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Introduction: Military installations are at increased risk for the transmission of infectious disease. Personnel who live and train on military installations live and train near one another facilitating disease transmission. An understanding of historical sanitation and hygiene can inform modern practices. This is especially pertinent considering the continuing rise of variants of infectious diseases, such as the recent pandemic of the 2019 severe acute respiratory syndrome coronavirus 2. In this article, we review the rise and decline of infectious disease at the United States Military Academy (USMA) during the period spanning 1890 through 1910, and the public health interventions used to combat disease spread.Materials and Methods: Primary data regarding cadet illness were acquired from the historical archives of the USMA. These included annual reports, clinical admission records, casualty ledgers, and sanitation reports. Unpublished documents from the medical history of USMA provide periodic trends of health among cadets because of infectious disease.Results: Between 1890 and 1910, the USMA at West Point was confronted with cases of influenza, measles, mumps, scarlet fever, smallpox, typhus, and malaria. In response, a series of non-pharmaceutical interventions (NPIs) were instituted to curb the spread of infectious disease. These interventions most likely proved effective in suppressing the transmission of communicable diseases. The most common and arguably the most effective NPI was the physical separation of the sick from the well.Conclusions: The USMA experience mirrored what was occurring in the larger U.S. Army in the early 20th century and may serve as a model for the application of NPIs in response to modern infectious diseases resulting from novel or unknown etiologies. [ABSTRACT FROM AUTHOR]

The health concerns for military women who serve in austere environments include feminine hygiene, risk of infection, and limited knowledge of gynecologic conditions, symptoms, and prevention. The purpose of this study is to evaluate the effectiveness of the Women's Health Promotion Program (WHPP) for Austere Environments that was implemented in the military community setting of a large operational military unit on a southeastern U.S. military base. The WHPP is a pilot-tested program designed to educate women to recognize and prepare for environments that require alteration of feminine hygiene behaviors, with the goal of maintaining genitourinary health. Evaluation of the WHPP was designed according to the RE-AIM framework, which measures the Reach, Efficacy/effectiveness, Adoption, Implementation, and Maintenance of a health promotion program. The WHPP was offered to 49 military units (none of which declined) and presented to 443 military women in those units. One year after the implementation of the WHPP, the rates of urinary tract infections, vaginal candidiasis infections, and menstrual disorders decreased among the units that participated in the WHPP. These findings lay the foundation for an Army-wide adoption of this WHPP that could enhance readiness in military women. [ABSTRACT FROM AUTHOR]

Clinical quality management (CQM) is a fixture of modern U.S. healthcare to include fixed military medical treatment facilities. CQM is now being applied to the battlefield. In a related fashion, standards of care have been proposed in the context of combat medicine. The overall goal is to improve the medical care of casualties. Despite good intentions, the concepts and execution of CQM and standards of care are neither well-described in the literature nor established in official military doctrine and regulation. This has resulted in variable and haphazard applications that range from the positive and supportive to the negative and counterproductive. This article outlines the use of CQM in combat operations and asserts that a deliberate analysis of the benefits and risks is needed before its continued use. Future directions should focus on the impact of CQM on mission, doctrine, training, staffing, and unit organization. Rigorous adherence to evidence of effectiveness is essential before applying CQM in the combat zone. [ABSTRACT FROM AUTHOR]

Obtaining and maintaining a military force hearty enough for the trials of campaign and combat is the concern of military hygiene. It has been a challenge for governments and commanders for centuries. Empirical practices in recruiting, training, and maintaining service members gave way to more scientific, evidenced-based practices of the 18th century, and the research-driven, laboratory-proven methods of the late 19th century. As science made military medicine predictable, it widened the intellectual and professional gap between commander and medical officer, weakening trust and hindering communication. It also distanced the medical officer from the more mundane health and fitness concerns of service members by transforming military hygiene into military preventive medicine. Medical misadventures consequent to this state of affairs continue into the 21st century and will remain until a philosophical and educational shift in the value of military hygiene occurs. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the risk of hospitalization among Marines deployed during Operations Enduring and Iraqi Freedom by military occupational specialty (MOS). Methods: Trends in risk of hospitalization as a function of injury cause (explosive munitions and small arms [EM/SA]), anatomical location, and injury type were analyzed to identify which MOSs were more likely to have open wound injuries or trauma to the extremities. The study population consisted of 163,939 Marines deployed at any time during the study period (September 11, 2001-January 31, 2007). Hospitalized Marines (n = 2,718) were matched to nonhospitalized Marines on rank, time deployed, and number of deployments. Results: Noninfantry MOSs had lower risk of hospitalization compared with infantry, regardless of injury cause or location. Trends differed for EM/SA versus other injury causative agents, but did not differ by anatomical location among EM/SA. Conclusion: This information allows for quantitative assessment of risk by MOS in combat situations. [ABSTRACT FROM AUTHOR]

