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Total force health sys 26 jan 10
- 1. Jim Larsen Jelarsen1@cox.net One Team; One Fight Conserve the Fighting Strength Total Force Plus Life-Cycle Health Readiness System
- 2. IssuesIssues 1/26/10 2 1. Where are the ‘human performance’ boundaries? What do we include/exclude? 2. What are the measurable outcome criteria? Combat performance or health-wellness? Operational Readiness (OR) rates? 3. CAUTION: Statistics may NOT tell us if it is: • Nosocomical • A marker • A causal agent
- 3. • The Total Force Plus* health status affects: – Force mission accomplishment – Force readiness and deployability – Force manpower levels – Recruiting – Costs 1/26/10 3 * Total Force Plus = AC-RC Service members, recruits/cadets, spouses, children, and retirees/vets. Total Force Plus Life-Cycle Health Readiness System: Impacts Total Force Plus Life-Cycle Health Readiness System: Impacts By 2020, 52.5% of recruitable population will be medically disqualified “Impact of Physical, Behavioral, and Moral Disqualification of Prime Market” 2005
- 4. • All members affect the Total Force. • Most diseases and conditions are chronic and relatively invisible in the short-term. • “Downstream” issues highlight “upstream” issues. • Retiree Cardio Vascular Disease (CVD) may reflect years of high LDL cholesterol. • Child lead levels may reflect service member range safety issues. 1/26/10 4 Total Force Plus Life-Cycle Health Readiness System: Why Total Force Plus? Total Force Plus Life-Cycle Health Readiness System: Why Total Force Plus? * Total Force Plus = AC-RC Service members, recruits/cadets, spouses, children, and retirees/vets.
- 5. • Recruits enter the system with undiagnosed health issues (e.g. dental status, osteopenia, depression, alcoholism, etc.). • Recruits/Soldiers may be under-nourished, affecting performance, injury rates, attrition, and costs. • High injury rates affect deployability, manpower levels, attrition, future injury rates, and costs. • No comprehensive life cycle monitoring system means no evidence- based feedback process to build an investment strategy. 1/26/10 5 Total Force Plus Life-Cycle Health Readiness System: Why Do We Need a Comprehensive Life Cycle System? * Total Force Plus Life-Cycle Health Readiness System: Why Do We Need a Comprehensive Life Cycle System? * * See references in Notes VA 2010 budget request is nearly $113 billion “By mid-December, more than 25,803 American service members had been evacuated from Iraq since the war began nearly three years ago, according to Pentagon officials. Nearly 80 percent of them were shipped out because of routine illnesses and injuries unrelated to combat.”
- 6. * Estimate based on 2005 Camber Prime Market Study; 2005 DOD QMA Study; 2005 Woods & Poole (2006 projections) 0 6 12 18 24 30 36 Potential Market Qualified Market Prime Market Millions Incarcerated 0.6 Disqualified 13.9 • Medical • Mental • Moral In-Military 1.1 HSDG IIIB 1.9 HSDG Female I-IIIA 3.0 30.8 M 2.2 M 14 M HSDG Male I-IIIA 3.4 HSDG Male I-IIIA 3.4 HSDG Male I-IIIA 2.2 HSDG < CAT IIIB 2.6 17-24 YO Youth Population (M/F) Total Market minus - Disqualified Potential Market minus - Cat IV - Non-HSDG Qualified Market minus - IIIB - I-IIIA Females - No Waivers (1.2 M) Youth Market 8.3 M 10.7 6.1 5.2 8.8 Non-HSDG 3.1 HSDG Female I-IIIA 3.0 HSDG IIIB 1.9 Recruiters must focus on finding the 7.1% (Prime Market) Numbers BEFORE Propensity is considered Less than 3 of 10 (17-24 y/o) are fully qualified to serveLess than 3 of 10 (17-24 y/o) are fully qualified to serve 1/26/10 6
- 7. % 17-20 y/o Who Do Not Meet Army Accession Weight Standards Source: Nolte et al, “U.S. Military Weight Standards: What Percentage of U.S. Adults Meet the Current Standards?” The American Journal of Medicine, Vol 113, Oct 15, 2002 ObesityObesity 1/26/10 7
- 8. % 17-20 y/o Who Will Not Meet Army Accession Weight Standards in 2015 Projection based on 35% increase predicted by bariatric experts. ObesityObesity 1/26/10 8
- 9. 9 OsteopeniaOsteopenia Source: Dr. Rivero study at Great Lakes Naval Training Center (2001-2002). • High rates of osteopenia in stress fracture cases. • Women have higher rates of osteopenia and multiple stress fractures. 12/23/09 Note: • PT studies may have results that vary by gender. • Differing osteopenia rates may partially explain that.
