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Rowh A, Lindfield R, Gaines J. Force Health Surveillance in the NATO Does Not Meet the Needs of Its Users: A Structured Evaluation of EpiNATO-2. Mil Med 2023:usad438. [PMID: 37966392 PMCID: PMC11093880 DOI: 10.1093/milmed/usad438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/04/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Disease and non-battle injuries (DNBIs) cause substantial losses among military personnel. NATO has monitored DNBIs among its personnel since 1996 using multiple versions of a tool now called EpiNATO-2, but the surveillance system has never been systematically evaluated. Following a request from NATO to the CDC, the objective of this study was to assess surveillance system attributes of EpiNATO-2 using CDC's updated guidelines for evaluating public health surveillance systems. MATERIALS AND METHODS Between June and October 2022, a literature review and key informant interviews were conducted to assess the following attributes: usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, positive predictive value, representativeness, timeliness, stability, informatics system quality, informatics service quality, and informatics interoperability. Key informant interviews were conducted in Kosovo, Germany, and remotely with EpiNATO-2 users spanning three levels: clinical and data entry personnel (tactical level); regional medical and public health officers (operational level); and senior commanders and other governmental entities (strategic level). RESULTS Fourteen EpiNATO-2 users participated in interviews, representing 3 of the 5 major NATO missions, 3 partner entities, and 7 nationalities. All users (100%) reported that the system did not meet their needs, with most users noting the following challenges: lack of clearly defined system objectives; poor data quality due to ambiguous case definitions and frequently unsubmitted reports (37% missing during January to June 2022); long delay between the occurrence of health events and the availability of corresponding data (≥2 weeks); and an antiquated and inflexible data management system. Overall, performance was deemed unsatisfactory on 11 of the 13 attributes. CONCLUSIONS This multinational sample of EpiNATO-2 users at all military levels reported that the system is currently not useful with respect to its stated objectives. Opportunities exist to improve the performance and usefulness of EpiNATO-2: improve case definitions, modernize data infrastructure, and regularly evaluate the surveillance system.
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Affiliation(s)
- Adam Rowh
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Robert Lindfield
- NATO Military Medicine Center for Excellence, Munich 80637, Germany
| | - Joanna Gaines
- Centers for Disease Control and Prevention, Washington, DC 20024, USA
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A single dose of ciprofloxacin reduces the duration of diarrhea among service members deployed in Africa. Infect Dis Now 2023; 53:104643. [PMID: 36642099 DOI: 10.1016/j.idnow.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/27/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To assess the effectiveness of the adjunction of a one-gram single dose of ciprofloxacin to a symptomatic treatment for the early treatment of uncomplicated diarrhea during military operations of the French service members in Africa. PATIENTS AND METHODS This phase IV, multicentric, randomized, open-label, controlled trial was conducted in Chad, Mali, and in Central African Republic. A total of 267 French service members having at least one loose stool in the previous 24 hours were enrolled from May 2015 to June 2016. Participants were randomized to receive ciprofloxacin 1 g and a symptomatic treatment (racecadotril 100 mg three times a day and ad libidum oral rehydration solution) or a symptomatic treatment alone. The primary outcome was the duration of the diarrhea. Secondary outcomes were evaluated at the 72-hour endpoint and included recovery status, number of loose stools, frequency and duration of associated symptoms and safety of treatments. RESULTS Among 267 participants, 242 completed the trial. Participants receiving ciprofloxacin and a symptomatic treatment (n = 124) were significantly more likely to be cured at the endpoint than those who only received a symptomatic treatment (118): 94.4 % versus 74.6 % (OR = 5.7; 95 %CI: [2.4-13.6]; p < 10-3). The antibiotic therapy reduced the average diarrhea duration by 30 % (p = 10-4). Fever at inclusion was associated with a longer episode (HR = 0.61; 95 %CI: [0.41-0.89]; p = 0.012). No adverse event of medications was reported. CONCLUSION A single dose of ciprofloxacin was effective and safe in treating uncomplicated diarrhea among service members in Africa.
