Military medicine
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Multicenter Study
Immune cytokine response in combat casualties: blast or explosive trauma with or without secondary sepsis.
The aim of this study was to assess the prognostic value of tumor necrosis factor (TNF) alpha, interleukin (IL)-8, IL-4, and IL-10 in combat casualties. Fifty-six casualties with severe trauma (blast and explosive) who developed sepsis and 20 casualties with the same severity of trauma without sepsis were enrolled in this study. Fifty-five casualties developed multiple organ dysfunction syndrome; 36 died. ⋯ Mean values of IL-8 were 60-fold, TNF-alpha were 43.5-fold, and IL-10 were 70-fold higher in the multiple organ dysfunction syndrome group (p < 0.01). Mean values of IL-8 were 2.3-fold and IL-10 were 1.4-fold higher in nonsurvivors and TNF-alpha were 2.2-fold higher in survivors (p < 0.01). IL-4 had no significance as a predictor of severity and outcome.
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Multicenter Study
Knowledge and risks of human immunodeficiency virus transmission among veterans with severe mental illness.
This study is among the first to examine knowledge about human immunodeficiency virus (HIV) and behavioral risks for HIV transmission among veterans with severe mental illness (SMI), a group at high risk for HIV infection. This study examined associations between accuracy of HIV knowledge, risk behaviors, and clinical and demographic characteristics in a sample of male veteran psychiatric inpatients diagnosed with SMI (N = 353). ⋯ Inaccurate HIV knowledge was associated with older age, minority status, education level, marital status, no homelessness within the previous 6 months, and no reported history of illicit intranasal drug use. There is a need for more effective HIV prevention interventions for persons with SMI.
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Multicenter Study Comparative Study
Primary care outcomes and provider practice styles.
The purpose of this study was to evaluate change in patient outcomes as a function of practice styles of primary care providers. A prospective, repeated-measures, correlational design was used. Data were collected about (1) providers' self-ratings of practice styles, inclusive of practice model, confidence, autonomy, collaboration, information giving, and job satisfaction, and (2) primary care patients' self-ratings of health status, functional status, information seeking, and satisfaction. ⋯ Practice style did affect patient satisfaction. Patients were least satisfied with providers who scored high on collaboration and most satisfied with providers who scored low on the practice model. Neither provider type nor interpersonal attributes had an effect on health outcomes; sicker patients got better and healthy patients stayed that way.
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Multicenter Study
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. ⋯ 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.
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Multicenter Study
Demographic and psychosocial risk factors for preterm delivery in an active duty pregnant population.
The effects of work climate, pregnancy transitions stress, maternal medical conditions, health risk behaviors, psychological health, and demographic characteristics were examined among 269 pregnant military women. The study found that single and separated/divorced military women were at greater risk for preterm delivery than married women. ⋯ Psychosocial variables distinguished the three marital status groups--married, single, and separated/divorced--but none of these variables was related to preterm delivery. In a logistic regression analysis, marital status was a more significant predictor of preterm delivery than were medical conditions.