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Biomedical subjects

J W Gardner

Publications and source records attributed to J W Gardner.

At least 19 recordsLinked to original sources
PubMed2001

Long-term follow-up after exertional heat illness during recruit training.

PURPOSE: To evaluate long-term susceptibility to subsequent serious exertional heat illness (EHI) in military recruits who suffered exertional heat illness during basic training. METHODS: We identified Marine Corps members who completed at least 6 months of military service and suffered EHI treated as outpatients (N = 872) or inpatients (N = 50) during basic training in 1979-1991 at the Parris Island Marine Corps Recruit Depot, SC (EHI cases). We compared them to 1391 similar members (noncases) who did not experience EHI during basic training. These subjects were followed from 6 months after accession into the military through the subsequent 4 yr. Follow-up was through military personnel records to determine retention and military hospital databases to determine subsequent hospitalizations during military service. RESULTS: Military retention rates were slightly lower for those who suffered EHI during basic training, compared with those who did not (24% vs 30% at 4 yr, respectively). Outpatient EHI cases also had about 40% higher subsequent hospitalization rates in military hospitals than noncases during their continued military service, although these differences declined over time and diagnoses showed little relationship to EHI. EHI cases had higher rates of subsequent hospitalization for EHI, but the number was too small (five hospitalizations) to provide stable comparisons. CONCLUSION: Hospitalization for EHI is uncommon during subsequent military service after an initial episode during basic training, and occurrence of EHI during basic training has only a small impact on subsequent military retention and hospitalization.

Adult↗
PubMed2000

Cigarette smoking and exercise-related injuries among young men and women.

BACKGROUND: We evaluate whether a recent history of cigarette smoking is a risk factor for exercise-related injuries sustained during Army basic training, controlling for factors such as demographic, physical fitness, and health variables. METHODS: We conducted an observational cohort study in 1087 male and 915 female Army recruits undergoing 8-week basic military training. Data were collected from questionnaires, anthropometric measurements, physical fitness tests, company training logs, and medical records of all clinic visits. RESULTS: During the 8-week training period, 33% of men and 50% of women had at least one clinic visit for injury, including 14% of men and 25% of women who lost more than 5 days of training due to injury. Recruits who reported smoking at least one cigarette in the month prior to beginning basic training (which was conducted in a smoke-free environment) had significantly higher injury rates during training than those who did not report smoking (40% versus 29% for men, and 56% versus 46% for women). The relationship with smoking history was present most strongly for overuse injuries (32% versus 24% in men and 51% versus 40% in women). Multiple logistic regression analyses controlling for all other factors consistently showed adjusted odds ratios of about 1.5 for injury rate in those with a history of smoking compared to those without. CONCLUSIONS: The association of history of cigarette smoking with injury occurrence was consistent throughout the analyses, with very little confounding by other factors. The detrimental effects of smoking on injuries appears to persist at least several weeks after cessation of smoking.

Adolescent↗
PubMed2000

Effect of rest from running on overuse injuries in army basic training.

BACKGROUND: It has been hypothesized that a period of rest from running in the early weeks of basic military training will prevent stress fractures among recruits. DESIGN: Modification of running schedules in companies of Army recruits undergoing basic military training was assigned. SETTING/PARTICIPANTS: Six male training companies were enrolled and followed during their 8 weeks of basic military training at Fort Bliss, Texas, in summer/fall 1989. INTERVENTION: Intervention companies were asked to rest from running during the second, third, or fourth week of basic military training. MAIN OUTCOME MEASURES: Data were collected from questionnaires, anthropometric measurements, Army physical fitness tests, company training logs, and medical record abstraction of all clinic visits. RESULTS: Among the 1357 enrolled male recruits, there were 236 (17%) with overuse injury and 144 (11%) with traumatic injury, resulting in 535 clinic visits and 1927 training days lost. Stress fracture/reaction rates varied from 3 to 8 per 100 recruits among the intervention companies and 2 to 7 per 100 recruits among the non-intervention companies. Total injury rates were 18 to 35 per 100 recruits in the intervention companies and 18 to 29 per 100 recruits in the non-intervention companies. CONCLUSIONS: The study provided no evidence for a protective effect on overuse injuries of resting from running for 1 week early in basic military training. There was varied physical training among the companies, however, with variation of injury rates that likely related to factors other than the intervention.

Adolescent↗
PubMed2000

The Department of Defense Medical Mortality Registry.