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Lόpez-Vélez R, Lebens M, Bundy L, Barriga J, Steffen R. Bacterial travellers' diarrhoea: A narrative review of literature published over the past 10 years. Travel Med Infect Dis 2022; 47:102293. [PMID: 35247581 DOI: 10.1016/j.tmaid.2022.102293] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
Travellers' diarrhoea (TD) is the most frequent illness experienced by international travellers to lower-income countries with bacterial agents considered to account for 80-90% of cases. In this review, we summarise evidence published on bacterial TD over the past 10 years, focusing on the epidemiology and aetiology of TD. Diarrhoeagenic Escherichia coli (DEC) continue to be the most commonly implicated bacteria in TD, although Enteropathogenic E. coli (EPEC) and Enteroaggregative E. coli (EAEC) now appear to be predominant where Enterotoxigenic E. coli (ETEC) was previously considered most prevalent globally. Where fluroquinolone resistance had primarily been documented for Campylobacter in Southeast Asia, widespread resistance has been observed in most regions of the world for multiple enteropathogens, including Shigella, Salmonella, ETEC and EAEC. Implementation of novel molecular methods for pathogen detection has led to identification of bacterial pathogens, including Clostridium difficile (with and without the use of prior antibiotics), Arcobacter species and Bacteroides fragilis, as aetiological agents in TD. The widespread resistance to first-line antibiotics in multiple bacterial enteropathogens warrants continued surveillance and re-evaluation of current treatment practices. Further investigations are required to determine the prevalence and geographical distribution of bacterial enteropathogens that have been more recently implicated in TD.
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Affiliation(s)
- Rogelio Lόpez-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, 28034, Madrid, Spain.
| | - Michael Lebens
- Department of Microbiology and Immunology, University of Gothenburg, Box 435, SE-40530, Gothenburg, Sweden.
| | - Leah Bundy
- Elements Communications Ltd, Westerham, TN16 1RQ, UK.
| | - Juan Barriga
- Department of Medical Affairs Europe, Emergent BioSolutions, 1455, Madrid, Spain.
| | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, World Health Organization Collaborating Centre for Travelers' Health, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland; Epidemiology, Human Genetics and Environmental Sciences Division, University of Texas School of Public Health, Houston, TX 77030, Texas, USA.
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Factors That Affect Emergency Responder Wellbeing: Considerations for Public Health Responders. Disaster Med Public Health Prep 2021; 16:809-817. [PMID: 33818365 DOI: 10.1017/dmp.2020.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE The purpose of this study is to identify key risk factors that could negatively affect public health emergency responders' health and wellbeing. We seek to use this information to provide recommendations and strategies to mitigate such risks. DESIGN/METHODOLOGY/APPROACH A narrative review of the peer-reviewed literature on wellbeing of military personnel and other responders was conducted. Data was grouped and categorized according to overarching domains. FINDINGS Factors associated with wellbeing were categorized into 5 domains: (1) demographics; (2) mental health concerns; (3) social networks; (4) work environment; and (5) postdeployment life. The strategies identified to promote wellbeing included mental health assessments, preparedness trainings, debriefs in the field, postdeployment debriefs, resources in the field, and further postdeployment decompression strategies. ORIGINALITY/VALUE This study provides a unique understanding of the risk factors associated with poor health and wellbeing outcomes in public health emergency response work by extending the body of knowledge that focuses on other types of emergency and military response.
