Study
Abstract
BACKGROUND & AIMS:
Some acute enteric infections are associated with the development of functional gastrointestinal disorders, most commonly irritable bowel syndrome but also other functional and organic gastrointestinal sequelae. Clostridium difficile infection has increased in incidence and severity, however, few studies have evaluated functional disorders after this infection.
METHODS:
We evaluated the epidemiology and sequelae of C difficile in the US military population by using the US Department of Defense's Armed Forces Health Surveillance Center Defense Medical Ecounter Database. We then performed a retrospective cohort study of 891 active-duty US military personnel who developed C difficile from 1998 to 2010 and 3231 matched subjects who had not been exposed to C difficile. Subjects were identified based on International Classification of Diseases, 9th revision, Clinical Modification codes for C difficile disease.
RESULTS:
C difficile was associated independently with increased rate ratios (RRs) for incident irritable bowel syndrome (RR, 6.1; 95% confidence interval [CI], 2.9-12.9), gastroesophageal reflux disease (GERD) (RR, 1.9; 95% CI, 1.4-2.6), dyspepsia (RR, 3.3; 95%, 1.4-7.7), and constipation (RR, 2.2; 95% CI, 1.3-3.7). Approximately 14.1% of subjects with C difficile later were identified with one of these functional gastrointestinal disorders (FGDs), compared with 6% of controls. Community- and health care-associated C difficile were associated at similar rates with these sequelae. Patients were at increased risk for FGDs within 3 months of a C difficile episode, with one additional case of FGD developing for every 12 diagnoses of C difficile.
CONCLUSIONS:
The incidence of community- and health care-associated C difficile has increased in the US military population from 1998 through 2010. As for other gastrointestinal infections, C difficile disease is associated with clinically relevant functional sequelae in this military population.
- Publication Status: Published
- Sponsoring Organization: Navy
- Sponsoring Office: Naval Medical Research Center
- Congressionally Mandated: No
- Funding Source: Navy
- Release Date/Publication: November 01, 2015
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Citation: Gutiérrez RL, Riddle MS, Porter CK. Increased risk of functional gastrointestinal sequelae after Clostridium difficile infection among active duty United States military personnel (1998-2010). Gastroenterology. 2015 Nov;149(6):1408-14.
Study
Abstract
Long-term antimalarial chemoprophylaxis is currently used by deployed U.S. military personnel. Previous small, short-term efficacy studies have shown variable rates of side effects among patients taking various forms of chemoprophylaxis, though reliable safety and tolerability data on long-term use are limited. We conducted a survey of troops returning to Fort Drum, NY following a 12-month deployment to Operation Enduring Freedom, Afghanistan from 2006 to 2007. Of the 2,351 respondents, 95% reported taking at least one form of prophylaxis during their deployment, and 90% were deployed for > 10 months. Compliance with daily doxycycline was poor (60%) compared with 80% with weekly mefloquine (MQ). Adverse events (AEs) were reported by approximately 30% with both MQ and doxycycline, with 10% discontinuing doxycycline compared with 4% of MQ users. Only 6% and 31% of soldiers reported use of bed nets and skin repellents, respectively. Compliance with long-term malaria prophylaxis was poor, and there were substantial tolerability issues based on these anonymous survey results, though fewer with MQ than doxycycline. Given few long-term antimalarial chemoprophylaxis options, there is an unmet medical need for new antimalarials safe for long-term use.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Walter Reed National Military Medical Center
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: September 01, 2015
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Citation: Saunders DL, et. al.,
Study
Abstract
Recent armed conflicts and the expanded reach of international terror groups has resulted in an increased incidence of blast-related injuries in both military and civilian populations. Mass-casualty incidents may require both on-scene and in-hospital triage to maximize survival rates and conserve limited resources. Initial evaluation should focus on the identification and control of potentially life-threatening conditions, especially life-threatening hemorrhage. Early operative priorities for musculoskeletal injuries focus on the principles of damage-control orthopaedics, with early and aggressive debridement of soft-tissue wounds, vascular shunting or grafting to restore limb perfusion, and long-bone fracture stabilization via external fixation. Special considerations such as patient transport, infection control and prevention, and amputation management are also discussed. All orthopedic surgeons, regardless of practice setting, should be familiar with the basic principles of evaluation, resuscitation, and initial management of explosive blast injuries.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Walter Reed National Military Medical Center
- Congressionally Mandated: No
- Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
- Release Date/Publication: September 01, 2015
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Citation: Balazs GC, Blais MB, Bluman EM, Andersen RC, Potter BK. Blurred front lines: triage and initial management of blast injuries. Curr Rev Musculoskelet Med. 2015 Sep;8(3):304-11.