The Department of Defense Medical Mortality Registry is being implemented at the Office of the Armed Forces Medical Examiner, Armed Forces Institute of Pathology, providing the first comprehensive medical mortality surveillance for the Department of Defense. The Registry attempts to obtain complete medical and circumstantial information on every military active duty death for medical surveillance and prevention research. Medical records, autopsy reports, eyewitness accounts, and investigative reports are reviewed to validate and synthesize medical, circumstantial, and risk factor information on each death. All military active duty deaths since 1980 are currently identified and classified by manner of death (accident, suicide, homicide, illness, hostile, undetermined). Military death rates have decreased during the past two decades by nearly half. About three-quarters of military deaths are attributable to injury (accident, suicide, homicide). The Registry creates new opportunities for prevention-oriented research as it collects detailed information on every military death.

Government Agencies↗
PubMed1998

The Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine: status of the Federal Medical School after 25 years.

In its first 25 years, the Uniformed Services University of the Health Sciences (USUHS) has become a quality institution of medical education that provides a steady flow of career physicians for the military. It compares favorably with U.S. medical school averages in all aspects of undergraduate medical education: faculty, teaching facilities, matriculants, curriculum, student performance, and cost. USUHS provides excellent medical education and adds unique preparation for uniformed public service. It also provides military-specific graduate education, graduate medical education, continuing health education, medical research, clinical services, consultation, public service, and ties with international military, medical, and research institutions.

Accreditation↗
PubMed1997

The extent of military medicine topics taught in military family practice residency programs: Part I. A survey of current military family practice residency directors.

The Military Unique Curricula (MUC) was published in 1988 as a guideline for instruction at military residencies in military-specific topics. To evaluate the degree of implementation and the perceived necessity of the MUC curricula and the attitudes and logistical factors relevant to military medicine instruction in military family practice residencies, questionnaires were sent to all 18 military family practice residency directors. The results reveal a wide range of opinions regarding the importance of military medicine and the amount of instruction of military medicine topics among the residency programs. The total number of topics taught was correlated (p < 0.05) with years as residency director, awareness of the MUC, and an opinion that the material would not be better taught at service-specific schools. There appears to have been little influence of the MUC on the curricula of military family practice residencies since its publication.

Attitude of Health Personnel↗
PubMed1997

The extent of military medicine topics taught in military family practice residency programs: Part II, A survey of residency graduates from 1987-1990.

The Military Unique Curricula (MUC) was published in 1988 as a guideline for instruction at military residencies in military-specific topics. Questionnaires were sent to 464 military family practice residency graduates from 1987-1990 to evaluate the degree of implementation of the MUC and attitudes and logistical factors relevant to military medicine instruction in military family practice residencies. Analysis reveals a range of opinions regarding the importance of military medicine and the amount of instruction on military medicine topics offered among programs. The total number of topics offered for instruction was positively correlated (p < 0.05) with the time available to teach the material, a perception that the material would not be best learned at the Combat Casualty Care Course, and the presence of a specific military medicine curriculum within the residency. This survey provides baseline information for future evaluation of the influence of MUC on military medicine instruction in residency programs. Suggestions are offered to improve instruction on military medicine topics in military family practice residencies.

Attitude of Health Personnel↗
PubMed1996

Risk factors predicting exertional heat illness in male Marine Corps recruits.

A matched population-based case-control study was conducted on exertional heat illness (EHI) in male Marine Corps recruits in basic training at Parris Island, SC. Physical fitness and anthropometric measurements were obtained for 391 of 528 cases of EHI identified in this population during 1988-1992, and 1467 of 1725 controls matched to cases by initial training platoon. The risk for developing EHI increased with increase in body mass index (BMI = weight.height-2) as measured on arrival and with increase in time to complete a 1.5-mile run conducted during the first week. Recruits at highest risk for developing exertional heat illness had a BMI of 22 or more kg.m-2 and a 1.5-mile run-time for 12 of more minutes. These recruits had an eightfold higher risk for developing exertional heat illness during basic training when compared with those with BMI less than 22 kg.m-2 and 1.5-mile run-time under 10 min (P < 10(-6). Only one-fifth (18%) of male recruits met these criteria for high risk, but they accounted for nearly half (47%) of the exertional heat illness cases occurring during the 12-wk basic training course.

Adolescent↗
PubMed1996

Exertional heat illness in Marine Corps recruit training.

