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Sleep in the Military: Promoting Healthy Sleep Among U.S. Servicemembers

April 14, 2015 Comments off

Sleep in the Military: Promoting Healthy Sleep Among U.S. Servicemembers
Source: RAND Corporation

Sleep disturbances are a common reaction to stress and are linked to a host of physical and mental health problems. Given the unprecedented demands placed on U.S. military forces since 2001, there has been growing concern about the prevalence and consequences of sleep problems for servicemembers. Sleep problems often follow a chronic course, persisting long after servicemembers return home from combat deployments, with consequences for their reintegration and the readiness and resiliency of the force. Therefore, it is critical to understand the role of sleep problems in servicemembers’ health and functioning and the policies and programs available to promote healthy sleep. This report provides the first comprehensive review of sleep-related policies and programs across the U.S. Department of Defense (DoD), along with a set of actionable recommendations for DoD, commanders, researchers, and medical professionals who treat U.S. servicemembers. The two-year multimethod study also examined the rates and correlates of sleep problems among post-deployed servicemembers, finding negative effects on mental health, daytime impairment, and perceived operational readiness. The research reviewed evidence-based interventions to treat sleep disturbances among servicemembers and veterans and exposed several individual- and system-level barriers to achieving healthy sleep. Implementing evidence-based treatments is just one step toward improving sleep across the force; as the research recommendations highlight, it is equally important that policies and programs also focus on preventing sleep problems and their consequences.

Genetically Determined Height and Coronary Artery Disease

April 10, 2015 Comments off

Genetically Determined Height and Coronary Artery Disease
Source: New England Journal of Medicine

BACKGROUND
The nature and underlying mechanisms of an inverse association between adult height and the risk of coronary artery disease (CAD) are unclear.

METHODS
We used a genetic approach to investigate the association between height and CAD, using 180 height-associated genetic variants. We tested the association between a change in genetically determined height of 1 SD (6.5 cm) with the risk of CAD in 65,066 cases and 128,383 controls. Using individual-level genotype data from 18,249 persons, we also examined the risk of CAD associated with the presence of various numbers of height-associated alleles. To identify putative mechanisms, we analyzed whether genetically determined height was associated with known cardiovascular risk factors and performed a pathway analysis of the height-associated genes.

RESULTS
We observed a relative increase of 13.5% (95% confidence interval [CI], 5.4 to 22.1; P<0.001) in the risk of CAD per 1-SD decrease in genetically determined height. There was a graded relationship between the presence of an increased number of height-raising variants and a reduced risk of CAD (odds ratio for height quar-tile 4 versus quartile 1, 0.74; 95% CI, 0.68 to 0.84; P<0.001). Of the 12 risk factors that we studied, we observed significant associations only with levels of low-density lipoprotein cholesterol and triglycerides (accounting for approximately 30% of the association). We identified several overlapping pathways involving genes associated with both development and atherosclerosis.

CONCLUSIONS
There is a primary association between a genetically determined shorter height and an increased risk of CAD, a link that is partly explained by the association between shorter height and an adverse lipid profile. Shared biologic processes that determine achieved height and the development of atherosclerosis may explain some of the association. (Funded by the British Heart Foundation and others.)

Hepatitis C: A Focus on Dietary Supplements

April 7, 2015 Comments off

Hepatitis C: A Focus on Dietary Supplements
Source: National Center for Complementary and Integrative Health (NCCIH)

Hepatitis C is a liver disease caused by a virus. It’s usually chronic (long-lasting), but most people don’t have any symptoms until the virus causes liver damage, which can take 10 or more years to happen. Without medical treatment, chronic hepatitis C can eventually cause liver cancer or liver failure. Conventional medical treatments are available for chronic hepatitis C. Some people with hepatitis C also try complementary health approaches, especially dietary supplements. This fact sheet provides basic information on hepatitis C, summarizes scientific research on selected supplements, and suggests sources for additional information.

CDC Grand Rounds: the Future of Cancer Screening

April 7, 2015 Comments off

CDC Grand Rounds: the Future of Cancer Screening
Source: Morbidity and Mortality Weekly Report (CDC)

Cancer is the second leading cause of death in the United States, with 52% of deaths caused by cancers of the lung and bronchus, female breast, uterine cervix, colon and rectum, oral cavity and pharynx, prostate, and skin (melanoma) (1). In the 1930s, uterine cancer, including cancer of the uterine cervix, was the leading cause of cancer deaths among women in the United States (2). With the advent of the Papanicolaou (Pap) test in the 1950s to detect cellular level changes in the cervix, cervical cancer death rates declined significantly (2). Since this first cancer screening test, others have been developed that detect the presence of cancer through imaging procedures (e.g., mammography, endoscopy, and computed tomography) and laboratory tests (e.g., fecal occult blood tests) (3).

