Delay in diagnosis of neck of femur stress fracture in a female military recruit

We report the delay in diagnosis of a Neck of Femur (NOF) stress fracture in mixed sex basic military training. Stress fractures are common in military training with the incidence reported as ranging between 3.2-31%. NOF stress fractures, whilst only representing around 8% of stress fractures are associated with a high morbidity. It is imperative that medical officers looking after military recruits have a sound knowledge of the potential signs, symptoms and presentation of these injuries. Medical officers should always remains vigilant for stress fractures especially in mixed military training.     

Cost-effective syphilis screening in military recruit applicants.

A cost-effectiveness analysis of syphilis screening was performed. Strategies included no screening, universal testing at military entrance processing stations, universal testing at basic training centers, and contracting centralized screening. Probabilities derived from data retained on recruit applicants from 1989 through 1991 (N = 1,588,143) and from the published literature were used. Cost estimates were derived from costs incurred by the military and costs projected from implementing new strategies. Sensitivity analyses were performed. Modifying the existing contract for human immunodeficiency virus screening to include syphilis screening would maximize the effectiveness of screening at a cost to the Department of Defense of $9.52 per additional year of service received. The no-screening option was significantly more cost-saving than the current method of testing. Syphilis is rare and treatable, and individuals with syphilis will be identified by other means in many cases. Syphilis screening of recruit applicants at the military entrance processing stations should cease, saving the military $2,541,000 per year.     

Eosinophilic fasciitis in a military recruit: MRI evaluation with clinical correlation

Eosinophilic fasciitis (EF) is an uncommon connective tissue disease. We report a patient with EF who presented with episodic swelling and stiffness of his legs and forearms in combination with peripheral eosinophilia. Imaging studies of the legs and forearms, including computed tomography (CT) and magnetic resonance imaging (MRI), clearly demonstrated the characteristic finding of fascial thickening. The complete clinical imaging and pathological findings are described in this report. Cross-sectional imaging is useful in diagnosing EF and in the appropriate clinical scenario may be helpful in differentiating EF from other connective tissue diseases.     

A 36-year-old military recruit with recurrent myalgias and weakness

The objective of this study was to discuss a comprehensive yet cost-effective approach to working up active duty patients with recurrent rhabdomyolysis. A 36-year-old male Army recruit was evaluated at Walter Reed Army Medical Center for recurrent rhabdomyolysis. This case illustrates a practical and cost-effective approach to this goal. Questions along the way are meant to highlight military relevance and expand diagnostic considerations of muscle pain beyond the usual. The case takes an interesting twist and reinforces that, as providers, we must explore every aspect of our patient's history to the fullest to be effective diagnosticians.     

Characteristics of skeletal stress fractures in female military recruits of the Israel defense forces on bone scintigraphy

AIM: Clinical surveys on stress fractures (SF) in female military recruits are scarce. The aim of this study was to characterize the scintigraphic findings and classify the distribution and pattern of SF in a group of female recruits of the Israel Defense Forces (IDF). MATERIALS AND METHODS: The bone scans of 146 female recruits (age range, 19-20.6 years) with suspected SF were assessed retrospectively. The SF lesions were classified qualitatively into 4 grades of bone response according to the classification criteria introduced by Zwas et al. SF location and distribution were analyzed, and in several cases, the abnormalities were correlated radiographically. RESULTS: One hundred forty-six female recruits were examined, of which 93 (64%) had bone scan findings of SF with a total of 247 SF. Forty-eight patients (with or without SF) had shin splints, 32 had thigh splints, and 34 had normal scans. Several SF were detected in sites that were not clinically suspected. Thirty-nine percent of the SF were located in the feet (tarsal bones 22.7%, metatarsal 16.2%), 36.8% in tibiae (predominantly in the midthird), 15.7% in femurs, 6.5% in the pubic and sacroiliac regions, and 2% in the fibula. SF in the tibiae and femurs were mainly located in the posterior aspect of the medial cortical region. Forty-nine percent of the patients had bilateral SF. The SF were classified on a 4-grade scale: 41.3% were grade I, 37.2% grade II, 15.8% grade III, and 5.7% grade IV. Thirty-three percent of the patients had one site of SF, 31% had 2 sites, 7.5% had 3 sites, 12% had 4 sites, 7.5% had 5 sites, and 9% had more than 5 sites of SF. Different grades of lesions were often found in the same patient. Sixty-five percent of the patients had SF in the feet, 59% in the tibiae, 26% in the femurs, 14% in the pubic or sacroiliac regions, and 5% in the fibula. Radiography was performed in 15% of the patients. Only one patient had a positive finding on radiography. CONCLUSIONS: This study shows that lower leg SF are not uncommon in female military recruits. We clearly distinguished between SF and shin splints, which have important clinical consequences on treatment. Most of the SF were mild (grade I and II) located in the feet and tibiae. This study supports the experience gained in other studies, and emphasizes the significant number of pubic and sacroiliac SF in female soldiers, which is significantly higher in comparison with previous reports on male soldiers.     

