An analysis is provided from 19,265 Physical Evaluation Board diagnoses from 10,406 Navy personnel from 1998 to 2000. The leading diagnostic categories were musculoskeletal and mental disorders as well as for subgroups of women and officers. Musculoskeletal conditions were 41.6% of the diagnoses and decreased with advancing age (42.9% for <30 years; 41.1% for 30-40 years; 37.6% for >40 years; chi2 for trend [1 df] = 26.4; p = 0.000). Mental disorders were 11.8% of the diagnoses and also decreased with advancing age (14.1% for <30 years; 10.4% for 30-40 years; 8.8% for >40 years; chi2 for trend [1 df] = 84; p = 0.000). Diagnoses for injury and poisoning (8.9%), nervous system (7.6%), and ill-defined conditions (4.7%) completed the top five categories below age 40 years, whereas circulatory disorders were evident after age 40 years. These findings suggest priorities for reducing overall medical disability losses in our active duty Navy forces.
Disease and nonbattle injury (DNBI) patterns were analyzed for reports from the Commander Fifth Fleet for 2000-2001 covering 217,972 person-weeks. The overall DNBI rate was 4.38 visits per 100 person-weeks with the largest subcategory being "other medical/surgical" conditions (1.36 visits/100 person-weeks and over 30% of the initial patient visits). This was followed by dermatological (0.89 visits/100 person-weeks) and respiratory conditions (0.65 visits/100 person-weeks). Collapsing total injuries would have created the third largest incidence category. The mean DNBI rate for cruisers/destroyers/ frigates (4.23 visits/100 person-weeks; SD, 2.64 visits) was not significantly different from aircraft carriers (4.76 visits/100 person-weeks; SD, 1.60, t(df = 207) = -0.91, p = 0.363) but was statistically different from supply ships (8.93 visits/100 person-weeks; SD, 2.44, t(df = 191) = -6.23, p = 0.000) and amphibious support ships (8.07 visits/100 person-weeks; SD, 3.99, t(df = 190) = -4.72, p = 0.000). These results are compared with historical data from land-based units, and the limitations in shipboard DNBI reporting are discussed.
An outbreak of typhoid fever in Yakima County, Wash., is compared with 11 similar episodes of groundwater transmission of typhoid fever reported in the literature. The survival time and the distance bacteria can travel in groundwater are analyzed by using a linear regression correlated with the velocity of groundwater flow in various types of soils.
Reported cases of malaria in the Navy and Marine Corps were reviewed from the Naval Disease Reporting System (NDRS) and the Defense Medical Epidemiological Database (DMED). For 1997 through 2000, NDRS identified 62 cases of malaria and DMED identified 162 cases. Further analysis compared NDRS and DMED information with Composite Health Care System (CHCS) records in the Hampton Roads catchment area. The review of 46 patient records available in CHCS found that 30 patient encounters were miscoded in DMED for malaria treatment when they were actually for malaria chemoprophylaxis, 12 visits were coded for malaria treatment, and 4 visits had no apparent relationship to malaria. Ten of the 12 patients reported as treated for malaria in CHCS were also recorded in NDRS. This review suggests a need for further analysis and additional efforts to improve reporting and coding compliance to enhance medical surveillance and force health protection.
Reported cases of Lyme disease for Navy and Marine Corps personnel during 1997-2000 are presented from data collected in the Naval Disease Reporting System and the Defense Medical Epidemiological Database. Naval Disease Reporting System identified 210 case subjects; 60% were men, 49% were family members, and 37% were active duty, and most originated in the second quarter of the calendar year. States reporting the greatest number of reports were Connecticut (44%), North Carolina (16%), Rhode Island (10%), and Virginia (10%), which was generally consistent with national figures and the concentration of military populations. Incidence rates from Defense Medical Epidemiological Database for Lyme disease were generally higher for active duty personnel than reported civilian rates. Areas for improvement for Naval Disease Reporting System are identified and include additional emphasis on complete reporting on patient history and on Lyme disease antibody testing results. These findings suggest that Lyme disease is an important disease in military medicine, particularly in the eastern United States.
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