Back to Top Skip to main content

Hearing Conservation Measures of Effectiveness Across the Department of Defense

Kori Reese, an audiology technician at Naval Branch Health Clinic Jacksonville’s occupational health clinic, conducts a hearing exam with Airman Diosney Moraga. Naval Hospital Jacksonville and Navy Medical Readiness and Training Command Jacksonville won the Chief of Naval Operation’s Award for Achievement in Ashore Safety (large non-industrial command) for Fiscal Year 2019. (U.S. Navy photo by Jacob Sippel). Kori Reese, an audiology technician at Naval Branch Health Clinic Jacksonville’s occupational health clinic, conducts a hearing exam with Airman Diosney Moraga. Naval Hospital Jacksonville and Navy Medical Readiness and Training Command Jacksonville won the Chief of Naval Operation’s Award for Achievement in Ashore Safety (large non-industrial command) for Fiscal Year 2019. (U.S. Navy photo by Jacob Sippel).

Recommended Content:

Medical Surveillance Monthly Report

WHAT ARE THE NEW FINDINGS?

DoD Hearing Conservation Program evaluation has historically been limited to service-specific metrics. This article presents the findings from the first review of data on the Measures of Effectiveness developed by the DoD Hearing Conservation Working Group.

WHAT IS THE IMPACT ON READINESS AND FORCE HEALTH PROTECTION?

Hazardous noise exposure is one of the most common occupational hazards within the DoD; such exposure can cause hearing loss or tinnitus that may directly affect a service member's ability to communicate effectively. The data presented here represent a means to evaluate the services’ efforts at hearing s conservation.

ABSTRACT

This article summarizes the findings from the first report of the new, standard Measures of Effectiveness developed by the Department of Defense (DoD) Hearing Conservation Program Working Group in 2018. When examining periodic hearing test results of DoD personnel, the overall risk of potential hearing injury/illness was stable from 2012 through 2018. The National Guard and Reserve components showed a higher potential risk of hearing loss, possibly related to lower compliance on follow-up tests when a shift in hearing occurred. Finally, the overall percentage of DoD personnel (who received periodic hearing tests) with hearing impairment decreased over the years presented.

BACKGROUND

Starting in 1949 with the first U.S. Air Force (USAF) regulation on noise,1 Hearing Conservation Programs (HCPs) have been implemented within the military and most commercial occupational settings where hazardous noise is present. These programs protect individuals who are exposed to hazardous noise from developing noise-induced hearing loss or tinnitus, which may result in permanent disability and negatively affect quality of life.2 Basic components of an HCP to mitigate the negative effects of noise on the worker include noise exposure monitoring, engineering and administrative controls (e.g., reducing the noise at the source, limiting personnel work hours around a hazard), audiometric evaluation, use of hearing protection devices, education and motivation, record keeping, and program evaluation.3

The Occupational Safety and Health Administration (OSHA) directs that employers maintain an accurate record of all workers’ noise exposures and audiometric testing information.4 Maintaining accurate and complete records provide evidence of compliance with regulations and are used to evaluate the effectiveness of the program.5 Due to the military’s transient workforce, the Department of Defense (DoD) uses a system of records that allows for monitoring audiograms of service members and DoD civilian personnel at installations worldwide: the Defense Occupational and Environmental Health Readiness System - Hearing Conservation Data Repository (DOEHRS-HC DR). This system allows for capture, analysis, and storage of hearing test (audiograms) results worldwide for DoD HCPs.

Each DoD component establishes, maintains, and evaluates the effectiveness of its own HCP. At a minimum, hearing test results that document a significant threshold shift (STS) and a permanent threshold shift (PTS), as well as rates of compliance with requirements for hearing tests, are collected, reviewed by program managers, and reported to higher headquarters.6 However, because each service varies in how the metrics are gathered and reported, STS and PTS rates are not always standardized and thus not always comparable. For example, in the Army and Marines Corps, all service members receive hearing tests on at least an annual basis due to the risk of noise-induced hearing loss secondary to exposures to weapon fire noise during required weapon qualification.

