Military Hospital (military + hospital)

Distribution by Scientific Domains


Selected Abstracts


Aggravating factors for melasma: a prospective study in 197 Tunisian patients

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 9 2010
C Guinot
Abstract Background, Melasma is a frequent cause of consultations at dermatology departments by dark-skinned patients in Tunisia. Objective, To investigate factors that influence melasma severity in a large Tunisian population. Methods, A total of 197 patients (188 women and 9 men), who attended Tunis Military Hospital for a consultation were included prospectively from August 2005 to August 2006. Disease severity was estimated using the Melasma Area and Severity Index (MASI). Aggravating factors were investigated using multiple logistic regressions. Results, Of the women included, 14% presented phototype III, 45% phototype IV and 41% phototype V; 76% presented a centrofacial melasma phenotype, 23% a malar and 1% a mandibular phenotype. About 60% developed melasma before thirty. Sun exposure was reported as a triggering factor by 51% of women and as an aggravating factor by 84%. Pregnancy was reported as an aggravating factor by 51% of women who had been pregnant, and oral contraceptive use reported by 38% of women exposed to oral contraceptives. The risk of severe melasma was about three times higher for women with age at onset under 30, phototype V and major lifetime sun exposure and about 8 times higher for women exposed to oral contraceptives. Conclusion, This study identifies a number of factors associated with the severity of melasma. Further epidemiological studies in this type of population, in particular, to investigate triggering factors, are justified by the aesthetic damage caused by melasma in dark-skinned patients, lack of efficacy of existing treatments, non-compliance with photoprotection recommendations and the challenge of treatment. [source]


Depressive symptoms and suicidal ideation during isotretinoin treatment: a 12-week follow-up study of male Finnish military conscripts

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 11 2009
LMH Rehn
Abstract Objective, To investigate the putative association between isotretinoin treatment and depressive symptoms or suicidal ideation among Finnish male military conscripts. Methods, Consecutive acne patients were enrolled into an uncontrolled, prospective 12-week follow-up study conducted at the Central Military Hospital, Helsinki, Finland. Of the 135 patients prescribed isotretinoin, 126 (93.3%) completed the follow-up. Depression and suicidal ideation were investigated with the Beck Depression Inventory (BDI) at baseline, weeks 4,6, and weeks 10,12. Results, BDI mean score was low at baseline and declined further significantly (p < 0.001) during the follow-up from 3.0 (SD 3.948) to 1.8 (SD 3.783) among patients on isotretinoin. Moreover, the proportion of patients with clinically significant depressive symptoms (BDI , 10) declined non-significantly from 7.1 % to 3.2 %. Suicidal ideation was reported by 17 (13.5 %) patients at baseline and 9 (7.1%) patients at the end of the follow-up (NS). During the follow-up, one non-depressed patient attempted suicide while intoxicated by alcohol. Conclusion, On group level, isotretinoin seems not to be typically associated with treatment-emergent depression or suicidal ideation among young men. However, the possibility that individual patients may be susceptible for mood effects of isotretinoin as a rare idiosyncratic reaction can not be excluded. [source]


Childbearing in U.S. Military Hospitals: Dimensions of Care Affecting Women's Perceptions of Quality and Satisfaction

BIRTH, Issue 1 2005
Erica M. Harriott MHSA
Information is lacking about how well the military health system has adopted patient-centered approaches for promoting individual choice and preference in a bureaucratically structured military hospital. The purpose of this study was to examine women's evaluations of maternity care with respect to decision-making, confidence, trust in health care providers, and treatment within the military hospital. Methods: The Department of Defense Inpatient Childbirth Survey was mailed to a simple stratified random sample of beneficiaries who received maternity care at a military hospital between July 1 and September 30, 2001. Data for 11 dimensions of women's care and experiences were examined from self-reported assessments of 2,124 respondents who gave birth at one of 44 military hospitals. A multiple logistic regression model was estimated to determine which dimensions of care predicted beneficiaries' likelihood to recommend the military hospital to family and friends. Result: Less than 50 percent of respondents would recommend the military hospital to family and friends. Significantly associated with women's willingness to recommend their specific military hospital to others were courtesy and availability of staff, confidence and trust in provider, treatment with respect and dignity, information and education, physical comfort, involvement of friends and family, continuity and transition, and involvement in decision-making. Conclusions: In a military population, obstetric patients who are treated with respect, courtesy, and dignity, are involved in decisions about their care, and have established trusting relationships with their practitioners are significantly more likely to recommend the military hospital to others. It is important for military health care leaders to establish a proactive program of patient-centered maternity care. Continuous care, education, support services, and a multidisciplinary approach should be integrated to retain and recapture obstetric patients who are served in military hospitals in the United States. [source]