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Luft A, Corcostegui SP, Millet M, Gillard J, Boissier J, Rondy P, Bancarel J, Carfantan C. Aeromedical Evacuations Within the French Armed Forces: Analysis of 2,129 Patients. Mil Med 2021; 185:468-476. [PMID: 31642486 DOI: 10.1093/milmed/usz268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The doctrine of medical support during French military operations is based on a triptych: forward medical stabilization, forward damage control surgery, and early strategic aeromedical evacuation (Strategic-AE). The aim of this study was to describe the last piece, the evacuation process of the French Strategic-AE. METHODS We conducted a retrospective cohort analysis using patient records from 2015 to 2017. All French service members requiring an air evacuation from a foreign country to a homeland medical facility were included. Data collected included age, medical diagnosis, priority categorization, boarding location, distance from Paris, type of plane and flight, medical team composition, timeline, and dispatch at arrival. RESULTS We analyzed 2,129 patients evacuated from 71 countries, most from Africa (1,256), the Middle East (382), and South America (175). Most patients (1,958) were not severely injured, although some considered priority (103) or urgent (68). Diagnoses included disease (48.6%), nonbattle injuries (43%), battle stress (5.3%), and battle injuries (3%). 246 Strategic-AE used medical teams in flight, 136 of them in a dedicated Falcon aircraft. The main etiologies for those evacuations were battle injuries (24%), cardiovascular (15.4%), infections (8%), and neurologic (7.3%). The median time of management for urgent patients was about 16 hours but longer for priority patients (26 hours). Once in France, 1,146 patients were admitted to a surgery department and 96 to an intensive care unit. CONCLUSION This is the first study to analyze the French Strategic-AE system, which is doctrinally unique when compared to its North Atlantic Treaty Organization allies. North Atlantic Treaty Organization allies favor care in the theatre in place of the French early Strategic-AE. However, in the event of a high intensity conflict, a combination of these two doctrines could be useful.
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Affiliation(s)
- Antoine Luft
- Department of Defense, Operational headquarters, French Military Medical Service, 60 boulevard du Général Valin CS 21623, Paris Cedex 15 75509, France
| | - Simon-Pierre Corcostegui
- Special Medical Unit of Satory, French Military Medical Service, Camp des matelots, CS 10702, Versailles Cedex 78013, France
| | - Marianne Millet
- Paris Fire Brigade, French Military Medical Service, 47 rue Saint Fargeau, Paris 75020, France
| | - Jonathan Gillard
- Department of Defense, Operational headquarters, French Military Medical Service, 60 boulevard du Général Valin CS 21623, Paris Cedex 15 75509, France
| | - Jerome Boissier
- Department of Defense, Operational headquarters, French Military Medical Service, 60 boulevard du Général Valin CS 21623, Paris Cedex 15 75509, France
| | - Patrick Rondy
- Department of Defense, Operational headquarters, French Military Medical Service, 60 boulevard du Général Valin CS 21623, Paris Cedex 15 75509, France
| | - Jérôme Bancarel
- Medical Center of Rochefort, French Military Medical Service, BA 721 r Bois Bernard, Rochefort Air 17133, France
| | - Cyril Carfantan
- Department of Defense, Operational headquarters, French Military Medical Service, 60 boulevard du Général Valin CS 21623, Paris Cedex 15 75509, France
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Gentile G, Tong C, Renaud C, Menoud N, Casanova L, Blatteau JE, Christen JR, Texier G, Mayet A, Simon F. Incidence of leptospirosis in the French armed forces from 2004 to 2018: Retrospective analysis. Travel Med Infect Dis 2020; 39:101951. [PMID: 33333213 DOI: 10.1016/j.tmaid.2020.101951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The French military personnel may be exposed to leptospirosis during their training or on duty on the field in continental France, and most of all, in intertropical areas in the French departments and in Africa. The aim of this study was to assess the incidence of leptospirosis from epidemiological surveillance and cases data from 2004 to 2018, and to propose tools to assess leptospirosis risk prior to any mission or leisure activity. METHOD A retrospective epidemiological study on leptospirosis cases among French Armed Forces was conducted. More data were collected for 2 clusters in Martinique, as most of leptospirosis cases among French military personnel were identified in Martinique. RESULTS Eighty-eight cases of leptospirosis were reported, 15 cases in continental France and 73 cases in overseas (including 42 cases in the French West Indies). The global leptospirosis incidence rate in continental France was 0.3/100,000 person-years and in overseas 24/100,000 person-years with the higher incidence rate in Martinique (99/100,000 person-years) and in Mayotte (36.9/100,000 person-years). For the clusters in Martinique, between January and June 2009, 7 cases were declared; between 2016 and 2018, 16 cases were reported, high proportions of severe cardiac, renal and neurological forms (6/16) and hospitalizations (9/16). CONCLUSION The occupational risk is real in French Armed Forces, particularly in malaria-free intertropical areas where chemoprophylaxis by doxycycline is not applied. Prevention can be optimized by the use of practical tools such as tables and cartographies, leading to a better leptospirosis risk assessment and application of preventive recommendations.
