Search

Objectives: To examine the efficacy of an outside-the-boot parachute ankle brace (PAB) in reducing risk of ankle injury to army paratrooper trainees and to identify inadvertent risks associated with PAB use. Design: The authors compared hospitalization rates for ankle, musculoskeletal, and other traumatic injury among 223 172 soldiers trained 1985–2002 in time periods defined by presence/absence of PAB use protocols. Multiple logistic regression analysis estimated adjusted odds ratios (OR) and 95% confidence intervals for injury outcomes, comparing pre and post brace periods to the brace protocol period. Setting: A research database consisting of training rosters from the US Army Airborne training facility (Fort Benning, GA) occupational, demographic, and hospitalization information. Main outcome measures: Injuries were considered training related if they occurred during a five week period starting with first scheduled static line parachute jump and a parachuting cause of injury code appeared in the hospital record. Results: Of 939 parachuting related hospitalizations during the defined risk period, 597 (63.6%) included an ankle injury diagnosis, 198 (21.1%) listed a musculoskeletal (non-ankle) injury, and 69 (7.3%) cited injuries to multiple body parts. Risk of ankle injury hospitalization was higher during both pre-brace (adjusted OR 2.38, 95% CI 1.92 to 2.95) and post-brace (adjusted OR 1.72, 95% CI 1.27 to 2.32) periods compared with the brace protocol period. Odds of musculoskeletal (non-ankle) injury or injury to multiple body parts did not change between the brace and post-brace periods. Conclusion: Use of a PAB during airborne training appears to reduce risk of ankle injury without increasing risk of other types of traumatic injury.

Aims: To identify sociodemographic and occupational determinants of knee related disability discharge from the US Army among enlisted women, and to investigate effect modification. Methods: A case-control study of 692 cases of knee related disability discharge and 2080 incidence density matched controls nested within the population of all 244 000 enlisted women on active duty in the US Army, 1980–97. We used logistic regression to identify determinants of disability, stratified to explore effect modification by demographic and work characteristics. Results: The risk of disability discharge was twice as high (odds ratio (OR) 2.4, 95% confidence interval (CI): 1.71 to 3.47) for the oldest (33–60 years) versus the youngest (17–21 years) women. Non-whites had lower risk than whites (OR 0.5, 95% CI: 0.41 to 0.60), as did married (OR 0.7, 95% CI: 0.54 to 0.81) relative to non-married women. Those of lower rank (pay grades E1–E3) were at five times the risk of disability discharge compared to those of higher ranks (pay grades E4–E9, OR 5.0, 95% CI: 2.86 to 8.33), while ORs were highest for those with longer duration of service compared to women on active duty for a year or less (OR 1.4, 95% CI: 0.8 to 2.55 after 12 years). Race modified several effects, including that of rank. Age, duration of service, and pay grade were too highly correlated to draw firm conclusions about their independent modifying effects on risk of disability discharge from the Army. Conclusions: Sociodemographic factors had larger effects than occupational characteristics on risk of knee related disability discharge from the US Army. Interactions suggest subgroups at differing risk levels that might be targeted for more detailed investigations.

OBJECTIVE—There are relatively few published studies conducted among people of younger ages examining short term outcomes of cigarette smoking, and only a small number with outcomes important to employers. The present study was designed to assess the short term effects of smoking on hospitalisation and lost workdays. DESIGN—Retrospective cohort study. SETTING—Military population. SUBJECTS—87 991 men and women serving on active duty in the US Army during 1987 to 1998 who took a health risk appraisal two or more times and were followed for an average of 2.4 years. MAIN OUTCOME MEASURES—Rate ratios for hospitalisations and lost workdays, and fraction of hospitalisations and lost workdays attributable to current smoking (population attributable fraction). RESULTS—Compared with never smokers, men and women who were current smokers had higher short term rates of hospitalisation and lost workdays for a broad range of conditions. Population attributable fractions (PAFs) for outcomes not related to injury or pregnancy were 7.5% (men) and 5.0% (women) for hospitalisation, and 14.1% (men) and 3.0% (women) for lost workdays. Evidence suggests that current smoking may have been under reported in this cohort, in which case the true PAFs would be higher than those reported. CONCLUSIONS—In this young healthy population, substantial fractions of hospitalisations and lost workdays were attributable to current smoking, particularly among men. Keywords: young men; hospitalisation; lost workdays; employers