Hearing ability is also considered an element of individual readiness due to the need to communicate effectively on the battlefield and its relationship to warfighter lethality and survivability. The Air Force and Navy hearing conservation programs take a risk-based approach in which only members who are exposed to routine hazardous noise are enrolled in an audiometric monitoring program and receive periodic hearing tests. To resolve discrepancies between services, the DoD Hearing Conservation Working Group (HCWG) agreed upon standard HCP Measures of Effectiveness (MOEs) in 2018. These MOEs were then prepared and codified by the U.S. Air Force School of Aerospace Medicine's Epidemiology Consult Service Division and the Armed Forces Health Surveillance Branch Air Force Satellite.

METHODS

DOEHRS-HC DR data were used to generate MOEs at the DoD level and for each individual service. Data were stratified by component (active component [AC], National Guard [NG], reserve component, and civilian) and presented as annual percentages among those who were tested. This report presents findings for calendar years 2012 through 2018. All statistical analyses were performed using SAS/STAT software, version 9.4 (2014, SAS Institute, Cary, NC).

It is important to note that, if an individual’s reference or periodic hearing test reveals a hearing threshold exceeding 25 decibels hearing level (dBHL) in either ear, then that individual is considered to suffer from hearing impairment. A reference test is the initial hearing test received by an individual before exposure to hazardous noise duty. A periodic test is the monitoring hearing test done regularly to detect changes in hearing that may be associated with hearing injury/illness. When compared to the reference test, changes in hearing in the periodic test may initially be characterized as a significant threshold shift (STS). An STS is an average deterioration in hearing threshold of 10 dBHL or more at 2000, 3000, and 4000 Hz in either ear on the monitoring test, when compared to the individual’s reference test. When an STS occurs, follow-up testing is required to confirm whether the shift is temporary or permanent.7,8,9 If the STS has resolved at the time of the follow-up test, it is considered to have been a temporary threshold shift (TTS). Conversely, if an STS is confirmed on follow-up testing, or the member does not return for retesting within the specified timeframe, the STS is considered to represent a permanent threshold shift (PTS). The timeframe for follow-up testing varies from 30 to 90 days from the periodic test depending on service-specific regulations. Hearing is assessed at least annually for individuals and is compared to the most current reference test available. If an individual had more than one periodic or reference test series in a given calendar year, their most recent test series was used in the analysis. Aggregate data for 4 MOEs were compiled across all services and are described in this report.

MOE 1 examines potential hearing illnesses/injuries by calculating the percentages of tested individuals who had results of STS, TTS, and PTS. The percentages of threshold shifts were calculated by taking the number of unique individuals meeting each set of respective criteria on an annual (a type of periodic test) hearing test per calendar year and dividing by the total number of individuals who received an annual hearing test. For example, the number of individuals with a PTS is divided by the number of those who received an annual hearing test in a given time frame and the result is expressed as a percentage.

MOE 2 measures compliance with the requirement for follow-up testing after an STS. This MOE is similar to the DoD Instruction 6055.12 definition of compliance rates, but instead of measuring annual compliance with hearing tests,6 it measures non-compliance when follow-up is required. The rate of non-compliance is calculated by dividing the number of people with an STS who did not receive follow-up testing within the required time frame by the total number of tests indicative of STS per year. The time frame for follow-up testing is based on service-specific requirements.

MOE 3 is a measure of the frequency of hearing impairment (hearing thresholds above 25 dBHL) or the frequency of those with clinically normal hearing (hearing thresholds at 25 dBHL or below) in a population of interest. In this report, MOE 3 focuses on the proportion of hearing impairment counts among individuals who received testing per year. Percentages of hearing impaired were calculated by taking the number of individuals (including enlisted accessions as a separate population) with hearing impairment results on a periodic or reference hearing test per year and dividing by the total number of individuals who received a periodic or reference hearing test in the same year.

MOE 4 calculates the percentages of unique individuals who qualify for Veterans Affairs (VA) claims using counts and criteria as outlined in 38 CFR §3.385, Disability Due to Impaired Hearing.10 Service members meeting these criteria are deemed audiometrically eligible for service-connected disability for hearing impairment; however, there are multiple, additional criteria required before a disability rating for hearing loss is awarded by the VA. The audiometric criteria for MOE 4 are as follows: 1) any threshold greater than or equal to 40 dBHL from 500 to 4000 Hz in either ear, or 2) an average of the 3 highest frequencies between 500 to 4000 Hz greater than 25 dBHL (pure-tone average). The percentage of individuals meeting the VA compensation criteria was defined as the number who met the VA criteria per year divided by the total number of individuals who received a periodic or reference hearing test in that same year.