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Affiliation(s)
- Gaetan Gentile
- Aix-Marseille Université, Département Universitaire de Médecine Générale, Faculté des Sciences Médicales et Paramédicales, 13885, Marseille, France; Aix-Marseille Université, Institut des Neurosciences des Systèmes, INSERM UMR 1106, France; Comité Pédagogique, Pôle Formation-enseignement-recherche, Laveran Military Teaching Hospital, Marseille, France.
| | - Christelle Tong
- Centre D'épidémiologie et de Santé Publique des Armées. GSBDD Marseille Aubagne, 111 Avenue de La Corse BP40026, 13568, Marseille Cedex 02, France.
| | - Christophe Renaud
- Centre Médical des Armées de Toulon, Antenne de L'école de Plongée de Saint-Mandrier, France.
| | - Nastasia Menoud
- Aix-Marseille Université, Département Universitaire de Médecine Générale, Faculté des Sciences Médicales et Paramédicales, 13885, Marseille, France.
| | - Ludovic Casanova
- Aix-Marseille Université, Département Universitaire de Médecine Générale, Faculté des Sciences Médicales et Paramédicales, 13885, Marseille, France; Aix-Marseille Université, VITROME-IHU Méditerranée & ORS PACA (Observatoire Régional de La Santé), France.
| | - Jean-Eric Blatteau
- Service de Médecine Hyperbare et D'Expertise Plongée, HIA Sainte-Anne, Toulon, France.
| | - Jacques-Robert Christen
- Department of Infectious Diseases and Tropical Medicine, Laveran Military Teaching Hospital, Marseille, France.
| | - Gaetan Texier
- Centre D'épidémiologie et de Santé Publique des Armées. GSBDD Marseille Aubagne, 111 Avenue de La Corse BP40026, 13568, Marseille Cedex 02, France; Aix-Marseille Université, VITROME-IHU Méditerranée & ORS PACA (Observatoire Régional de La Santé), France; École Du Val de Grâce, Paris, France.
| | - Aurelie Mayet
- Centre D'épidémiologie et de Santé Publique des Armées. GSBDD Marseille Aubagne, 111 Avenue de La Corse BP40026, 13568, Marseille Cedex 02, France; École Du Val de Grâce, Paris, France; Aix-Marseille Université, INSERM, IRD, SESSTIM UMR1252, Marseille, France.
| | - Fabrice Simon
- Comité Pédagogique, Pôle Formation-enseignement-recherche, Laveran Military Teaching Hospital, Marseille, France; Department of Infectious Diseases and Tropical Medicine, Laveran Military Teaching Hospital, Marseille, France; École Du Val de Grâce, Paris, France.