BACKGROUND: Exertional heat illness (EHI) is a recurring problem in military training resulting in loss of manpower and training effectiveness. A scientific approach to this problem requires quantitative analysis of factors related to its occurrence. METHODS: Review of clinic and hospital records identified all cases of EHI occurring among 217,000 Marine Corps recruits (90% male, 80% age 18-20 yr) entering 12-week basic training at Parris Island, SC during 1982-1991. RESULTS: There were 1454 cases, 89% males and 11% females; 11% of male and no female cases were hospitalized. The majority (88%) of cases occurred during May-September, with a peak rate of 2% of recruits in summer. Most of the cases occurred during the cooler early morning hours when recruits performed strenuous exercise. During 0700-0900 hours the rate of heat casualties increased substantially as the Wet Bulb Globe Temperature Index (WBGT) increased, beginning at levels as low as 65 degrees F. EHI rates increased 26- and 39-fold at WBGT 75- < 80 degrees F (over baseline rates at < 65 degrees F) for immediate and prior day exposures, respectively. Exposure to WBGT of 80 + degrees F was infrequent (25%) among the early morning cases at the time of illness, while it was common (87%) on the day prior to illness, suggesting a lasting effect of heat exposure. CONCLUSIONS: Risk for EHI in military training increases markedly as WBGT levels rise above 65 degrees F; cases occur primarily with strenuous exercise (e.g., running); and heat stress exposure on prior days may be important.

Adolescent↗
PubMed1995

Behavioral factors explaining the low risk for cervical carcinoma in Utah Mormon women.

We used data from a population-based case-control study conducted in Utah from 1984 to 1987 to determine whether the low incidence of cervical carcinoma in Mormon women can be explained by adherence to their religious teachings, which proscribe smoking and extramarital sexual relations. Mormon women had substantially lower risk for cervical carcinoma than non-Mormons [odds ratio (OR) = 0.39; 95% confidence interval (CI) = 0.28-0.54]; this low risk was confined to those who attended church frequently. The protective effect disappeared after controlling for differences in age, sexual behavior, and smoking (OR = 1.22; 95% CI = 0.80-1.87).

Adult↗
PubMed1995

Should the audiometric database analysis method (draft ANSI S12.13-1991) for evaluating the effectiveness of hearing conservation programs be accepted as a US national standard?.

The value of audiometric database analysis (ADBA) procedures for evaluating the effectiveness of hearing conservation programs (HCPs) was studied in a population of 82,195 workers. We rated the HCP using four ADBA procedures. Results showed that the HCP ratings ran the gamut from "unacceptable" to "acceptable" from year to year and from procedure to procedure. A mere 7 percent of the total population was eligible for ADBA analysis. This drastically reduced sample size precludes subgroup analyses of even a large cohort and likely could not be applied to the HCPs of most small- and medium-sized businesses. The low levels of agreement observed (weighted kappa = 15%-25%) between the ADBA procedures reflect poor validity. Generalizability of these results would be inappropriate when so few nonrandomly selected individuals contribute to the evaluation. In view of these problems, acceptance of the ADBA method as a national standard may not be warranted.

Audiology↗
PubMed1994

Fatal rhabdomyolysis presenting as mild heat illness in military training.

A 30-year-old black male soldier with sickle cell trait presented with fatal exertional rhabdomyolysis (which was unrecognized during 14 hours at a field clinic). After prompt treatment for heat exhaustion, his symptoms seemed mild and he was afebrile. His clinical course illustrates the potential for severe illness in the absence of fever, the importance of assessing mental dysfunction, indications for laboratory evaluation, the need for comprehensive management of severe dehydration and acidosis, common laboratory features of acute renal failure and exertional rhabdomyolysis, and the increased risk of exercise-related death in those with sickle cell trait.

Adult↗
PubMed1993

Accumulation of aliphatic amines in gastric juice of acute renal failure patients. Possible cause of hypergastrinemia associated with uremia.

In this study we analyzed by gas chromatographic headspace analysis the composition and concentration of gastrin-stimulatory volatile aliphatic amines in the gastric juice of healthy subjects and acute renal failure patients. We demonstrated that although these aliphatic amines are present in the gastric juice of normal subjects in trace amounts, they accumulate in the gastric juice of uremic subjects. This 30-40-fold elevation in gastric juice amine concentration agreed favorably with the 40-50-fold augmentation in serum gastrin levels in acute renal failure, with a significant association (r = 0.87) existing between these two parameters. It was also determined that a 2-hr hemodialysis procedure resulted in a modest nonparallel decline in both gastric amine and serum gastrin levels. These results support the hypothesis that the accumulation of volatile aliphatic amines in the gastric juice of uremic individuals may induce an activation of the antral G cells, resulting in hypergastrinemia.

Acute Kidney Injury↗