Primary osteopenia in a female military flight crewmember

This report describes a case of primary severe osteopenia in a 35-yr-old female crewmember of a USAF transport aircraft. This previously healthy individual presented with musculoskeletal symptoms that led to the incidental finding of severe osteopenia on plain films of the pelvis. The subsequent evaluation, including dual energy X-ray absorptiometry (DEXA) showed a T-score of 1-2 SD below sex-adjusted expected levels for age. Work-up revealed no secondary causes and the patient was placed on alendronate sodium, vitamin D, and calcium supplementation. Within 2 yr, her bone studies were normal. The crewmember was returned to normal flight status and has had no aeromedical problems. Osteopenia and osteoporosis represent points on a continuum of bone disease. Recognizing and addressing risk factors for osteoporosis earlier may reduce the chances for fractures later in life. Aeromedical specialists must be cognizant of the increased risk for bone disease in female crewmembers.     

Physical and psychological stressors linked with stress fractures in recruit training

This study aimed to measure ambulation in infantry army basic training, and to evaluate if covering more distance can explain stress fractures in a stressor–stress model. Forty‐four male combat recruits (18.7 ± 0.7 years) participated in a 6‐month rigorous high intensity combat training program. Baseline data included anthropometric measurements, VO₂max, and psychological questionnaires. Actual distance covered was measured using a pedometer over an 11‐week training period. Psychological questionnaires were repeated after 2 months. Sixteen recruits were diagnosed with stress fractures by imaging (SFi = 36.4%). Statistical analysis included comparing measured variables between SFi and those without stress fractures (NSF). The recruits covered 796 ± 157 km, twofold the distance planned of 378 km (P < 0.001). The SFi group covered a distance 16.4% greater than that of the NSF group (866 ± 136 and 744 ± 161 km, respectively, P < 0.01), and also demonstrated greater psychological stress. These data reveal the importance of adherence to or enforcement of military training programs. In the light of these data, the Israeli Defense Forces program needs reappraisal. A stressor–stress response might explain the susceptibility of certain recruits for injury. Using advanced technology, monitoring ambulation may prevent stress fracture development by limiting subjects exceeding a certain level. Psychological profile may also play a role in predicting stress fracture development.     

Seroprevalence of hepatitis A, B, and C in a United States military recruit population.

One thousand five hundred thirty-eight U.S. Navy and Marine Corps enlisted recruits were tested for hepatitis A, B, and C serologic markers. The recruit population (mean age, 19 years) was 91% male, 69% white, 17% black, 9% Hispanic, 2% Filipino, and 2% "other" racial/ethnic group. Anti-HAV was found in 129 (8.4%) recruits, anti-HBc in 35 (2.3%), HBsAg in 5 (0.3%), and anti-HCV in 4 (0.3%). For recruits born in the U.S., the prevalence of anti-HAV and anti-HBc was 5.5% and 1.3%, respectively; for the 7% of recruits born outside the U.S., the prevalence was 44.9% and 14.0%, respectively. By logistic regression analysis, seropositivity for hepatitis A and B was independently associated with age, nonwhite racial/ethnic groups, and birth outside of the U.S. This study indicates that there is a relatively low risk of hepatitis A, B, and C infection among Navy and Marine Corps recruits.     

Physiological effects of a military training program on male and female cadets.