Pedestrian suicide bombers (SB) pose an infectious threat to United States (U.S.) forces. The objective of this study is to evaluate the use of rapid human immunodeficiency virus (HIV) antibody assays under contaminated field conditions and develop plans to mitigate the infectious threat. Twenty-six commercially available rapid HIV antibody assays were contaminated with environmental substances. Half of the tests were conducted with HIV-1 antibody (Ab) positive controls and half with HIV Ab negative controls. There were no test failures. Using statistical approximations to evaluate the plausibility of a zero failure rate, the upper 95% confidence limit for the occurrence of a test failure by chance is at most 10.8%. These results suggest the test's success is less likely because of chance and further studies should be conducted for validation. Regardless of the methodology, it is important to develop plans to mitigate infectious risks from pedestrian suicide bombers. [ABSTRACT FROM AUTHOR]

The Uniformed Services University hosted a conference in July 2008 entitled "Warfighter Nutrition: Advanced Technologies and Opportunities" with Health Affairs and the Defense Advanced Research Projects Agency to develop strategic and tactical plans that could enhance Force Health Protection (FHP) by optimizing warfighter nutrition within the Department of Defense (DoD). The conference focused on three aspects of military nutrition: (1) fueling the forces, or garrison feeding; (2) performance optimization or operational feeding during deployment: and (3) nutritional interventions to support health reset and healing. Presentations by speakers addressed practical interventions (i.e., ready for implementation now) and advanced technologies (i.e., approaches meriting prioritized research and development efforts to transition into application). The conference concluded that nutritional optimization represents an integral and proactive approach to prevent illness, injury, and performance degradation throughout all phases of military service. The overarching consensus achieved was that warfighter nutrition, as a cornerstone of FHP, warrants the critical attention of both medical and line leadership to move quickly to support current initiatives and future advanced technologies. [ABSTRACT FROM AUTHOR]

In 2005 the United States and Romania signed a historic access agreement establishing the first U.S. military bases in the former Soviet bloc country of Romania. The bases will host joint exercises aimed at developing regional military cooperation with forces throughout the entire 92-country USEUCOM area of responsibility (AOR). These forward operating bases (FOBs) or "lily pads" will include the Smârdan Training Range, Babadag Training Range, Mihail Kogălniceanu (MK) Air Base, and Cincu Training Range. They will be under the command of Joint Task Force East (JTF-East), headquartered at the MK Air Base. Here described are the naturally occurring pathogens of clinical significance that exist in the region, including those of known biowarfare/bioterrorism (BW/BT) potential. Notwithstanding the length of deployment for training, proactive clinical and environmental surveillance should be linked to the implementation of adequate Force Health Protection (FHP) measures to minimize the impact these medical threats may have on JTF-East operations. [ABSTRACT FROM AUTHOR]

Objective: Rising U.S. asthma prevalence will be reflected in military applicants. We studied retaining mild asthmatics on active duty. Methods: A cohort study at Great Lakes Naval Training Center from 2000 to 2002 compared recruits diagnosed during basic training with mild asthma to matched comparison recruits on outpatient visits. hospitalizations, and discharge through August 2003. Results: A total of 136 asthmalic and 404 control subjects were enrolled. Overall attrition was greater among the asthma cohort (p < 0.01), largely during training. Asthmatics used more health care than controls during training (0.1 vs. 0.004 per person-month). No asthma-related hospitalizations or deaths occurred during the study. Conclusions: Although attrition during recruit training was higher in mild asthmatics, nearly 40% of recruits were retained on active duty without significant risk of hospitalization or excessive outpatient treatment after recruit training. These findings argue for consideration of a trial on active duly for recruits with mild asthma. [ABSTRACT FROM AUTHOR]