The U.S. Preventive Services Task Force (USPSTF) provides cancer screening recommendations and continually reviews the scientific evidence for the potential benefits and harms of screening (4). USPSTF cancer screening recommendations that are graded A or B (indicating that they are recommended by USPSTF) include those for breast cancer, cervical cancer, colorectal cancer, and for lung cancer in heavy smokers (4) (Table 1); Grade A indicates high certainty that the net benefit is substantial, and Grade B indicates high certainty that the net benefit is moderate, or moderate certainty exists that the net benefit is moderate to substantial. Healthy People 2020 objectives include cancer-related objectives that address incidence, mortality, and screening for each of these cancers; no objective has been established for lung cancer screening because it was not recommended by USPSTF until 2013, after the Healthy People 2020 objectives were released (5) (Table 2).

Circulation of Highly Pathogenic Avian Flu in North American Birds

April 6, 2015 Comments off

Circulation of Highly Pathogenic Avian Flu in North American Birds
Source: USGS

Highly pathogenic avian influenza (HPAI) H5 viruses of Eurasian origin continue to circulate and evolve in North American wild birds.

The U.S. Geological Survey and U.S. Department of Agriculture published the genetic analysis of a mixed-origin HPAI H5N1 avian flu virus in the journal Genome Announcements today. This novel virus was discovered in a green-winged teal in Washington State that was sampled at the end of 2014. It is a mixed-origin virus containing genes from the Eurasian HPAI H5N8 and genes from North American low pathogenic avian influenza from wild birds. This H5N1 virus is different from the well-known Asian H5N1 HPAI virus that emerged in 1996.

This new publication follows a recent article describing the introduction of Eurasian HPAI H5N8 into North America at the end of 2014 and the detection of a different mixed-origin virus (HPAI H5N2) in wild birds. In March 2015, the HPAI H5N2 virus was detected in commercial turkey flocks in Minnesota, Missouri and Arkansas, in a backyard flock of mixed poultry in Kansas and in a wild bird in Wyoming.

CRS — Health Care for Veterans: Traumatic Brain Injury (March 9, 2015)

March 31, 2015 Comments off

Health Care for Veterans: Traumatic Brain Injury (PDF)
Source: Congressional Research Service (via Homeland Security Digital Library)

In recent years, Congress, the Department of Defense (DOD), and the Department of Veterans Affairs (VA) have increased attention to traumatic brain injury (TBI), which is known as a “signature wound” of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). Although the early stages of TBI treatment may occur within the military health care system (if the injury occurs during military service), this report focuses on the VA health care system. In FY2015, VA spending for TBI is estimated to be $234 million. The VA projects the 10-year (FY2016–FY2025) costs of TBI to be $2.2 billion (including $0.5 billion for OEF/OIF veterans).

The type of treatment needed depends on the severity of the injury. Most cases of mild TBI— representing the majority of injuries—resolve without medical attention. Moderate or severe TBI requires immediate treatment. In the case of servicemembers, treatment begins at the site of the event and continues at a military treatment facility. Once stabilized, servicemembers may remain at a military treatment facility or be sent to VA medical facilities.

Trends and Racial/Ethnic Disparities in Gluten-Sensitive Problems in the United States: Findings from the National Health and Nutrition Examination Surveys From 1988 to 2012

March 31, 2015 Comments off

Trends and Racial/Ethnic Disparities in Gluten-Sensitive Problems in the United States: Findings from the National Health and Nutrition Examination Surveys From 1988 to 2012
Source: American Journal of Gastroenterology

Objectives:
Racial disparities in the prevalence of celiac disease (CD) and the number of people without CD avoiding gluten (PWAG) in the United States are unknown. We aimed to describe racial differences in the prevalence of CD and PWAG, and evaluate the trends of CD in the noninstitutionalized civilian adult population of the US between 1988 and 2012.

Methods:
A population-based cross-sectional study was conducted using data from the National Health and Nutrition Examination Surveys (NHANES) from 1988 to 1994, 1999 to 2004, and 2009 to 2012. Serum samples from the NHANES participants were tested for CD serology, which included IgA tissue transglutaminase (tTG IgA) and, if findings were abnormal, for IgA endomysial antibodies. Information about adherence to a gluten-free diet was obtained by means of an interviewer-administered questionnaire.

Results:
In NHANES 2009–2012, the adjusted prevalence of CD was significantly higher (P<0.0001) among non-Hispanic whites (1.0%) than among non-Hispanic blacks (0.2%) and Hispanics (0.3%), whereas the adjusted prevalence of PWAG was significantly higher (P=0.01) in blacks (1.2%) as compared with Hispanics (0.5%) and whites (0.7%). The seroprevalence of CD in adults aged 50 years and older increased from 0.17% (95% confidence interval (CI) 0.03–0.33) in 1988–1994 to 0.44% (95% CI 0.24–0.81) in 2009–2012 (P<0.05).

Conclusions:
The overall prevalence of CD increased between 1988 and 2012 and is significantly more common in whites. In addition, a higher proportion of individuals maintaining a gluten-free diet in the absence of a diagnosis of CD are blacks.

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