Study
Abstract
The extent to which multiple past concussions are associated with lingering symptoms or mental health problems in military service members is not well understood. The purpose of this study was to examine the association between lifetime concussion history, cognitive functioning, general health, and psychological health in a large sample of fit-for-duty U.S. Army soldiers preparing for deployment. Data on 458 active-duty soldiers were collected and analyzed. A computerized cognitive screening battery (CNS-Vital Signs(®)) was used to assess complex attention (CA), reaction time (RT), processing speed (PS), cognitive flexibility (CF), and memory. Health questionnaires included the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Military Version (PCL-M), Zung Depression and Anxiety Scales (ZDS; ZAS), Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the Alcohol Use and Dependency Identification Test (AUDIT). Soldiers with a history of multiple concussions (i.e., three or more concussions) had significantly greater post-concussive symptom scores compared with those with zero (d=1.83, large effect), one (d=0.64, medium effect), and two (d=0.64, medium effect) prior concussions. Although the group with three or more concussions also reported more traumatic stress symptoms, the results revealed that traumatic stress was a mediator between concussions and post-concussive symptom severity. There were no significant differences on neurocognitive testing between the number of concussions. These results add to the accumulating evidence suggesting that most individuals recover from one or two prior concussions, but there is a greater risk for ongoing symptoms if one exceeds this number of injuries.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Walter Reed National Military Medical Center
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: September 01, 2015
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Citation: Dretsch MN, et. al., Multiple Past Concussions Are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers. J Neurotrauma. 2015 Sep 1;32(17):1301-6.
Study
Abstract
Divergent findings from previous research examining gender differences in the development of posttraumatic stress disorder (PTSD) among US military members deployed to the operations in Iraq or Afghanistan (recent operations) prompted this study utilizing a matching approach to examine whether risk for new-onset PTSD and PTSD severity scores differed by gender. US military members from the Millennium Cohort Study deployed in support of the recent operations were followed for approximately 7 years from baseline through 2 follow-up periods between 2001 and 2008. Propensity score matching was used to match 1 male to each female using demographic, military, and behavioral factors including baseline sexual assault. Analyses were stratified by combat experience defined as reporting at least one of five exposures during follow-up. Outcome measures included a positive screen for PTSD and severity scores measured by the PTSD Patient Checklist-Civilian Version. Discrete-time survival analysis quantified the association between gender and incident PTSD. Among 4684 matched subjects (2342 women and men), 6.7% of women and 6.1% of men developed PTSD during follow-up. Results showed no significant gender differences for the likelihood of developing PTSD or for PTSD severity scores among women and men who reported combat experience and among those who did not. This study is the first of its kind to match a large population of male and female service members on important baseline characteristics including sexual assault. Findings suggest that while combat deployed personnel develop PTSD, women do not have a significantly different risk for developing PTSD than men after experiencing combat.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: September 01, 2015
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Citation: Jacobson IG, et. al., Longitudinal assessment of gender differences in the development of PTSD among US military personnel deployed in support of the operations in Iraq and Afghanistan. J Psychiatr Res. 2015 Sep;68:30-6.