Tested at the beginning and the end of the 6-week training program which all incoming cadets (plebes) undergo upon entering the U.S. Military Academy were 29 males and 26 females (17-21 years old). The aerobic training consisted of running for 30 min 5-6 d/week at varied speeds depending upon performance in an initial 1.5-mile run test. Females responded to training with a significant increase (p is less than 0.001) in VO2 max from 46.0 +/- 1.0 to 49.7 +/- 0.8 ml/kg.min (7.9%). Males did not increase their initial VO2 max (59.4 +/- 1.1 ml/kg.min) significantly. Both groups significantly reduced HRmax and percent body fat. Their initial VO2 max values and activity history accounted for the lack of a significant increase in this highly-fit population of males. Blood lactates were significantly decreased (p is less than 0.05) at the same two submaximal workloads after training. The initial difference in aerobic power between males and females was reduced from 22% to 18%.     

女民兵阅兵训练应激状态下月经改变状况调查

 目的 了解女民兵阅兵训练应激状态下月经改变状况,为保障女民兵阅兵训练顺利进行提供理论和实践依据.方法 对国庆60周年阅兵训练女民兵272人进行调查,对其月经情况、经期行为、月经相关知识的来源和需求等进行分析.结果 月经周期异常占31%,月经经期异常占19%,月经经量异常占62%,经期卫生行为不良率为18%.认为需要进一步了解月经相关知识的人占女民兵总数的87%,其中33%有强烈需求.结论 阅兵训练可影响女民兵月经功能,女民兵存在月经知识缺乏及经期不健康行为,应对其进行月经健康教育,提高其月经知识水平,保障阅兵受训女民兵身心健康,确保高质量完成阅兵任务.     

某军队医院人才培养“云梯计划”成效分析与思考

目的对某军队医院人才培养“云梯计划”实施3年后的综合成效进行科学分析,为下一步更好落实人才培养计划提出建议。方法“云梯计划”实施3年后,采用科学的评估标准,邀请5名专家对医院2010—2012年纳入“云梯计划”支持范围的60名医务人员的人才培养成效进行综合评估。结果培养资助计划完成率为783%,综合评分主要集中在4~6分、2~4分2个区间,得分较为集中的区间人数占总人数的660%。结论培养计划完成率偏低,对科研能力培养效果较为明显,但新技术开展水平不高。应制订科学的培养计划,努力促进“云梯计划”高效落实,继续加大医疗科研支持力度,加强科研科学化与规范化管理,并不断强化国内进修管理。     

Estimated cost of dental treatment for active duty and recruit U.S. military personnel

This paper estimates the cost of restoring U.S. military personnel to optimal oral health. The data come from a 30-site oral health survey of Army, Navy, Marine Corps, and Air Force personnel conducted from February 1994 to January 1995. A systematic random sample of 2,711 recruits was drawn. From a prestratified, random sample of 15,924 active duty personnel, 13,050 (82% response rate) participated in the survey. Applying their best clinical judgment, one dentist per site charted comprehensive dental treatment needs on each service member. Radiographs were used. After the samples were weighted to reflect the 1994 population of recruits (202,144) and active duty personnel (1,699,662), treatment costs were calculated applying median fees reported by U.S. general dentists in 1995. Results show total estimated costs of $1.9 billion for active duty personnel and $203 million for recruits. Periodontal disease accounts for the greatest proportion (47%) of active duty treatment costs, and oral surgery accounts for the greatest proportion (32%) of recruit treatment costs. The cost of restoring U.S. service members to optimal oral health is substantial.     

"军事生物安全"的理论研究

现代生物科技大量涌入军事领域,在促进武器装备、军队指挥、军事后勤、作战方法等发生变化的同时也将产生一系列新的安全问题,这些安全问题将广泛涉及军队、国家以及人类等诸多层面,具有极强的不确定性、不可知性与无序性.为此,我们要在新的安全竞争领域里早做思考和决策,以"军事生物安全"的理论研究为先导,前瞻性地研究"军事生物安全"战略并寻求长效的防御机制.     

The "woman" in military recruitment

Transsexuality is a phenomenon, which presents a rarity on recruitment. A case of male-to-female genuine transsexualism was presented in term of psychological-psychiatric evaluation of a recruit for military service. A phenomenon of transsexualism is discussed through etiology, clinical picture, diagnosis, differential diagnosis and modern treatment.