Effect of Preexisting Chronic Disease on Primary Cesarean Delivery Rates by Race for Births in U.S. Military Hospitals, 1999,2002

BIRTH, Issue 3 2004
Andrea Linton MS
This finding suggests that other maternal factors may explain the elevated rates. The purpose of this study was to examine the prevalence of specific chronic diseases identified as risk factors for complications during pregnancy, labor, and delivery, and to explore the strength of each disease to predict a cesarean outcome. Methods: United States military hospital discharge records from 1999 to 2002 for singleton births to women without a previous cesarean were used to calculate primary cesarean and chronic disease rates for diabetes, hypertension, cardiovascular disease, renal disease, anemia, asthma, sexually transmitted diseases, and substance abuse. Stepwise logistic regression was used to calculate adjusted odds ratios for dichotomized race and chronic disease indicators for five maternal age groups using the,2difference(p < 0.05) to identify significant variables for inclusion in the model. Primary cesarean delivery rates were then adjusted for the presence of chronic diseases that were significantly associated with a cesarean outcome. Results: Diabetes, genital herpes, and hypertension were significant predictors of cesarean use among all maternal age groups. Cardiovascular disease, renal disease, asthma, and anemia were predictors in some age groups. The remaining disease conditions were not significant predictors for cesarean delivery. Adjustment of cesarean rates for these chronic diseases did not significantly alter the differences in primary cesarean rates for black and Asian mothers relative to white mothers. Conclusions: The presence of certain chronic conditions before pregnancy may increase the likelihood that a woman will deliver by cesarean section. Adjustment of cesarean rates for the presence of these chronic diseases, however, does not account for the difference in cesarean rates observed for white and minority mothers in the study population. The potential for underreporting of chronic diseases complicates a true assessment of the impact of chronic disease on cesarean delivery rate variations between white and minority women. [source]


An Outbreak of Respiratory Diseases among Workers at a Water-Damaged Building , A Case Report

INDOOR AIR, Issue 3 2000
MARKKU SEURI
Abstract We describe a military hospital building with severe, repeated and enduring water and mold damage, and the symptoms and diseases found among 14 persons who were employed at the building. The exposure of the employees was evaluated by measuring the serum immunoglobulin G (IgG)-antibodies against eight spieces of mold and yeast common in Finnish water and mold damaged buildings and by sampling airborne viable microbes within the hospital. The most abundant spieces was Sporobolomyces salmonicolor. All but one of the employees reported some building-related symptoms, the most common being a cough which was reported by nine subjects. Four new cases of asthma, confirmed by S. salmonicolor inhalation provocation tests, one of whom was also found to have alveolitis, were found among the hospital personnel. In addition, seven other workers with newly diagnosed rhinitis reacted positively in nasal S. salmonicolor provocation tests. Skin prick tests by Sporobolomyces were negative among all 14 workers. Exposure of the workers to mold and yeast in the indoor air caused an outbreak of occupational diseases, including asthma, rhinitis and alveolitis. The diseases were not immunoglobulin E (IgE)-mediated but might have been borne by some other, as yet unexplained, mechanism. [source]


Guidelines Abstracted from the Department of Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Stroke Rehabilitation