RESULTS

Service representation in the data used for this analysis was approximately 60% Army, 14% Navy, 14% Marines, and 12% Air Force.11 Figures 1a and 1b show results for MOE 1. Overall, from 2012 through 2018, percentages of potential hearing injury/illness (MOE 1) exhibited a stable pattern or steady decline during the period for AC and civilians, and essentially a stable pattern for NG and reserve members after 2014. Annual percentages of STS and PTS were consistently higher in NG (STS range: 15.1 – 16.3%, PTS range: 12.8 – 14.9%) and reserve members (STS range: 13.7 – 18.4%, PTS range: 11.8 – 17.2%) when compared to AC members (STS range: 8.1 – 11.0%, PTS range: 4.8 – 7.2%). Over the course of the 7-year period, civilian percentages of STS (range: 13.6 – 16.2%) were broadly similar to that of reserve and NG members. Annual percentages of PTS in civilians (range: 9.4 – 10.5%) were higher than those among AC members, but lower than percentages among reserve and NG members (Figures 1a, 1b).

The frequency of non-compliance with follow-up testing (MOE 2) demonstrated a downward trend from 2012 through 2017 among AC, NG, and civilians. Overall, non-compliance among reserve members trended upward during the 7-year study period. In general, non-compliance was substantially lower among AC members (range: 28.2 – 55.0%) and civilians (range: 27.6 – 54.9%) when compared to reserve (range: 78.5 – 93.9%) and NG members (range: 82.0 – 95.5%) (Figure 2).

The percentages of those with hearing test results indicative of hearing impairment (MOE 3) decreased slightly but steadily from 2012 through 2018 for all service members and civilians (Figure 3). A stable, but slightly downward trend was also noted for DoD enlisted accessions. The percentages of those tested who met the VA compensation criteria (MOE 4) decreased steadily over the 7-year period for all components and the DoD overall (Figure 4). This downward trend appeared to occur equally across all service components.

EDITORIAL COMMENT

MOE 1 results show that DoD civilian personnel have generally maintained a stable risk of hearing injury/illness from 2012 through 2018. The goal for this MOE was to detect potential hearing injuries/illnesses due to hazardous noise exposure; therefore, only the periodic annual tests were used to better reflect the personnel who are more routinely exposed. However, because only periodic annual tests were used in computing this measure, it is not recommended to compare MOE 1 STS, PTS, and/ or TTS outcomes to similar metrics found in DOEHRS-HC DR aggregate reports, or in other surveillance or research projects. Additionally, not all services are evenly represented within the DOEHRS-HC DR since each branch has its own criteria for enrolling members onto the program as previously stated.

Examination of MOE 1 results across components revealed that AC members had the lowest STS and PTS percentages, and the highest TTS percentages compared to reserve, and NG members. This trend in reserve and NG members may be the result of high non-compliance on follow-up tests as evident in the pattern of MOE 2 results. When an individual does not comply with the required follow-up test to verify a shift in hearing on the periodic annual hearing test within the required time frame, then a TTS automatically becomes a PTS in the DOERH-HC DR until the individual takes the next year’s hearing test. Therefore, an accurate analysis of permanent hearing injury/illness in these 2 populations is not possible until the differences in the proportions of non-compliance are addressed.

The explanation for the elevated proportions of STS, TTS, and PTS among DoD civilian personnel is unknown; however, the results for this population may reflect differences in age and/or years of noise exposure compared to service member populations (as the effects of noise on the auditory system are cumulative over time), as well as non-compliance with follow- up testing when an STS is captured. Overall, the comparisons between these 4 groups should be undertaken with care due to the differences in their contributions to the dataset (AC 63%; reserve 12%; NG 18%; DoD civilian personnel 7%). In other words, although AC accounts for the largest percentage of test results represented in the DOEHRS-HC DR data, the rules of surveillance are quite different between services and in comparison to reserve, NG or DoD civilian populations. In addition, there are significant age and sex differences between the DoD civilian population and the other populations. Furthermore, there may be additional exposures for the reserves and NG; for example a traditional guardsman only on orders 1 weekend a month could have a concurrent full-time civilian position with hazardous noise exposure.

