Articles: health.
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Hepatitis C virus (HCV) is primarily transmitted through blood-to-blood contact. Leading health agencies have called for the elimination of HCV as a public health threat, with universal screening considered a part of the strategy. Hepatitis C virus screening among incoming cadets and cadet candidates at the United States Air Force Academy (USAFA) was implemented in 2023. The purpose of this quality improvement project was to determine the results of this screening and the associated fiscal costs, benefits, and harms to make a recommendation for future incoming classes. ⋯ The prevalence of chronic HCV infection among incoming USAFA cadets and cadet candidates was 0%, below the population screening threshold that warrants screening, according to the Centers for Disease Control and Prevention. The harms of screening, including fiscal costs and potential psychological harm to individuals with a false positive screen, likely outweigh the benefits. We recommend against universal HCV screening in 2024 upon accession of USAFA cadets and cadet candidates.
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Historical Article
Application of the Modified Grunow-Finke Risk Assessment Tool to the Sverdlovsk Anthrax Outbreak of 1979.
The modified Grunow-Finke tool (mGFT) is an improved scoring system for distinguishing unnatural outbreaks from natural ones. The 1979 Sverdlovsk anthrax outbreak was due to the inhalation of anthrax spores from a military laboratory, confirmed by Russian President Boris Yeltsin in 1992. At the time the Soviet Union insisted that the outbreak was caused by meat contaminated by diseased animals. At the time there was no available risk assessment tool capable of thoroughly examine the origin of the outbreak. ⋯ These findings align with the confirmed unnatural origin of the outbreak, highlighting the value of tools such as the mGFT in identifying unnatural outbreaks. Such tools integrate both intelligence evidence and biological evidence in the identification of unnatural outbreaks. The use of such tools for identifying unnatural outbreaks is limited. Outbreak investigation can be improved if risk assessment tools become integral to routine public health practice and outbreak investigations.
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Case Reports
Don't Overlook Syphilis: An Atypical Rash in a Woman With Neurologic, Ocular, and Otic Involvement.
The manifestations of syphilis, a sexually transmitted infection caused by Treponema pallidum, can be divided into primary, secondary, or tertiary stages. In addition, syphilis can cause a latent infection with no clinical manifestations and be diagnosed solely by serologic testing. Secondary syphilis is especially known for causing a rash and diverse clinical manifestation which can make its diagnosis challenging-particularly in patients whose medical and sexual histories do not align with the classical epidemiologic and textbook description of secondary syphilis. ⋯ This case highlights the importance of considering syphilis in the differential diagnosis of sexually active patients with a rash, even when their clinical presentations do not align with the textbook description of a syphilitic rash. Health care providers must remain vigilant for the diagnosis of syphilis in diverse clinical contexts, as early recognition and treatment are vital to prevent further syphilitic complications and transmission in military and civilian populations. Timely identification and intervention are crucial for both patient care and public health.
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U.S. DoD global health engagements offer opportunities for strategic engagement and building capability in collaboration with foreign military and civilian counterparts. Global health engagement activities can take the form of health security alliances and allow the USA and its allies and partners to prepare for, mitigate, and respond to emerging biothreats and other harmful health events that may negatively impact national security. One such example is the African Partnership Outbreak Response Alliance (APORA), which was designed to expand African Partner Nation militaries' infectious disease outbreak response capabilities. This publication evaluates the development, implementation, and outcomes of APORA to better understand the program's effectiveness in developing Partner Nation medical capabilities and the efficacy of health security alliances more broadly. ⋯ As a whole, these findings support APORA's objectives to develop and leverage partnerships to support medical capacity building, promote collaboration between military and civilian sectors, and increase access to opportunities and financial resources. Further evaluation is required to capture additional civilian perspectives while continuing to expand upon military perspectives in order to produce more generalizable findings. That said, this study enables key stakeholders to understand how to strengthen and expand future alliances to improve both health and security outcomes.
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Physical inactivity, hereafter inactivity, is a serious health problem among U.S. veterans, hereafter veterans. Inactive adults are at risk for adverse cardiac events and premature mortality. Specifically, among veterans, inactivity has been associated with a 23% increase in mortality. In order to increase physical activity among veterans, we developed Veterans Affairs (VA) MapTrek, a mobile-phone-based web app that allows users to take a virtual walk in interesting locations around the world while tracking their progress against that of others like themselves on an interactive map. Steps are counted by a commercially available Fitbit triaxial accelerometer, and users see their progress along a predefined scenic path overlaid on Google Maps. The objective of this study was to determine the effectiveness of VA MapTrek to increase physical activity in a population of veterans at risk for obesity-related morbidity. ⋯ Our study underscores the potential of VA MapTrek as an intervention for promoting walking among veterans who face elevated risks of obesity and cardiac issues. Rural veterans are a high-risk population, and new interventions like VA MapTrek are needed to improve veterans' health.