shelf ice resting on the sea floor. The breakthroughs of the end moraines in front of the glacial basins suggest that the shelf ice has floated further seaward over the increasing depths. 4) Petrographically the shelf sediments consist of gneisses, granites and basalts. While gneisses and granites occire on the nearby coast, basalt is not known to exist here. Either this material has been drifted by icebergs from the basalt province to the north or exists on the southeast Greenland shelf itself. The last interpretation is supported bythe high portion of basalt contained in the sediment samples taken and the strong magnetic anomalies probably caused by basaltic intrusions. 5) A magnetic profile allows the recognition of two magnetically differing areas which approximately coincide with the glacial erosion and accumulation zones. The inner shelf shows a strong and variable magnetic field because the glacially eroded basement forms the sea floor. The outer shelf is characterized by a weak and homogenous magnetic field, as the magnetized basement lies at greater depthy, buried by a thick cover of glacial sediments. The strong magnetic anomalies of the inner shelf are probably caused by dike swarms, similar to those observed further to the north in the Kangerdlugssuaq Fjord region. This interpretation is supported by the high basalt content of the sediment samples and the rough topography of the ice scoured plains which correlates in general with the magnetic fluctuations. The dike structures of the basement have been differentially eroded by the shelf ice. 6) The continental slope, extending from the shelf break at 313 m to a depth of 1270 m with an average slope of 11°, is characterized by delta-shaped projections in front of the shelf basins, by marginal plateaus, ridges and hills, by canyons and slumping features. The projections could be identified as glaciomarine sediment fans. This conclusion is supported by the strong decrease of magnetic field intensity. The deep sea hills and ridges with their greater magnetic intensities have to be regarded as basement outcrops projecting through the glaciomarine sediment cover. The upper continental rise, sloping seaward at about 2°, is composed of wide sediment fans and slump material. A marginal depression on the continental rise running parallel to the shelf edge has been identified. In this depression bottom currents capable of erosion have been recorded. South of Cape Farvel the depression extends to the accumulation zone of the "Eirik" sedimentary ridge. 7) By means of a study of the recent marine processes, postglacial modification of the ice-formed relief can be postulated. The retention effect of the fjord troughs and the high velocity of the East Greenland stream prevents the glacial features from being buried by sediments. Bottom currents capable of active erosion have only been found in the marginal depression on the continental rise. In addition, at the time of the lowest glacio-eustatic sea level, the shelf bottom was not situated in the zone of wave erosion. Only on the continental slope and rise bottom currents, sediment slumps and turbidity currents have led to significant recent modifications. Considering these results, the geomorphological development of the southeast Greenland continental terrace can be suggested as follows: 1. initial formation of a "peneplain", 2. fluvial incision, 3. submergence, and finally 4. glacial modification.