Study
Abstract
Can social resilience be trained? We report results of a double-dissociative randomized controlled study in which 48 Army platoons were randomly assigned to social resilience training (intervention condition) or cultural awareness training (active control group). The same surveys were administered to all platoons at baseline and after the completion of training to determine the short-term training effects, generalization effects beyond training, and possible adverse effects. Multilevel modeling analyses indicated that social resilience, compared with cultural awareness, training produced small but significant improvements in social cognition (e.g., increased empathy, perspective taking, & military hardiness) and decreased loneliness, but no evidence was found for social resilience training to generalize beyond these training foci nor to have adverse effects. Moreover, as predicted, cultural awareness, compared with social resilience, training produced increases in knowledge about and decreases in prejudice toward Afghans. Additional research is warranted to determine the long-term durability, safety, and generalizability of social resilience training.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Walter Reed National Military Medical Center
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: July 01, 2015
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Citation: Cacioppo JT, Adler AB, Lester PB, McGurk D, Thomas JL, Chen HY, Cacioppo S. Building social resilience in soldiers: A double dissociative randomized controlled study. J Pers Soc Psychol. 2015 Jul;109(1):90-105.
Study
Abstract
BACKGROUND:
In outbreak settings, mass vaccination strategies could maximize health protection of military personnel. Self-administration of live attenuated influenza vaccine (LAIV) may be a means to vaccinate large numbers of people and achieve deployment readiness while sparing the use of human resources.
METHODS:
A phase IV, open-label, randomized controlled trial evaluating the immunogenicity and acceptance of self-administered (SA) LAIV was conducted from 2012 to 2014. SA subjects were randomized to either individual self-administration or self-administration in a group setting. Control randomized subjects received healthcare worker-administered (HCWA) LAIV. Anti-hemagglutinin (HAI) antibody concentrations were measured pre- and post-vaccination. The primary endpoint was immunogenicity non-inferiority between SA and HCWA groups. Subjects were surveyed on preferred administration method.
RESULTS:
A total of 1077 subjects consented and were randomized (529 SA, 548 HCWA). Subject characteristics were very similar between groups, though SA subjects were younger, more likely to be white and on active duty. The per-protocol analysis included 1024 subjects (501 SA, 523 HCWA). Post-vaccination geometric mean titers by vaccine strain and by study group (HCWA vs. SA) were: A/H1N1 (45.8 vs. 48.7, respectively; p=0.43), A/H3N2 (45.5 vs. 46.4; p=0.80), B/Yamagata (17.2 vs. 17.8; p=0.55). Seroresponses to A components were high (∼67%), while seroresponses to B components were lower (∼25%). Seroresponse did not differ by administration method. Baseline preference for administration method was similar between groups, with the majority in each group expressing no preference. At follow-up, the majority (64%) of SA subjects preferred SA vaccine.
CONCLUSIONS:
LAIV immunogenicity was similar for HCWA and SA vaccines. SA was well-tolerated and preferred to HCWA among those who performed SA.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Walter Reed National Military Medical Center
- Congressionally Mandated: No
- Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
- Release Date/Publication: July 01, 2015
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Citation: Burgess TH, et. al.,
Study
Abstract
In response to the unprecedented Ebola virus disease (Ebola) outbreak in West Africa, the U.S. government deployed approximately 2,500 military personnel to support the government of Liberia. Their primary missions were to construct Ebola treatment units (ETUs), train health care workers to staff ETUs, and provide laboratory testing capacity for Ebola. Service members were explicitly prohibited from engaging in activities that could result in close contact with an Ebola-infected patient or coming in contact with the remains of persons who had died from unknown causes. Military units performed twice-daily monitoring of temperature and review of exposures and symptoms ("unit monitoring") on all persons throughout deployment, exit screening at the time of departure from Liberia, and post-deployment monitoring for 21 days at segregated, controlled monitoring areas on U.S. military installations. A total of 32 persons developed a fever during deployment from October 25, 2014, through February 27, 2015; none had a known Ebola exposure or developed Ebola infection. Monitoring of all deployed service members revealed no Ebola exposures or infections. Given their activity restrictions and comprehensive monitoring while deployed to Liberia, U.S. military personnel constitute a unique population with a lower risk for Ebola exposure compared with those working in the country without such measures.