The trend seen in MOE 3 of fewer individuals presenting with a hearing impairment over the past 6 years could be the result of multiple factors, such as effective hearing conservation prevention efforts, employee turnover, a reduction in noise exposure due to an overall decrease in combat operations, and/or force reduction efforts (e.g., reduction in force by medical requirement enforcement, or decrease in waivers for hearing issues identified at accession). Additionally, the DoD civilian population had a higher percentage meeting the hearing impairment criteria. As with the MOE 1 results for civilians, this observation may have been due to differences in age and/or years of noise exposure for this population compared to service member populations. Alternatively, this trend could also have been the result of less comprehensive efforts in hearing conservation for non-military individuals within DoD. As the DoD continues to emphasize noise-induced hearing loss prevention and to monitor metrics like the MOEs, the downward trend of members meeting MOE 4 VA Criteria indicates fewer individuals are meeting audiometric hearing impairment criteria. There are additional criteria that need to be met before a final service-connected disability rating can be obtained for hearing loss such as speech recognition scores below a specified cut-off and medical professional concurrence.

A limitation of the DOEHRS-HC DR data, particularly for more recent years in this report, is the real-time nature of the system in which hearing tests are continuously being imported/exported, edited, and corrected at installations and service levels; decidedly, the data become more stable over time. Therefore, there is less confidence in some data trends until they are shown to be stable in subsequent years; MOE 3 and 4 results show recent shifts in their respective trends between 2017 and 2018, for example.

The MOEs methods and data sets will continually be reviewed by the DoD HCWG and adjusted as needed based on the ever changing mission sets and hazardous noise environments. Upon the request of the DoD HCWG, the Air Force Hearing Conservation Program Office at USAFSAM is evaluating early warning shifts (greater than or equal to 15dB shift at 1,000, 2,000, 3,000 or 4,000 Hz on periodic hearing tests compared to reference hearing test for an individual) for use as a more sensitive indicator for potential hearing injury/illness. These shifts are also flagged in the DOERHS-HC DR data and are very similar to the NIOSH recommended STS criteria.12 Preliminary data show that early warning shifts have a high positive predictive value in identifying those service members who will present with an STS on their periodic hearing test. Additionally, for the last several years, the Army has taken the STS reporting a step further by creating a “new case of STS” metric, due to the STS’s dependence on follow-up test compliance. This metric only counts a new STS; it does not count a repeat STS that was noted the year before. A repeat STS can happen when the member does not complete the required follow up during the year prior; therefore, the reference was never re-established and the member presents with another shift. This metric helps the Army better understand the incidence of hearing injury and STS within their members. The addition of these 2 metrics could give the individual services the ability to better evaluate the effectiveness of their programs and make real-time recommendations, making these metrics good candidates for inclusion as an MOE in the future.

Author affiliations: U.S. Air Force School of Aerospace Medicine, Epidemiology Consult Service, Wright-Patterson AFB, OH (Mr. Wolff, Maj Batchelor, Dr. McKenna); U.S. Army Medical Material Development Activity, Warfighter Expeditionary Medicine and Treatment Project Management Office, Fort Detrick, MD (Maj Williams).

Acknowledgements: James D. Escobar, MPH; Deborah C. Lake, AuD; Theodore Mason; Joel R. Bealer, MA (CDR, USN); John A. Merkley, AuD (LTC, USA); Martin B. Robinette, AuD (LTC, USA).

REFERENCES

1. Department of the Air Force. Air Force Regulation No. 160-3. 31 August 1949.

2. American National Standards Institute (ANSI). ANSI Technical Report, Evaluating the Effectiveness of Hearing Conservation Programs through Audiometric Data Base Analysis. ANSI S12.13 TR- 2002 (R-2011).