- 10. Quantitative Ultrasound Screen (QUS) re Stress Fractures in Female Army Recruits Quantitative Ultrasound Screen (QUS) re Stress Fractures in Female Army Recruits 1012/23/09 • QUS calcaneal measurements on 4,139 female Army recruits at Basic Training (BT) start. • The incidence of stress fractures were 4.7%. • The highest risk of stress fracture was found in white women in Q1 of SOS who smoked and didn’t exercise (RR, 14.4). • The combination of QUS measurements with evaluation of individual risk factors can identify recruits who are at the very highest risk of stress fracture. Note: 1.The bone strength ‘gold standard’ is Bone Geometry (USARIEM) (Peripheral quantitative computed tomography (pQCT). 2.The U.S.-adapted W.H.O. FRAX (fracture prediction) algorithm is available on the NOF website (www.NOF.org) and atwww.shef.ac.uk/FRAX (note criticisms of FRAX)
- 11. • Monitoring systems • Training/Education • Delivery Systems • Supply Chain Control 1/26/10 11 Total Force Plus Life-Cycle Health Readiness System: Program Structure Total Force Plus Life-Cycle Health Readiness System: Program Structure
- 12. 1/26/10 12 Total Force Plus Life-Cycle Health Readiness System: Program Structure Total Force Plus Life-Cycle Health Readiness System: Program Structure Medical Nutrition Fitness Resilience Concept Monitoring Training/Education Delivery Supply Chain One Team; One Fight
- 13. 1/26/10 13 Total Force Plus Life-Cycle Health Readiness System: Medical Total Force Plus Life-Cycle Health Readiness System: Medical Medical Nutrition Fitness Resilience Concept Integrated Medicine* approach -Improved Stds of Care -Improved Clinical Practice Guidelines -Team-based rehabilitation doctrine Monitoring • Comprehensive Blood Chemistry Plus** at defined life cycle points. • Injury/disease database (AHLTA Plus) ICW VA & Tricare Training/E ducation • NCOES/WOES/OES (ACCP) (Spouse /family orientation) (DOD Schools/ local HS with mil pop) • Embedded training (posters, Jody calls, etc.) • Diagnosis-based prescriptive (link to Ed Svcs) Delivery • Combat-model fix forward treatment (see USMC SMIP ATC) • Enhanced Specialty/MOS/ASI skills • Enhanced MWR staff skills and programs • Enhanced Ed Svc skills and programs Supply Chain • Joint programs with CDC • Mixed DODMERB-MEPCOM entry screening model • Recruiting/IET based ‘get ready’ programs *Health-focused medicine that treats the whole person (body, mind, and spirit), examining symptoms and causes. Ex. 1: Treating a stress fracture with casting and reduced activity and looking at bone health, nutritional deficiencies, diet, and exercise regimens. ** TBD "The problem with sudden cardiac death is that, of all the people that have heart disease ... half of the time the first symptom is a heart attack," said Dr. Stephen Kopecky, professor of medicine and a cardiologist at the Mayo Clinic in Rochester, Minn. "And half of that half will [die] within an hour." "The problem with sudden cardiac death is that, of all the people that have heart disease ... half of the time the first symptom is a heart attack," said Dr. Stephen Kopecky, professor of medicine and a cardiologist at the Mayo Clinic in Rochester, Minn. "And half of that half will [die] within an hour."