- Publication Status: Published
- Sponsoring Organization: DoD agency, office, or organization other than the Army, Navy, Air Force, or Defense Health Agency
- Sponsoring Office:
- Congressionally Mandated: No
- Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
- Release Date/Publication: July 01, 2015
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Citation: Cardile AP, et. al., Monitoring Exposure to Ebola and Health of U.S. Military Personnel Deployed in Support of Ebola Control Efforts - Liberia, October 25, 2014-February 27, 2015. MMWR Morb Mortal Wkly Rep. 2015 Jul 3;64(25):690-4.
Study
Abstract
INTRODUCTION:
Knowledge of disease burden attributable to functional gastrointestinal disorders (FGD) in travelers is lacking, despite the high incidence of travelers' diarrhea (TD) associated with increased FGD risk. One tool for assessing the impact of disease on health-related quality of life is the health utility index (HUI), which values health states based on preferential health outcomes. Health utilities can be used as preference weights in the estimation of quality-adjusted life-years (QALYs).
METHODS:
Six months following travel to Egypt or Turkey, 120 US military personnel completed a survey on TD during deployment, health-related quality of life (SF-36), and the onset of functional bowel disorders (Rome II). Elements from the SF-36 were used to develop SF-6D values, which were combined with health state valuations to enable calculation of HUI scores for each subject. Mean index scores were compared across functional outcomes, specific symptoms, and demographic profiles.
RESULTS:
The presence of FGD significantly reduced index scores, with irritable bowel syndrome (IBS) and dyspepsia showing the greatest impact (-0.17 and -0.19, respectively) compared with those with no FGD (p < 0.05). Importantly, however, several individuals met multiple FGD outcome definitions. Additionally, a number of symptoms associated with abnormal bowel habits and abdominal pain were associated with reduced index scores regardless of outcome.
CONCLUSION:
FGD are associated with significant morbidity as assessed by HUIs. Given the strong link between TD and FGD as well as the large number of travelers from the developed to the developing world, additional study is needed to further understand this association and efforts aimed at primary disease prevention are warranted.
Published 2015. This article has been contributed to by US Government employees and their work is in the public domain in the USA.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
- Release Date/Publication: July 01, 2015
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Citation: Porter CK, et. al., Establishment of Health Utility Indices for Post-Infectious Functional Gastrointestinal Disorders in Active Duty US Military. J Travel Med. 2015 Jul-Aug;22(4):237-41.
Study
Abstract
Combat trauma wounds with invasive fungal infections (IFIs) are often polymicrobial with fungal and bacterial growth, but the impact of the wound microbiology on clinical outcomes is uncertain. Our objectives were to compare the microbiological features between IFI and non-IFI wounds and evaluate whether clinical outcomes differed among IFI wounds based upon mold type. Data from U.S. military personnel injured in Afghanistan with IFI wounds were examined. Controls were matched by the pattern/severity of injury, including blood transfusion requirements. Wound closure timing was compared between IFI and non-IFI control wounds (with/without bacterial infections). IFI wound closure was also assessed according to mold species isolation. Eighty-two IFI wounds and 136 non-IFI wounds (63 with skin and soft tissue infections [SSTIs] and 73 without) were examined. The time to wound closure was longer for the IFI wounds (median, 16 days) than for the non-IFI controls with/without SSTIs (medians, 12 and 9 days, respectively; P < 0.001). The growth of multidrug-resistant Gram-negative rods was reported among 35% and 41% of the IFI and non-IFI wounds with SSTIs, respectively. Among the IFI wounds, times to wound closure were significantly longer for wounds with Mucorales growth than for wounds with non-Mucorales growth (median, 17 days versus 13 days; P < 0.01). When wounds with Mucorales and Aspergillus spp. growth were compared, there was no significant difference in wound closure timing. Trauma wounds with SSTIs were often polymicrobial, yet the presence of invasive molds (predominant types: order Mucorales, Aspergillus spp., and Fusarium spp.) significantly prolonged the time to wound closure. Overall, the times to wound closure were longest for the IFI wounds with Mucorales growth.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Walter Reed National Military Medical Center
- Congressionally Mandated: No
- Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
- Release Date/Publication: July 01, 2015
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Citation: Warkentien TE, et.al., Impact of Mucorales and Other Invasive Molds on Clinical Outcomes of Polymicrobial Traumatic Wound Infections. J Clin Microbiol. 2015 Jul;53(7):2262-70.