3. Centers for Disease Control and Prevention. In: Franks JR, Stephenson MR, Merry CJ, eds. Preventing Occupational Hearing Loss: A Practical Guide. Cincinnati, OH: National Institute for Occupational Safety and Health; 1996.

4. Council for Accreditation in Occupational Hearing Conservation. In: Hutchison T, Schulz T, eds. Hearing Conservation Manual. 5th ed. Milwaukee, WI: Council for Accreditation in Occupational Hearing Conservation; 2014:13–18.

5. Occupational Safety and Health Administration. 29 CFR 1910.95, Occupational noise exposure. 23 June 2008.

6. Office of the Under Secretary of Defense for Personnel and Readiness. Department of Defense Instruction 6055.12. Hearing Conservation Program. 14 August 2019.

7. Office of the Secretary of the Air Force. Air Force Instruction 48-127. Occupational Noise and Hearing Conservation Program. 26 February 2016.

8. Headquarters, Department of the Army. Pamphlet 40-501. Army Hearing Program. 8 January 2015.

9. Navy and Marine Corps Public Health Center. Navy Medical Department Hearing Conservation Proram Procedures. TM 6260.51.99-2. 15 September 2008.

10. 38 CFR §3.385. Disability due to impaired hearing. 59 FR 60560. 25 November 1994.

11. DOD Hearing Conservation Working Group and DOD Hearing Center of Excellence. Hearing Health Surveillance Data Review Military Hearing Conservation–CY18. https://hearing.health.mil/Resources/ News-and-Events/Hearing-Health-Review. Accessed 01 October 2019.

12. National Institute for Occupational Safety and Health. Criteria for a Recommended Standard, Occupation Noise Exposure, Revised Criteria 1998. Publication No. 98-126. June 1998.

FIGURE 1a. MOE 1: Percentages of STS, TTS, and PTS, U.S. active component service members and DoD civilians, 2012–2018

FIGURE 1b. MOE 1: Percentages of STS, TTS, and PTS, reserve component, U.S. Armed Forces, 2012–2018

FIGURE 2. MOE 2: Percentages of non-compliance with follow-up testing, by service component and DoD civilians, 2012–2018

FIGURE 3. MOE 3: Percentage hearing impaired by service component, DoD civilians, and enlisted accessions, 2012–2018

FIGURE 4. MOE 4: Percentages meeting VA criteria by service component, 2012–2018

You also may be interested in...

Characterizing the Contribution of Chronic Pain Diagnoses to the Neurologic Burden of Disease, Active Component, U.S. Armed Forces, 2009–2018

Article
10/1/2020
Belgian Medical Component 1st Lt. Olivier, a physical therapist, adjusts the neck of a pilot from the 332nd Air Expeditionary Wing, June 22, 2017, in Southwest Asia. Aircrew from the 332nd AEW received treatment for pains associated with flying high performance aircraft through a partnership program with the Belgian Medical Component. (U.S. Air Force photo/Senior Airman Damon Kasberg)

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Influenza Immunization Among U.S. Armed Forces Healthcare Workers, August 2015–April 2020

Article
10/1/2020
NORFOLK (Oct. 15, 2019) Lt. Sipriano Marte administers an influenza vaccination to Airman Tyler French in the intensive care unit aboard the Wasp-class amphibious assault ship USS Kearsarge (LHD 3). Kearsarge is underway conducting routine training. (U.S. Navy photo by Mass Communication Specialist Petty Officer 3rd Class Jacob Vermeulen/Released)

Surveillance Snapshot: Influenza Immunization Among U.S. Armed Forces Healthcare Workers, August 2015–April 2020

Recommended Content:

Medical Surveillance Monthly Report

Acute and Chronic Pancreatitis, Active Component, U.S. Armed Forces, 2004–2018

Article
10/1/2020
Istock 916163392 3D illustration of human body organs (pancreas).