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2006
Miriam Rodin MD
OBJECTIVES: To assist facilities in identifying those evidence-based processes of poststroke care that enhance measurable patient outcomes. The guideline(s) should be used by facilities (hospitals, subacute-care units and providers of long-term care) to implement a structured approach to improve rehabilitative practices and by clinicians to determine best interventions to achieve improved patient outcomes. OPTIONS: The guideline considers five elements of poststroke rehabilitation care: interdisciplinary teams; use of standardized assessments; intensity, timing, and duration of therapy; involvement of patients' families and caregivers in decision-making; and educational interventions for patients, families, and caregivers. Evidence, benefits, harms, and recommendations for each of the five designated elements and specific annotated recommendations for poststroke managements are presented separately. OUTCOMES: The overall guideline considers improvement in functional status measures as the primary outcome. Achieving community-dwelling status and preventing complications, death, and rehospitalization are also important outcomes. Costs are not specifically addressed. PARTICIPANTS: The Department of Veterans Affairs/Department of Defense (VA/DoD) Stroke Rehabilitation Working Group consisted of 28, largely VA and military hospital, representatives of medical and allied professions concerned with stroke diagnosis, management, and rehabilitation. Nine additional members with similar credentials served as the editorial committee. Technical consultation was contracted from ACS Federal Health Care, Inc., and the Center for Evidence-Based Practice, State University of New York,Upstate Medical University, Department of Family Medicine conducted evidence appraisal. Consensus was achieved over several years of facilitated group discussion and iterative evaluation of draft documents and supporting evidence. SPONSOR: The guideline was prepared under the auspices of the VA/DoD. No other source of support was identified in the document, or supporting documents. [source]


Childbearing in U.S. Military Hospitals: Dimensions of Care Affecting Women's Perceptions of Quality and Satisfaction

BIRTH, Issue 1 2005
Erica M. Harriott MHSA
Information is lacking about how well the military health system has adopted patient-centered approaches for promoting individual choice and preference in a bureaucratically structured military hospital. The purpose of this study was to examine women's evaluations of maternity care with respect to decision-making, confidence, trust in health care providers, and treatment within the military hospital. Methods: The Department of Defense Inpatient Childbirth Survey was mailed to a simple stratified random sample of beneficiaries who received maternity care at a military hospital between July 1 and September 30, 2001. Data for 11 dimensions of women's care and experiences were examined from self-reported assessments of 2,124 respondents who gave birth at one of 44 military hospitals. A multiple logistic regression model was estimated to determine which dimensions of care predicted beneficiaries' likelihood to recommend the military hospital to family and friends. Result: Less than 50 percent of respondents would recommend the military hospital to family and friends. Significantly associated with women's willingness to recommend their specific military hospital to others were courtesy and availability of staff, confidence and trust in provider, treatment with respect and dignity, information and education, physical comfort, involvement of friends and family, continuity and transition, and involvement in decision-making. Conclusions: In a military population, obstetric patients who are treated with respect, courtesy, and dignity, are involved in decisions about their care, and have established trusting relationships with their practitioners are significantly more likely to recommend the military hospital to others. It is important for military health care leaders to establish a proactive program of patient-centered maternity care. Continuous care, education, support services, and a multidisciplinary approach should be integrated to retain and recapture obstetric patients who are served in military hospitals in the United States. [source]


Effect of Preexisting Chronic Disease on Primary Cesarean Delivery Rates by Race for Births in U.S. Military Hospitals, 1999,2002

BIRTH, Issue 3 2004
Andrea Linton MS
This finding suggests that other maternal factors may explain the elevated rates. The purpose of this study was to examine the prevalence of specific chronic diseases identified as risk factors for complications during pregnancy, labor, and delivery, and to explore the strength of each disease to predict a cesarean outcome. Methods: United States military hospital discharge records from 1999 to 2002 for singleton births to women without a previous cesarean were used to calculate primary cesarean and chronic disease rates for diabetes, hypertension, cardiovascular disease, renal disease, anemia, asthma, sexually transmitted diseases, and substance abuse. Stepwise logistic regression was used to calculate adjusted odds ratios for dichotomized race and chronic disease indicators for five maternal age groups using the,2difference(p < 0.05) to identify significant variables for inclusion in the model. Primary cesarean delivery rates were then adjusted for the presence of chronic diseases that were significantly associated with a cesarean outcome. Results: Diabetes, genital herpes, and hypertension were significant predictors of cesarean use among all maternal age groups. Cardiovascular disease, renal disease, asthma, and anemia were predictors in some age groups. The remaining disease conditions were not significant predictors for cesarean delivery. Adjustment of cesarean rates for these chronic diseases did not significantly alter the differences in primary cesarean rates for black and Asian mothers relative to white mothers. Conclusions: The presence of certain chronic conditions before pregnancy may increase the likelihood that a woman will deliver by cesarean section. Adjustment of cesarean rates for the presence of these chronic diseases, however, does not account for the difference in cesarean rates observed for white and minority mothers in the study population. The potential for underreporting of chronic diseases complicates a true assessment of the impact of chronic disease on cesarean delivery rate variations between white and minority women. [source]