Study
Abstract
INTRODUCTION:
Third-party certification/verification of dietary supplements (DS), although not mainstream, is one way to help ensure high-quality products. In the medical setting, physicians may prescribe DS to correct a deficiency or improve a health care outcome, and they want products of a certain standard of quality, free of adulteration/contamination.
OBJECTIVE:
We reviewed DS dispensed from all Department of Defense military treatment facilities over a 5-year period to determine which products had been third-party reviewed and certified/verified.
METHODS:
By using product name, manufacturer, and/or National Drug Codes, we examined product listings on the websites of three independent-evaluating organizations.
RESULTS:
Over 1.5 million dietary supplement prescriptions consisting of 753 different products were dispensed from 2007 through 2011. Less than 3.6% of the products examined were third-party certified/verified by any of the three most well-known evaluation organizations: 19 were verified by United States Pharmacopeial Convention; 9 products were reviewed and 8 certified by ConsumerLab; and none of the products were certified by NSF International.
CONCLUSION:
Most DS dispensed by military treatment facilities are not reviewed by a third party. This is not unexpected, as third party certification is not yet mainstream. However, one way to reduce potential hazards and exposure to unsafe products is to encourage use of supplements that have third-party certification/verification.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
- Release Date/Publication: July 01, 2015
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Citation: Jones DR, Kasper KB, Deuster PA. Third-Party Evaluation: A Review of Dietary Supplements Dispensed by Military Treatment Facilities From 2007 to 2011. Mil Med. 2015 Jul;180(7):737-41.
Study
Abstract
This comprehensive review outlines the impact of military-relevant respiratory infections, with special attention to recruit training environments, influenza pandemics in 1918 to 1919 and 2009 to 2010, and peacetime operations and conflicts in the past 25 years. Outbreaks and epidemiologic investigations of viral and bacterial infections among high-risk groups are presented, including (i) experience by recruits at training centers, (ii) impact on advanced trainees in special settings, (iii) morbidity sustained by shipboard personnel at sea, and (iv) experience of deployed personnel. Utilizing a pathogen-by-pathogen approach, we examine (i) epidemiology, (ii) impact in terms of morbidity and operational readiness, (iii) clinical presentation and outbreak potential, (iv) diagnostic modalities, (v) treatment approaches, and (vi) vaccine and other control measures. We also outline military-specific initiatives in (i) surveillance, (ii) vaccine development and policy, (iii) novel influenza and coronavirus diagnostic test development and surveillance methods, (iv) influenza virus transmission and severity prediction modeling efforts, and (v) evaluation and implementation of nonvaccine, nonpharmacologic interventions.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Armed Forces Health Surveillance Center
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: July 01, 2015
-
Citation: Sanchez JL, Cooper MJ, Myers CA, Cummings JF, Vest KG, Russell KL, Sanchez JL, Hiser MJ, Gaydos CA. Respiratory Infections in the U.S. Military: Recent Experience and Control. Clin Microbiol Rev. 2015 Jul;28(3):743-800.
Study
Abstract
INTRODUCTION:
Although prior studies have examined the prevalence of dietary supplement use among various populations, data on single vitamins prescribed by health care providers are limited.
OBJECTIVE:
This study examined trends in single-vitamin supplement (A, C, D, E, K) prescriptions by providers from military treatment facilities from 2007 to 2011.
METHODS:
We examined prescription data from the Department of Defense Pharmacy Data Transaction Service to determine trends in the aforementioned single-vitamin supplement prescriptions. Prescription rates per 1,000 active duty personnel were estimated using population data retrieved from the Defense Medical Epidemiology Database (i.e., [number of prescriptions/population size] × 1,000).