Acute and Chronic Pancreatitis, Active Component, U.S. Armed Forces, 2004–2018

Recommended Content:

Medical Surveillance Monthly Report

Update: Surveillance of Spotted Fever Rickettsioses at Army Installations in the U.S. Central and Atlantic Regions, 2012–2018

Article
9/1/2020
This photograph depicts a dorsal view of a female Gulf Coast tick, Amblyomma maculatum. This tick species is a known vector for Rickettsial organisms, Rickettsia parkeri, and Ehrlichia ruminantium, formerly Cowdria ruminantium. R. parkeri is a member of the spotted fever group of rickettsial diseases affecting humans, while E. ruminantium causes heartwater disease, an infectious, noncontagious, tick-borne disease of domestic, and wild ruminants, including cattle, sheep, goats, antelope, and buffalo. Note the considerably smaller scutum, or shield covering only a small region of its dorsal abdomen, unlike its male counterpart, an example of which can be seen in PHIL 10877, and 10878, which sports a scutum covering its entire dorsal abdomen. The smaller scutum in the female enables its abdomen to expand considerably, leading to an engorged appearance after ingesting its host blood meal. (Content provider: CDC/ Dr. Christopher Paddock)

Recommended Content:

Medical Surveillance Monthly Report

Update: Routine Screening for Antibodies to Human Immunodeficiency Virus, Civilian Applicants for U.S. Military Service and U.S. Armed Forces, Active and Reserve Components, January 2015–June 2020

Article
9/1/2020
Spc. Jayson Sanchez of the Army Reserve’s 77th Sustainment Brigade receives a blood draw from phlebotomist Nikole Horrell during the mass medical-readiness event hosted Aug. 8-9, 2015 by the Army Reserve’s 99th Regional Support Command at Joint Base McGuire-Dix-Lakehurst, N.J., in an effort to increase Soldier readiness throughout the northeastern United States. More than 300 Army Reserve and Army National Guard Soldiers had the opportunity to take care of their Periodic Health Assessments, dental exams, vision screenings, HIV blood draws, immunizations, hearing tests, LOD processing and temporary/permanent profiles during the event. (U.S. Army photo by Sgt. Salvatore Ottaviano, 99th Readiness Division)

Recommended Content:

Medical Surveillance Monthly Report

Update: Incidence of Inguinal Hernia and Repair Procedures and Rate of Subsequent Pain Diagnoses, Active Component Service Members, U.S. Armed Forces, 2010–2019

Article
9/1/2020
Senegalese and Vermont National Guard medical care professionals repair a hernia at the Hopital de la Paix in Ziguinchor, Senegal, Feb. 14, 2018. Vermont Guardsmen work alongside Senegalese medical personnel to obtain real-world experience while providing valuable medical services as part of a Medical Readiness Training Exercise. (U.S. Army National Guard photo by Sgt. Avery Cunningham)

Recommended Content:

Medical Surveillance Monthly Report

DHA recognizes 25 years of AFHSB's health surveillance journal

Article
8/12/2020
Medical technicians wearing masks and entering information on a computer

25 Years of Surveillance Reporting in Monthly Journal

Recommended Content:

Armed Forces Health Surveillance Branch | Medical Surveillance Monthly Report

Commentary: The Limited Role of Vaccines in the Prevention of Acute Gastroenteritis

Article
8/1/2020
This is a medical illustration of drug-resistant, Shigella sp. bacteria, presented in the Centers for Disease Control and Prevention (CDC) publication entitled, Antibiotic Resistance Threats in the United States, 2019 (Content provider: CDC/Antibiotic Resistance Coordination and Strategy Unit; Photo credit:  CDC/Stephanie Rossow).

Commentary: The Limited Role of Vaccines in the Prevention of Acute Gastroenteritis

Recommended Content:

Medical Surveillance Monthly Report

Update: Incidence of Acute Gastrointestinal Infections and Diarrhea, Active Component, U.S. Armed Forces, 2010–2019

Article
8/1/2020
This illustration was updated in the Centers for Disease Control and Prevention’s (CDC’s) Antibiotic Resistance Threats in the United States, 2019. This illustration depicts a three-dimensional, computer-generated image of a group of extended-spectrum ß-lactamase-producing Enterobacteriaceae bacteria, in this case, Escherichia coli. The artistic recreation was based upon scanning electron microscopic imagery. This is an excellent visual example of the long, whip-like, peritrichous flagellae, sprouting from what appear to be random points on the organism’s exterior, as well as the numerous shorter, and finer fimbriae, imparting a furry look to the bacteria (Content provider: CDC/Antibiotic Resistance Coordination and Strategy Unit; Photo credit:  CDC/Alissa Eckert).

