Military medicine
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High numbers of dental emergencies (DE) in military service members (approximately 15% per annum) prompted the inclusion of Dental Readiness as one of six conditions that determine service members' Individual Medical Readiness (IMR). Additionally, even with the advances in body armor and helmet design, Cranio- and Oral-maxillofacial (CMF, OMF) injuries continue to occur in hostile environments. The objectives of this report are (1) to provide a comprehensive review of the incidence of DE and CMF/OMF injuries in US military personnel deployed in multiple environments and (2) to compare the rates of DE and CMF/OMF injuries occurring in the 20th century with the rates observed in the early 21st century. ⋯ The percentage of DE and OMF casualties that can be expected in hostile environments is approximately 12%. Using the most recent data since 2000, the mean DE rate was 118.2 per 1,000 PPY and the OMF rate was 3.0 per 1,000 PPY. Future research should yield information which is representative of the evolving military environment. This information should be used to enhance military-specific dental therapies and to guide protection of the craniofacial region. More importantly, quality data are necessary (1) to enable the accurate prediction of DE, CMF, and OMF casualties to insure that troop levels are sufficient for mission success and (2) to insure that all outcome variables are available to measure policy success or failure.
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Approximately, 320 physicians enter active duty in the U.S. Army each year, replacing a similar number separating from service. Despite the significant costs involved in educating and training physicians, factors associated with continued active service after completing obligations have not been well studied. ⋯ The physicians most likely to continue serving after completion of their obligation and ultimately retire are those who had the most years of service accumulated when they could leave the Army. Graduates from the Uniformed Services University of the Health Sciences (USU) incur an obligation of 7 years vs. 4 years for most other programs. USU also attracts a higher proportion of applicants with prior military service and pre-medical school service obligations. The lack of significant difference in service after obligation completion or achievement of retirement eligibility between USU and non-USU graduates was explained by the greater total service of USU graduates when their obligations were complete. Changing the obligation and incentives, such as salary, for other accessioning programs to mirror the USU model would likely minimize service differences between USU and non-USU graduates.
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Case Reports
Latent Lyme Disease Resulting in Chronic Arthritis and Early Career Termination in a United States Army Officer.
Lyme disease is a continuing threat to military personnel operating in arboriferous and mountainous environments. Here we present the case of a 24-year-old Second Lieutenant, a recent graduate from the United States Military Academy, with a history of Lyme disease who developed recurrent knee effusions following surgery to correct a hip impingement. ⋯ This case illustrates the profound effect that latent Lyme disease can have on the quality of life and the career of an active duty military member. It highlights the need for increased surveillance for Borrelia burgdorferi (B. burgdorferi) in military training areas and for the early and aggressive diagnosis and treatment of military personnel who present with the symptoms of acute Lyme disease.