RESULTS:
Across the 5-year period, the number of vitamin D prescriptions per 1,000 active duty personnel increased 454%. In contrast, the number of vitamin A, vitamin E, and vitamin K prescriptions per 1,000 active duty personnel decreased by 32%, 53%, and 29% respectively. Vitamin C prescriptions remained relatively constant. Across all age groups, total single-vitamin supplement prescriptions increased by 180%.
CONCLUSION:
Together, prescriptions examined in this study increased steadily from 2007 to 2011, primarily because of the increase in vitamin D prescriptions. The exhibited trend reflects the current general-population pattern of dietary supplement use, with large increases in vitamin D and declines in vitamin E.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
- Release Date/Publication: July 01, 2015
-
Citation: Morioka TY, Bolin JT, Attipoe S, Jones DR, Stephens MB, Deuster PA. Trends in Vitamin A, C, D, E, K Supplement Prescriptions From Military Treatment Facilities: 2007 to 2011. Mil Med. 2015 Jul;180(7):748-53.
Study
Abstract
OBJECTIVE:
To evaluate pregnancy outcomes in Centering Pregnancy patients.
METHODS:
This was an IRB-approved retrospective cohort study from November 2009 to January 2013 involving 202 Centering Pregnancy patients and 202 Certified Nurse Midwife patients. The primary outcome was mean gestational age at time of delivery. Secondary outcomes included cesarean and operative vaginal delivery rate, triage visit frequency, Neonatal Intensive Care Unit admission rate, 1 and 5 minute APGAR scores, birth weight, breastfeeding rate at discharge and 6 weeks postpartum, third and fourth degree laceration rate, weight gain in pregnancy, and excessive weight gain rate.
RESULTS:
There was no statistically significant difference in any obstetric outcome including preterm delivery rate. Centering Pregnancy patients were more likely to be active duty (52.0 vs. 35.6%, p = 0.001), younger (24.8 vs. 26.3 years old, p < 0.001), and nulliparous (75.2 vs. 56.9%, p < 0.001). There was a statistically significant increase in triage visit frequency ≥ 6 for Centering Pregnancy patients (11.9% vs. 8.9%, p = 0.011).
CONCLUSION:
There were no clinically significant differences in the primary or secondary outcomes. Significant cost savings could be realized by expanding Centering Pregnancy in the military health system.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Walter Reed National Military Medical Center
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: July 01, 2015
-
Citation: Walton RB, Shaffer S, Heaton J. Group Prenatal Care Outcomes in a Military Population: A Retrospective Cohort Study. Mil Med. 2015 Jul;180(7):825-9.
Study
Abstract
INTRODUCTION:
The role of testosterone in health and quality of life has become increasingly visible and overtly marketed to the public. Some evidence suggests that testosterone levels in men may be low because of a variety of reasons, including stress and environmental exposures.
OBJECTIVE:
This study examines trends in testosterone prescriptions dispensed by military treatment facilities (MTFs).
METHODS:
We examined data from the Department of Defense Pharmacy Data Transaction Service to determine the nature of androgen prescriptions dispensed through MTFs from 2007 through 2011.
RESULTS:
The number of androgen prescriptions increased more than two-fold across the military from 19,494 in 2007 to 45,270 in 2011. Most prescriptions (99%) were for men. Androgen prescription rates rose 23% per year from 2007 through 2011 (p < 0.001, CI 23-24%). The prescription rate for 35- to 44-year-olds increased more than any other age group, with annual increases averaging 33% (p < 0.001, CI 32-34%).
CONCLUSION:
The number of androgen prescriptions within MTFs rose significantly from 2007 through 2011. This is similar to rises in androgen prescriptions seen in civilian medical systems. Clinical indications for the sharp increase in testosterone prescriptions are unknown, and the indications for clinically appropriate testosterone replacement need further clarification.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
- Release Date/Publication: July 01, 2015
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Citation: Canup R, Bogenberger K, Attipoe S, Jones DR, Olsen CH, Stephens MB, Deuster PA. Trends in Androgen Prescriptions From Military Treatment Facilities: 2007 to 2011. Mil Med. 2015 Jul;180(7):728-31.
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