Childbearing in U.S. Military Hospitals: Dimensions of Care Affecting Women's Perceptions of Quality and Satisfaction

BIRTH, Issue 1 2005
Erica M. Harriott MHSA
Information is lacking about how well the military health system has adopted patient-centered approaches for promoting individual choice and preference in a bureaucratically structured military hospital. The purpose of this study was to examine women's evaluations of maternity care with respect to decision-making, confidence, trust in health care providers, and treatment within the military hospital. Methods: The Department of Defense Inpatient Childbirth Survey was mailed to a simple stratified random sample of beneficiaries who received maternity care at a military hospital between July 1 and September 30, 2001. Data for 11 dimensions of women's care and experiences were examined from self-reported assessments of 2,124 respondents who gave birth at one of 44 military hospitals. A multiple logistic regression model was estimated to determine which dimensions of care predicted beneficiaries' likelihood to recommend the military hospital to family and friends. Result: Less than 50 percent of respondents would recommend the military hospital to family and friends. Significantly associated with women's willingness to recommend their specific military hospital to others were courtesy and availability of staff, confidence and trust in provider, treatment with respect and dignity, information and education, physical comfort, involvement of friends and family, continuity and transition, and involvement in decision-making. Conclusions: In a military population, obstetric patients who are treated with respect, courtesy, and dignity, are involved in decisions about their care, and have established trusting relationships with their practitioners are significantly more likely to recommend the military hospital to others. It is important for military health care leaders to establish a proactive program of patient-centered maternity care. Continuous care, education, support services, and a multidisciplinary approach should be integrated to retain and recapture obstetric patients who are served in military hospitals in the United States. [source]


Effect of Managed Care Enrollment on Primary and Repeat Cesarean Rates Among U.S. Department of Defense Health Care Beneficiaries in Military and Civilian Hospitals Worldwide, 1999,2002

BIRTH, Issue 4 2004
Andrea Linton MS
However, little conclusive evidence exists to support this solution. We undertook a study of the Department of Defense health care beneficiary population to assess the impact of enrollment in TRICARE Prime, the Department's managed care health plan, on cesarean delivery rates. Methods: Pooled hospital discharge records from 1999,2002 for live, singleton births were analyzed to calculate primary and repeat cesarean rates for TRICARE Prime and non-Prime beneficiaries in the military and civilian hospitals that comprise the Department of Defense health care network. Stepwise logistic regression was used to calculate adjusted odds ratios for clinical indicators for each combination of health plan and hospital setting using the,2difference(p < 0.05)to eliminate nonsignificant variables from the model. Total primary and repeat cesarean rates were compared with primary and repeat cesarean rates for women with no reported clinical complications to account for differences in case mix across subgroups. Statistical significance of the differences calculated for subgroups was assessed using,2. Results: Primary cesarean rates were significantly lower for TRICARE Prime enrollees relative to non-Prime beneficiaries for all race subgroups and three of five age subgroups in military hospitals and four of five age subgroups in civilian hospitals. No significant differences in repeat cesarean rates were observed between Prime and non-Prime beneficiaries within any race or age subgroup. Breech presentation followed by dystocia, fetal distress, and other complications were significant predictors for primary cesarean. Previous cesarean delivery was the leading predictor for repeat cesarean delivery. Primary and repeat cesarean rates observed for military hospitals were consistently lower than rates observed for civilian hospitals within each health plan type and age group. Conclusions: Enrollment in the managed care health plan was significantly associated with lower risk of primary cesarean delivery relative to membership in other health plans offered to Department of Defense health care beneficiaries. Repeat cesarean rates in this population varied independently of health plan type. Primary cesarean delivery was generally associated with clinical complications, whereas previous cesarean delivery was the strongest indictor for a repeat cesarean delivery. A clear explanation of reduced cesarean rates for Prime enrollees remains elusive, but it is likely that factors beyond individual practitioner decision-making were at work. [source]