Highlighting these themes is a first step to fostering training collaborations between PHPM specialist physicians to augment transnational action on global public health challenges and also supports PHPM physician educators with innovative solutions from abroad that might address domestic specialty challenges.

We investigated a mixed outbreak of Legionnaires' disease (LD) and Pontiac fever (PF) at a military base to identify the outbreak's environmental source as well as known legionellosis risk factors. Base workers with possible legionellosis were interviewed and, if consenting, underwent testing for legionellosis. A retrospective cohort study collected information on occupants of the buildings closest to the outbreak source. We identified 29 confirmed and probable LD and 38 PF cases. All cases were exposed to airborne pathogens from a cooling tower. Occupants of the building closest to the cooling tower were 6·9 [95% confidence interval (CI) 2·2-22·0] and 5·5 (95% CI 2·1-14·5) times more likely to develop LD and PF, respectively, than occupants of the next closest building. Thorough preventive measures and aggressive responses to outbreaks, including searching for PF cases in mixed legionellosis outbreaks, are essential for legionellosis control.

Today's interconnected world has produced a distinct need for physician specialists in public health and preventive medicine. As the industrialized world confronts aging populations, rising health care costs, and a growing epidemic of chronic disease, it is clear that the focus of health care must become more preventive than curative.Although public health and preventive medicine exists in various forms worldwide, the literature has not yet examined different national strategies for postgraduate medical training in this unique specialty. This examination of present-day public health physician training in Canada and the United States represents a first step in addressing this gap.Using a standardized template for review, the authors compare key aspects of public health physician specialty training in both countries, including the definition and scope of the specialty; oversight and location of training; length of postgraduate training; specific clinical, academic, and practicum requirements; residency program funding; availability of residency positions; certification; and the roles of specialists.The authors explore similarities and differences between public health physician specialists in Canada and the United States in an effort to highlight training improvements for incorporation into each country's training program and to identify potential avenues of collaboration and cooperation across the border.

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BackgroundHealth and wellbeing initiatives vary in effectiveness due to programme design and offerings. The Partnership for Prevention programme expands access to up to 40 evidence-based clinical preventive services for all employees and eligible family members as part of a unique global health initiative.MethodsUsing a published RAND Europe model developed for the company, country-level return on investment was estimated over a five-year timeframe using programme utilisation data. Regional, global, and service-level averages were estimated using population-weighted country averages. Data were collected from 2012 to 2018 and analysed in 2018.ResultsThe programme is estimated to generate a global return of $4.28–$11.88 (after cost of investment), based on analysis of 57 countries and nearly 125,000 delivered services. Returns were positive for all regions, and immunisations, smoking cessation, and cardiovascular treatment generated the largest individual service returns.ConclusionsThis global health programme is projected to generate a significant return on investment by focusing on global utilisation of clinical preventive services.

Highly mobile multipurpose wheeled vehicle (HMMWV or Humvee) crashes present an important issue for the U.S. military. The aim of this study was to provide a descriptive analysis of occupants of military motor vehicle (MMV) crashes involving HMMWVs that occurred among deployed U.S. Army Soldiers. Crash-related data were collected from the U.S. Army Combat Readiness/Safety Center on MMV crashes among active duty Army personnel between 1999 and 2006. Records for 964 occupants with injuries from HMMWV crashes were analyzed, which represented 52% of the total occupants of MMV crashes. A significant association was observed between injury and engagement in combat, odds ratio 1.49 (1.03, 2.16). The risk of injury was greatest for gunners, odds ratio 2.37 (1.43, 3.92), and injury cost related to the crash was significantly related to prior deployment status (p < 0.001) and role of Soldier in the vehicle (Operator p = 0.005, Gunner p = 0.003). There was also a decrease over time in the number of crashes resulting in injury (p < 0.001). These data support the development of interventions that address the specific risks detailed, including the use of combat simulation training, increased protection for vulnerable positions, and enforcement of safety regulations.