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Lloro V, Lozano-de Luaces V, Lloro I, Manzanares MC. The Incidence of Dental Needs During Isolated Missions Compared to Non-isolated Missions: A Systematic Review and Implications for Future Prevention Strategies. Mil Med 2020; 184:e148-e155. [PMID: 30535397 DOI: 10.1093/milmed/usy364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/06/2018] [Accepted: 11/12/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Dental emergencies in isolated groups have always been difficult to treat. Especially in people or groups who cannot be evacuated and who need urgent dental assistance: long-term submarine missions, long-term spaceship trips, military or non-governmental organizations deployments in conflict areas, military maneuvers, etc. The dental and evacuation problems could put the success of the mission at risk, with relevant associated economic and strategic costs. Our study summarizes current evidence about dental problems in isolated personnel (submarines and Antarctic missions) compared to other non-isolation conditions (military deployment in conflict area, military maneuvers) with the objective to assess the need for specific dental equipment in special long-term isolation conditions. MATERIALS AND METHODS We searched Medline, Cochrane Library, and Dentalgate between 1960 and 2017 for studies reporting dental disease in long-term isolation conditions (minimum 1 month) versus non-isolation conditions. We conducted the systematic review with all studies fitting the inclusion criteria. The comparison of the incidence rate was performed fitting a Poisson regression model to see the effect of the individual's condition on the incidence of dental event. RESULTS Thirty-eight studies were included in the systematic review. Antarctic missions showed a higher dental incidence rate compared to non-isolation conditions, but submarine missions showed the lowest dental incidence rate. In the sub-analysis of acute dental events, those with great impact on unit effectiveness, the incidence rates were higher. Caries and secondary decay events were the most prevalent dental problem in all conditions, followed by periodontal pathology and fractures of teeth or tooth problems not due to tooth decay in isolation conditions, and then by molar problems and endodontic problems in non-isolation conditions. The most common acute dental events were third molar problems and endodontic problems in all conditions. CONCLUSION This systematic review shows that the incidence of dental pathology in long-term isolation conditions may seem relatively infrequent but it exists and is relevant. Dental events are unpredictable, unrelated to trauma, and caused mainly by poor dental status. Preventive measures considerably reduce dental prevalence.
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Affiliation(s)
- V Lloro
- Odontology Hospital UB, Feixa Llarga Street, Barcelona, Spain
| | - V Lozano-de Luaces
- Falculty of Medicine and Health Sciences, University of Barcelona, Feixa Llarga Street, Hospitalet, Spain
| | - I Lloro
- Institute of Space Sciences (IEEC-CSIC), Campus de la Universitat Autònoma de Barcelona (UAB) de Bellaterra, Carrer de Can Magrans, Cerdanyola del Vallès, Barcelona, Spain
| | - M C Manzanares
- Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, University of Barcelona, Feixa Llarga Street, Hospitalet, Spain
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Medical evacuations of members of the French armed forces for infectious diseases in foreign operations. Med Mal Infect 2019; 50:545-554. [PMID: 31672468 DOI: 10.1016/j.medmal.2019.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 11/15/2018] [Accepted: 09/13/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Medical evacuations from foreign settings are a major health and strategic problem for the armed forces. This work aimed to study the characteristics of French military evacuations due to infectious diseases. PATIENTS AND METHODS We performed a retrospective study based on the registers of the French operational military staff for health to assess the characteristics of the strategic medical evacuation of French armed forces members on missions abroad between January 1, 2011 and December 31, 2016. RESULTS Out of 4633 included cases, 301 medical evacuations (6.5%) were carried out due to infectious situations. More than half of patients were repatriated to surgical wards (162 patients, 54%), 108 patients (36%) to medical wards, 21 patients (7%) to intensive care units, six patients (2%) to an armed forces medical center, and four files (1%) were incomplete. Among infectious emergencies, malaria led to 30 evacuations (10%) including 11 to intensive care units and one death before evacuation. Infectious diseases requiring medical evacuation were most often mild and community-acquired. Most soldiers were evacuated without medical assistance. CONCLUSIONS Infectious diseases during missions and medical repatriations carried out for infectious reasons are important epidemiological indicators to monitor. They make it possible to adapt preventive measures, training, and diagnostic and therapeutic tools which can be made available to front-line military physicians.