Update: Incidence of Acute Gastrointestinal Infections and Diarrhea, Active Component, U.S. Armed Forces, 2010–2019

Recommended Content:

Medical Surveillance Monthly Report

Diarrhea and Associated Illness Characteristics and Risk Factors Among British Active Duty Service Members at Askari Storm Training Exercise, Nanyuki, Kenya, January–June 2014

Article
8/1/2020
This illustration was updated in the Centers for Disease Control and Prevention’s (CDC’s) Antibiotic Resistance Threats in the United States, 2019. This illustration depicts a three-dimensional computer-generated image of a cluster of drug-resistant, curly-cue shaped, Campylobacter sp. bacteria. The artistic recreation was based upon scanning electron microscopic imagery (Content provider: CDC/Antibiotic Resistance Coordination and Strategy Unit; Photo credit:  CDC/Alissa Eckert).

Diarrhea and Associated Illness Characteristics and Risk Factors Among British Active Duty Service Members at Askari Storm Training Exercise, Nanyuki, Kenya, January–June 2014

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Norovirus Outbreaks in Military Forces, 2015–2019

Article
8/1/2020
Based on electron microscopic imagery, this three-dimensional illustration provides a graphical representation of a single norovirus virion. Though subtle, the different colors represent different regions of the organism’s outer protein shell, or capsid (Content provider: CDC/Jessica A. Allen; Photo credit: CDC/Alissa Eckert).

Surveillance Snapshot: Norovirus Outbreaks in Military Forces, 2015–2019

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Cervical Cancer Screening Among U.S. Military Service Women in the Millennium Cohort Study, 2003–2015

Article
7/1/2020
Lt. Cmdr. Leslye Green, staff obstetrician and gynecologist, Naval Hospital Pensacola (NHP), uses a model to discuss cervical cancer with a patient at NHP. According to the Centers for Disease Control and Prevention (CDC), cervical cancer is highly preventable because screening tests for cervical cancer and vaccines to protect against human papillomavirus (HPV), which is the main cause of cervical cancer, are readily available. Cervical cancer is highly treatable and associated with long survival and good quality of life when it is detected early. (U.S. Navy photo by Mass Communication Specialist 1st Class Brannon Deugan)

Surveillance Snapshot: Cervical Cancer Screening Among U.S. Military Service Women in the Millennium Cohort Study, 2003–2015

Recommended Content:

Medical Surveillance Monthly Report

Epidemiology of Functional Neurological Disorder, Active Component, U.S. Armed Forces, 2000-2018

Article
7/1/2020
MRI film (iStock.com/temet)

Epidemiology of Functional Neurological Disorder, Active Component, U.S. Armed Forces, 2000-2018

Recommended Content:

Medical Surveillance Monthly Report

Alcohol-Related Emergency Department Visits, Hospitalizations, and Co-Occurring Injuries, Active Component, U.S. Armed Forces, 2009–2018

Article
7/1/2020
Sailors simulate a drunk driving accident during a Keep What You've Earned fair on Naval Base Kitsap Bangor. The fair encourages responsible alcohol use by celebrating the achievements in the sailors' Navy careers and actively engages sailors as advocates for responsible drinking. (U.S. Navy photo by Mass Communication Specialist 3rd Class Chris Brown)

Recommended Content:

Medical Surveillance Monthly Report

Animal-Related Injuries in Veterinary Services Personnel, U.S. Army, 2001–2018

Article
6/1/2020
Robin Jones (right), a retired Soldier and current veterinarian who works at the Fort Stewart Veterinary Treatment Facility, is being assisted by Spc. Krystall Shaw, an animal care specialist assigned to the clinic, as Jones uses a stethoscope on a patient to listen for proper breathing at the Fort Stewart Veterinary Treatment Facility on Fort Stewart, Georgia, April 10, 2020. The staff at the clinic continues to provide aid to working and privately owned animals during the COVID-19 pandemic. (U.S. Army photo by Sgt. Zoe Garbarino)

Recommended Content:

Medical Surveillance Monthly Report
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 12

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.