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Hooper T.I.,Uniformed Services University of the Health Sciences | Gackstetter G.D.,Analytic Services Inc. | LeardMann C.A.,Naval Health Research Center | Boyko E.J.,Seattle Epidemiologic Research and Information Center | And 4 more authors.
Population Health Metrics | Year: 2010

Background: Complete and accurate ascertainment of mortality is critically important in any longitudinal study. Tracking of mortality is particularly essential among US military members because of unique occupational exposures (e.g., worldwide deployments as well as combat experiences). Our study objectives were to describe the early mortality experience of Panel 1 of the Millennium Cohort, consisting of participants in a 21-year prospective study of US military service members, and to assess data sources used to ascertain mortality.Methods: A population-based random sample (n = 256,400) of all US military service members on service rosters as of October 1, 2000, was selected for study recruitment. Among this original sample, 214,388 had valid mailing addresses, were not in the pilot study, and comprised the group referred to in this study as the invited sample. Panel 1 participants were enrolled from 2001 to 2003, represented all armed service branches, and included active-duty, Reserve, and National Guard members. Crude death rates, as well as age- and sex-adjusted overall and age-adjusted, category-specific death rates were calculated and compared for participants (n = 77,047) and non-participants (n = 137,341) based on data from the Social Security Administration Death Master File, Department of Veterans Affairs (VA) files, and the Department of Defense Medical Mortality Registry, 2001-2006. Numbers of deaths identified by these three data sources, as well as the National Death Index, were compared for 2001-2004.Results: There were 341 deaths among the participants for a crude death rate of 80.7 per 100,000 person-years (95% confidence interval [CI]: 72.2,89.3) compared to 820 deaths and a crude death rate of 113.2 per 100,000 person-years (95% CI: 105.4, 120.9) for non-participants. Age-adjusted, category-specific death rates highlighted consistently higher rates among study non-participants. Although there were advantages and disadvantages for each data source, the VA mortality files identified the largest number of deaths (97%).Conclusions: The difference in crude and adjusted death rates between Panel 1 participants and non-participants may reflect healthier segments of the military having the opportunity and choosing to participate. In our study population, mortality information was best captured using multiple data sources. © 2010 Hooper et al; licensee BioMed Central Ltd. Source


Trofimovich L.,National Center for Telehealth and Technology | Reger M.A.,National Center for Telehealth and Technology | Luxton D.D.,National Center for Telehealth and Technology | Oetjen-Gerdes L.A.,Armed Forces Medical Examiner System
Suicide and Life-Threatening Behavior | Year: 2013

Suicide risk based on occupational cohorts within the U.S. military was investigated. Rates of suicide based on military occupational categories were computed for the Department of Defense (DoD) active component population between 2001 and 2010. The combined infantry, gun crews, and seamanship specialist group was at increased risk of suicide compared to the overall military population even when adjusted for gender, age, and deployment history. The results provide useful information that can help inform the DoD's suicide prevention mission. Data limitations and recommended areas for future research are discussed. © 2013 The American Association of Suicidology. Source


Smith A.B.,Armed Forces Institute of Pathology | Smith A.B.,Uniformed Services University of the Health Sciences | Lattin Jr. G.E.,Armed Forces Institute of Pathology | Lattin Jr. G.E.,Uniformed Services University of the Health Sciences | And 3 more authors.
American Journal of Neuroradiology | Year: 2012

BACKGROUND AND PURPOSE: Postmortem imaging with CT or MR is emerging as an effective technique to augment forensic autopsy. Expected findings on postmortem imaging of the brain may mimic pathologic processes in the living brain, leading to potential misdiagnosis. The purpose of this study is to describe the array of CT findings that can be expected to be present within the brain after death. MATERIALS AND METHODS: A retrospective review was performed using an anonymized data base of 33 postmortem head CTs with no evidence of trauma to the face or scalp. Head CTs were assessed for 1) loss of gray-white differentiation, 2) effacement of the ventricles and cisterns, 3) postmortem intravascular blood distribution, 4) presence of intracranial or intravascular air, and 5) an irregular appearance of the falx. Imaging findings were correlated with autopsy findings. RESULTS: Visualization of the basal ganglia was noted in 30 (91%) subjects, and the cortical ribbon was appreciated in 14 (42%). The ventricles and cisterns were effaced in 19 (58%) cases. An "expected postmortem blood distribution" was seen in 27 (82%) instances. Intravascular air was present in 14 cases (42%). A "lumpy" falx was present in 20 cases (61%). In 4 cases of subdural or subarachnoid hemorrhage noted on autopsy, but not on CT, retrospective review confirmed that a true discrepancy between the radiology and pathology findings persisted. CONCLUSIONS: Recognition of expected postmortem patterns is required before pathology can be accurately diagnosed. A limitation of CT virtual autopsy is the possibility of missing small blood collections. Source


Baadh A.S.,Winthrop University | Singh A.,Winthrop University | Choi A.,Winthrop University | Baadh P.K.,Winthrop University | And 2 more authors.
American Journal of Roentgenology | Year: 2016

OBJECTIVE. Paramedics and hospital-based providers occasionally need to place intraosseous devices to obtain vascular access in critically ill patients. Diagnostic radiologists must be prepared for the emergent administration of iodinated contrast media via the intraosseous route, and interventional radiologists should be familiar with the potential clinical uses of such access. CONCLUSION. We present a protocol for the administration of iodinated contrast media through the intraosseous route. We also highlight the clinical and radiologic aspects of intraosseous access. Source


Smallman D.P.,Uniformed Services University of the Health Sciences | Webber B.J.,U.S. Air force | Mazuchowski E.L.,Armed Forces Medical Examiner System | Scher A.I.,Uniformed Services University of the Health Sciences | And 2 more authors.
British Journal of Sports Medicine | Year: 2016

Background: Sudden cardiac death associated with physical exertion (SCD/E) is a complicated pathophysiological event. This study aims to calculate the incidence rate of SCD/E in the US military population from 2005 to 2010, to characterise the demographic and cardiovascular risk profiles of decedents, and to evaluate aetiologies of and circumstances surrounding the deaths. Methods: Perimortem and other relevant data were collected from the Armed Forces Medical Examiners Tracking System, Armed Forces Health Longitudinal Technology Application, and Defense Medical Epidemiology Database for decedents meeting SCD/E case definition. Incidence rates were calculated and compared using negative binomial regression. Results: The incidence of SCD/E in the Active Component (ie, full-time active duty) US military from 2005 to 2010 was 1.63 per 100 000 person-years (py):0.98 and 3.84 per 100 000 py in those aged <35 and ≥35 years, respectively. Atherosclerotic cardiovascular disease was the leading cause of death overall (55%) and in the ≥35-year age group (78%), whereas the leading cause of death in the <35-year age group (31%) could not be precisely determined and was termed idiopathic SCD/E (iSCD/E). SCD/E was more common in males than females (incidence rate ratio (IRR) = 5.28, 95% CI 2.16 to 12.93) and more common in blacks than whites (IRR=2.60, 95% CI 1.81 to 3.72). All female cases were black. Conclusions: From 2005 to 2010, the incidence of SCD/E in US military members aged <35 years was similar to most reported corresponding civilian SCD rates. However, the leading cause of death was iSCD/E and not cardiomyopathy. Improved surveillance and agebased prevention strategies may reduce these rates. Source

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