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Description of trauma among French service members in the Department of Defense Trauma Registry: understanding the nature of trauma and the care provided. Mil Med Res 2019; 6:7. [PMID: 30813959 PMCID: PMC6391821 DOI: 10.1186/s40779-019-0197-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/19/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Since 2001, the French Armed Forces have sustained many casualties during the Global War on Terror; however, even today, there is no French Military trauma registry. Some French service members (SMs) were treated in US Military Medical Treatment Facilities (MTFs) and were recorded in the US Department of Defense Trauma Registry (DoDTR). Our objective was to conduct a descriptive analysis of the injuries sustained by French SMs reported in the DoDTR and subsequent care provided to them to assist in understanding the importance of building a French Military trauma registry. METHODS Using DoDTR data collected from 2001 to 2017, a retrospective descriptive analysis was conducted. We identified 59 French SMs treated in US MTFs. The characteristics of the SMs' demographics, injuries, care provided to them, and discharge outcomes were summarized. RESULTS Among the 59 French SMs identified, 46 (78%) sustained battle injuries (BIs) and 13 (22%) sustained nonbattle injuries (NBIs). There were 47 (80%) SMs injured in Afghanistan (Opération Pamir), while 12 (20%) were injured in Opération Chammal in Iraq and Syria. Explosives accounted for 52.5% of injuries, while 25.4% were due to gunshot wounds; all were BIs. The majority of reported injuries were penetrating (59.3%), most of which were BIs (71.7%). The mean Injury Severity Score for BIs was 12 (SD = 8.9) compared to 6 (SD = 1.7) for NBIs. Around half of SMs (n = 30; 51%) were injured in Afghanistan between the years 2008-2010. Among a total of 246 injuries sustained by 59 patients, extremities were the body part most prone to BIs followed by the head and face. Four SMs died after admission (6.8%). CONCLUSIONS The DoDTR provides extensive data on trauma injuries that can be used to inform injury prevention and clinical care. The majority of injuries sustained by French SMs were BIs, caused by explosives, and predominantly occurring to the extremities; these findings are similar to those of other studies conducted in combat zones. There is a need to establish a French Military trauma registry to improve the combat casualty care provided to French SMs, and its creation may benefit from the DoDTR model.
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Pradines B, Rogier C. Contribution of the French army health service in support of expertise and research in infectiology in Africa. New Microbes New Infect 2018; 26:S78-S82. [PMID: 30402247 PMCID: PMC6205563 DOI: 10.1016/j.nmni.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 11/29/2022] Open
Abstract
Historically, infectious diseases have caused more casualties than battle. The French military health service therefore developed a range of research on vector-borne diseases such as malaria and arboviruses, antibiotic resistance, infectious agents that can be used as biological weapons and vaccines. The main objective is to control naturally acquired or provoked infectious diseases and limit their impact on armed forces as well as on civilian populations in France or abroad, particularly in Africa and anywhere French armies may be deployed. The expertise of the military health service teams in manipulating agents requiring high level of biosafety precautions and in organizing and providing medical care in unnatural conditions, including the battlefield, associated with complementarity staff experience (physicians, biologists, epidemiologists, researchers, pharmacists, logisticians), has been used in the management of the Ebola outbreak in Guinea.
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Affiliation(s)
- B. Pradines
- Unité Parasitologie et entomologie, Département des maladies infectieuses, Institut de recherche biomédicale des armées, Institut hospitalo-universitaire (IHU) Méditerranée Infection, Marseille, France
- Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- Centre national de référence du paludisme, Institut hospitalo-universitaire (IHU) Méditerranée Infection, Marseille, France
| | - C. Rogier
- Division Expertise et stratégie santé de défense, Direction centrale du service de santé des armées, Paris, France
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Aoun O, Rapp C, Bialé L, Imbert I, Lechevalier D, Banal F. An uncommon triad. J Travel Med 2017; 24:3954793. [PMID: 28931137 DOI: 10.1093/jtm/tax047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 11/14/2022]
Affiliation(s)
| | - Christophe Rapp
- Department of Infectious and Tropical Diseases, Bégin Military Hospital, Saint-Mandé, France
| | - Lisa Bialé
- Department of Rheumatology, Bégin Military Hospital, Saint-Mandé, France
| | - Isabelle Imbert
- Department of Rheumatology, Bégin Military Hospital, Saint-Mandé, France
| | | | - Frédéric Banal
- Department of Rheumatology, Bégin Military Hospital, Saint-Mandé, France