We investigated the impact of a customized alcohol-based instant hand sanitizer hand-hygiene regimen in an Army basic training setting. The entire population at the U.S. Army Field Artillery Training Center, Fort Sill, Oklahoma, participated in the 13-week prospective cohort study between January 18, 2005 and April 18, 2005. Two training battalions were randomly assigned to the control group, one to the primary intervention group (customized Purell Instant Hand Sanitizer regimen, education, reinforcement) and one to the secondary intervention group (customized Purell Instant Hand Sanitizer regimen). When compared to the control group, intervention groups experienced 40% less respiratory illness (p < 0.001), 48% less gastrointestinal illness (p < 0.02), 44% less lost training time (p < 0.001), and 31% fewer health care encounters (p < 0.001). These findings suggest that this intervention is capable of significantly reducing illness in this setting and has the potential to help reduce absenteeism in the military workforce as a whole. [ABSTRACT FROM AUTHOR]

Objective: This qualitative research study evaluated the attitudes, perceptions, and opinions of World War II veterans regarding the health impact of their military service. Methods: The study design involved adding relevant health questions to the interview format developed by the ongoing Veterans History Project, a military oral history depository directed and maintained by the U.S. Library of Congress. Audiotaped interviews conducted with individuals and a focus group were coded and evaluated. Key informants provided background information. Results: Findings included a general consensus among participants that military service during World War II was beneficial to their health. Preventive health practices were instilled as lifelong habits, as were feelings of self-confidence and independence. The Veterans Administration was viewed positively by respondents but was not used to any great extent. Conclusions: Current good health and feelings of patriotism. duty, and selflessness may underlie expressed positive attitudes about the health impact of service during World War II. [ABSTRACT FROM AUTHOR]

The LIFE (lifestyle change, individual readiness, fitness excellence, eating healthy) wellness program was an intensive, outpatient, healthy lifestyle change program with participants from the Army, Navy, Air Force, and Marine Corps. Our objective was to describe the LIFE program and to present before and after test results for this 1-year program. Fifty-three participants completed the 5-day intensive outpatient and 1-year follow-up program and maintained average weight losses of > 10 pounds and 14 pounds for men and women, respectively. Most of the weight loss occurred by 6 months. Participants who completed the program also showed increases in healthy eating attitudes, well-being, and overall quality of life. The LIFE change model has implications for improved service retention, health, and overall quality of life or patient evidence that matters (POEMS). The program is both portable and flexible and can be tailored to the demands of the dynamic military environment. [ABSTRACT FROM AUTHOR]

Elevated body weight among active duty Air Force (ADAF) members is a substantial and growing problem, and typically results from gaining small amounts of weight each year over many years. We designed a strategy to prevent annual weight gain in ADAF members using self-directed behavior change booklets followed by weekly e-mails about diet and physical activity for a year. The intervention was universally offered to ADAF members meeting selection criteria at five U.S. Air Force bases (n = 3.5021: members at 60 other U.S. Air Force bases served as controls (n = 65,089). The intervention was completely effective at preventing weight gain in a subgroup of men (those above the lowest three ranks, with baseline weight above maximum allowable) and in women, while controls continued to gain weight. Since the intervention did not require personalized contact, this approach has promise for large-scale population-based efforts aimed at preventing weight gain in working adults. [ABSTRACT FROM AUTHOR]

Objective: To determine whether an accessory to the Bair Hugger warming unit (BHWU), a piece of equipment intrinsic to the forward surgical team, could be designed and used to warm and to maintain large volumes of intravenous fluids at an optimal infusion temperature in an austere environment. Methods: The X-1 is a simple, collapsible, 5-gallon nylon cooler with handles, modified with a port for the BHWU hose and a one-way flutter valve vent. Results: The warming of intravenous fluids to the optimal infusion temperature was accomplished with the BHWU and X-1. The warming time was influenced by the ambient temperature, the starting temperature of the fluids, and the number of bags being warmed. The warmed fluid could be stored and maintained in the X-1. The heat retention of the fluids was influenced by the ambient temperature, the number of bags warmed, and the insulating properties of the X-1 Conclusions: The BHWU can be used with the compact X-1 to warm and to store large volumes of intravenous fluids at the optimal infusion temperature in the field environment and was successfully used by a forward surgical team in Afghanistan, during Operation Enduring Freedom, for the treatment of combat-wounded soldiers. [ABSTRACT FROM AUTHOR]

The factory-based permethrin coating technique has only recently been developed. Consequently, no data are available on residual activity, laundering, and weathering resistance in impregnated battle dress uniforms (BDUs) worn under military deployment conditions, or on the cross-contamination potential of such uniforms. Herein, factory-impregnated BDUs worn-out during military deployment to Afghanistan were investigated for residual permethrin concentration, residual efficacy against arthropod vectors, and cross-contamination during laundering and storage. When compared with BDUs subjected to 50 defined washings using the U.S. Insect/Arthropod Repellent Fabric Treatment method, no significant differences in efficacy were observed against Aedes mosquitoes, but remaining knockdown activity in Ixodes ticks was significantly better in polymer-coated BDUs. BDUs impregnated by the polymer-coating method were found to be effective for the life of the uniform, ensuring protection of soldiers in the field from arthropod vectors, while causing less cross-contamination than those treated by the Insect/Arthropod Repellent Fabric Treatment method. [ABSTRACT FROM AUTHOR]

Objective: The objective of this project was to evaluate the use of preprocedural mouth rinses in Army dental clinics. Materials and Methods: Three hundred six-question surveys were distributed to 10 Army dental organizations throughout the United States and Germany during the period from March 2001 to March 2002. Two hundred fifty-four surveys were completed and returned. Simple mathematics were used to evaluate answers to the questionnaires. Results: The 254 respondents included military dentists (n = 190), civilian dentists used by the military (n = 27), registered dental hygienists (n = 20), and military-trained dental hygiene technicians (n = 17). Eighty-four and one-tenth percent of respondents (n = 216) use preprocedural rinses in their practices to prevent possible disease transmission (n = 85) or to decrease chances of postoperative infection (n = 167). Chlorhexidine gluconate (n = 170) and phenol-based essential oil preparations (n = 84) are the most commonly used products. The perceived greatest benefits of preprocedural rinsing are to decrease oral bacterial load (38%), to decrease incidence of postoperative infection (21%), and to decrease aerosolization of bacteria (8.66%). Conclusions: Army dental clinics make extensive use of antimicrobial preprocedural rinses. Chlorhexidine and Listerine (Warner-Lambert Consumer Healthcare, Morris Plains, NJ) are the most commonly used products. Currently available literature appears to support the use of these products in preventing or diminishing the chances of postoperative infection. [ABSTRACT FROM AUTHOR]

Oral health is an integral part of general health. Previous research has shown that untreated oral conditions can result in increased rates of disease and nonbattle injury for deployed soldiers. The purpose of this study was to develop models for U.S. Army dental wellness and readiness using a multivariate regression analysis approach. Staffing levels and dental wellness and readiness rates were examined for the first three quarters of fiscal year 2002 at 40 Army installations. Full regression model equations were developed for percent dental wellness and readiness using location, time, dental provider types, and basic training installation as predictor variables. Both models were shown to be statistically significant, with wellness R2 = 0.37, F12,107 = 5.18. p < 0.001 and readiness R2 = 0.23, F12,107 = 2.65, p < 0.01. Further tests of specific predictor effects revealed that wellness was significantly associated with the specialties of general dentistry, hygienists, and oral surgery, and that readiness was significantly associated with region and the oral surgery specialty. Results may be useful for the U.S. Army to identify the best practices in an effort to optimize dental wellness and readiness. [ABSTRACT FROM AUTHOR]

Examines the metabolic responses to maximal exercise in Gulf War veterans (GV) with chronic fatigue syndrome (CFS). Advantages for studying GV with CFS; Methodology of the study; Potential limitations of the study.

Presents a study on health disturbances experienced by commanding officers of German battle tank. Features of the Raynaud syndrome experienced by soldiers; Percentage of officers who suffered from pain; Changes of ankle swelling in comparison to years of service.

Determines the long-term outcome for military trainees referred for a mental health evaluation during basic training in the U.S. Prevalent reasons for the discharge of military personnel; Percentage of trainees who returned to duty after the evaluation; Implications of the study for the uniformed mental health provider in a training environment.