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Riddle CAPTMS, Martin GJ, Murray COLCK, Burgess CAPTTH, Connor CP, Mancuso COLJD, Schnaubelt MER, Ballard LCTP, Fraser J, Tribble DR. Management of Acute Diarrheal Illness During Deployment: A Deployment Health Guideline and Expert Panel Report. Mil Med 2017; 182:34-52. [PMID: 28885922 PMCID: PMC5657341 DOI: 10.7205/milmed-d-17-00077] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Acute diarrheal illness during deployment causes significant morbidity and loss of duty days. Effective and timely treatment is needed to reduce individual, unit, and health system performance impacts. METHODS This critical appraisal of the literature, as part of the development of expert consensus guidelines, asked several key questions related to self-care and healthcare-seeking behavior, antibiotics for self-treatment of travelers' diarrhea, what antibiotics/regimens should be considered for treatment of acute watery diarrhea and febrile diarrhea and/or dysentery, and when and what laboratory diagnostics should be used to support management of deployment-related travelers' diarrhea. Studies of acute diarrhea management in military and other travelers were assessed for relevance and quality. On the basis of this critical appraisal, guideline recommendations were developed and graded by the Expert Panel using good standards in clinical guideline development methodology. RESULTS New definitions for defining the severity of diarrhea during deployment were established. A total of 13 graded recommendations on the topics of prophylaxis, therapy and diagnosis, and follow-up were developed. In addition, four non-graded consensus-based statements were adopted. CONCLUSIONS Successful management of acute diarrheal illness during deployment requires action at the provider, population, and commander levels. Strong evidence supports that single-dose antimicrobial therapy is effective in most cases of moderate to severe acute diarrheal illness during deployment. Further studies are needed to address gaps in available knowledge regarding optimal therapies for treatment, prevention, and laboratory testing of acute diarrheal illness.
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Affiliation(s)
- CAPT Mark S. Riddle
- Enteric Disease Department, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Gregory J. Martin
- Chief, Tropical Medicine-Infectious Diseases, Bureau of Medical Services, US Department of State, 2401 E St NW L209, Washington DC 20037, USA
| | - COL Clinton K. Murray
- Deputy Medical Corps Chief, Medical Corps Specific Branch Proponent Officer, Infectious Disease Consultant to the Army Surgeon General, Brooke Army Medical Center, 3551 Roger Brooke Dr, JBSA Fort Sam Houston, TX 78234, USA
| | - CAPT Timothy H. Burgess
- Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Col Patrick Connor
- Military Enteric Disease Group, Academic Department of Military Medicine, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, United Kingdom
| | - COL James D. Mancuso
- Department of Preventive Medicine & Biostatistics, The F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Maj Elizabeth R. Schnaubelt
- Infectious Disease Service, Landstuhl Regional Medical Center, Landstuhl, Germany, CMR 402, APO, AE, 19180, USA [Current Affiliation: Division of Global HIV and TB, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA]
| | - Lt Col Timothy P. Ballard
- Operational Medicine, Defense Institute for Medical Operations, 1320 Truemper St, Bldg 9122, JBSA-Lackland, TX 78236, USA
| | - Jamie Fraser
- Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr #100, Bethesda, MD 20817, USA
| | - David R. Tribble
- Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
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13
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Murphy H, Abuova G, Pandey P. South Central Asia. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Holy Murphy
- CIWEC Hospital and CIWEC Clinic Travel Medicine Center; Kathmandu Nepal
| | - Gulzhan Abuova
- Department of Infectious Diseases; South-Kazakhstan State Pharmaceutical Academy; Shymkent Kazakhstan
| | - Prativa Pandey
- CIWEC Hospital and CIWEC Clinic Travel Medicine Center; Kathmandu Nepal
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14
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Tuck J, Williams J, Doyle A. Gastro Enteritis in a military population deployed in West Africa in the UK Ebola response; was the observed lower disease burden due to handwashing? Travel Med Infect Dis 2016; 14:131-6. [DOI: 10.1016/j.tmaid.2015.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 11/28/2022]
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15
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Hickey JP, Flaherty G. An outbreak of viral conjunctivitis in an Irish military deployment to Liberia. Travel Med Infect Dis 2015; 13:197-9. [DOI: 10.1016/j.tmaid.2015.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 01/17/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
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