Presents information on the skip policy implemented by the U.S. Army for its Force Health Protection (FHP) program. Levels of in-theater care described in the FHP; Factors behind the use of the policy in in-theater hospital requirements; Methods by which the Air Force could support the skip policy.

Background: Dermatitis artifacta is not an uncommon disease in military settings. Soldiers may intentionally produce skin lesions to achieve sick leave from military duties, The aim of this work was to describe a series of soldiers with dermatitis artifacta. Methods: A prospective study was conducted among soldiers of the Israel Defense Force. Results: Fourteen soldiers from the Israel Defense Force were included in the study. There were 13 men and one woman. The ages of the patients ranged between 19 and 26 years. For all patients, dermatitis artifacts was characterized by the acute appearance of a pruritic rash located on readily accessible areas of the limbs and abdomen. The rash was associated with systemic symptoms for 12 (85.7%) of 14 patients. None of the patients admitted to intentionally inflicting the skin lesions. The rash consisted of erythematous patches with numerous papules and pustules arranged in a linear pattern. All patients were treated with topical corticosteroids, four patients were treated with antibiotics, and three patients were treated with systemic corticosteroids. For all patients, the eruption resolved completely within 1 to 3 weeks. Conclusions: In the context of soldiers standing to gain sick leave by assuming the sick role, dermatitis artifacta can be reliably diagnosed by noting the characteristic location and morphological features of the skin lesions. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor in response to an article published in "Military Medicine," which deals with the health of military personnel.

The article provides information on the upcoming articles of the periodical "Military Medicine."

Objective: The goal of this study was to determine the quality of groundwater for certain chemicals from all wells for the military units in Ankara (the capital city of Turkey) to evaluate special situations like a nuclear, biological, and chemical attack., Method: The quality of underground water has been evaluated chemically by examining 34 different water specimens. Various chemical parameters and heavy metals have been assessed in these samples by using an ion meter and atomic absorption spectrophotometer., Results: Nitrate and chloride have been assessed at a higher rate with the levels exceeding maximum contaminant levels. Mercury, arsenic, aluminum, iron, conductivity, and salinity have also had levels exceeding maximum contaminant levels for each of them according to the levels set by the World Health Organization., Conclusion: This study has given us some powerful clues that underground water in Ankara is at a growing risk to be contaminated mainly with nitrate and chloride. Although more detailed investigations are necessary for a better evaluation, it is clear that preventive measures should be implemented or improved.

The stresses of deployment affect both sexes, but some are either mildly or markedly different for women. These include certain female health and gynecological issues, nursing, and pregnancy. Separation from small children, isolation, the possibility of sexual assault, and risks of combat or being taken hostage are concerns for both genders. All of these issues should be addressed before and during deployment to ensure optimal individual and unit functioning and improve retention. Gynecological infections, redeployment for abnormal Papanicolaou smears, and pregnancy while on deployment can be avoided with proper hygiene and planning. There are resources available in pamphlet form, electronically, and on CD-ROM to help prepare service members, leaders, and health care personnel. Improvements in the ability to maintain personal hygiene and to communicate home should benefit both sexes.

Throughout history, battles, campaigns, and wars have often been decided by diseases, rather than bullets and tacticians. During the Korean War, Korean hemorrhagic fever (KHF) afflicted several thousand allied soldiers and an unknown number of Communist soldiers. This disease, and other members of a closely related group, the hemorrhagic fevers with renal syndrome, represent a continuing worldwide military and civilian threat. Through inexpensive and flexible environmental health measures, and readily available medical surveillance and testing, it is now possible to reduce the risk from this disease. In this paper, we will outline various environmental health measures developed to reduce the risk of contracting KHF and the justification for their use. We will also discuss a medical surveillance and testing program designed to get at-risk and symptomatic individuals to definitive care quickly in order to reduce overall morbidity and mortality.

US medical personnel serving in Ecuador analyzed how the field sanitation procedures of troops employed in Blazing Trails '87 had impact on living conditions and overall health of the troops. Such a situation allowed evaluation of USAR troop training and preparedness in field sanitation. Results indicate that field sanitation training needs to be improved at the unit level.