- 14. 14 Admiral Nelson 11 March 1804 to Dr. Mosely: “The greatest thing in all military service is health; and you will agree with me that it is easier for an officer to keep men healthy than it is for a physician to cure them”. Admiral Nelson 11 March 1804 to Dr. Mosely: “The greatest thing in all military service is health; and you will agree with me that it is easier for an officer to keep men healthy than it is for a physician to cure them”. • BCT (CHPPM) – Males: 19-37% are injured in a 9-wk cycle – Females: 42-67% are injured in a 9-wk cycle • Most injuries are overuse, compared to traumatic – Males: 75% – Females: 78% • Most injuries involve the lower extremity (low back, pelvis, hip and leg)* – Males: 83% – Females: 87% • Activities associated with injuries in BCT – Weight bearing activity; predominantly running, marching, walking 1/26/10
- 15. 15 1. New Clinical Practice Guideline for Hip Pain. 2. Early effective management works: a. Finding early avoids the fracture. b. 75% Increase in FNF detection Source: CPT Short, MAH, FJ ATC Femoral Neck FractureFemoral Neck Fracture 1. Small numbers, but high costs. 2. No visibility at DA level. 3. 100% Medical Board. 4. Lifetime of treatment.1/26/10
- 16. 16 • Treat Marines forward as Warrior Athletes. • Sports Medicine Physicians. • Certified Athletic Trainers (ATC’s) – Contracted civilians who work for USMC commands. – GREEN ASSETS (NCAA model) – Aligned with SMART rehab clinic operations – Clinically supervised by Navy Sports Medicine MDs when dealing with injuries – Emphasis on prevention, education, and treatment – Collect/enter injury data into TIMS (injury database) • 3 trainers for Parris Island (GIT)/1 ATC for San Diego. • 3 Athletic Training Room (ATRs) for Parris Island 1/26/10 RESULTS + Increased Paris Island grad rate (female 68.3% to 74.7%) + Increase in BCT Return to Full Duty (RTFD) rates from rehab: + male 55.5% to 64.3% + female 37.5% to 52.2% + Increase in BCT recycle grad rates (female 63.5% to 75%). – Decrease in BCT rehab discharge rates (male 13%; female 24%) – Decreased musculo-skeletal discharges at Infantry School (see chart at left). – Decreased attrition at OCS − male 8.7% to 3.8% − female 18.1% to 5.9%) + Greater cadre knowledge + Critical feedback on sources of injuries leading to fixes. + Conservative estimate of $3.5M in cost avoidance and $2.9M in Return on Investment in FY04 vs.. FY03. Fix Forward: USMC SMIP Athletic Trainer InitiativeFix Forward: USMC SMIP Athletic Trainer Initiative
- 17. 17 Prehabilitation 1. Females are at risk for knee injuries 2. Balancing quad-ham muscles reduces knee injuries by 80%. Pre-training Post-training 1/26/10 Sportsmetrics TM : the Key to Prevention of Serious Knee Ligament Injuries in Female Athletes, Catherine Walsh, M.S., Women’s Program Manager Cincinnati Sportsmedicine Research and Education Foundation Untrained Females Trained Females Males Injury Incidence/ 1,000 Player Exposures *p< .05 Results: All Sports; All Knee Injuries per 1,000 Athlete Exposures
- 18. 1/26/10 18 Total Force Plus Life-Cycle Health Readiness System: Medical What Might It Look Like? Total Force Plus Life-Cycle Health Readiness System: Medical What Might It Look Like?
- 19. 1/26/10 19 Total Force Plus Life-Cycle Health Readiness System: Nutrition Total Force Plus Life-Cycle Health Readiness System: Nutrition Med ical Nutrition Fitnes s Resilienc e Concept Evidence-based nutrition/supplementation focused on military environment, gender, and tissue monitoring. Monitoring Comprehensive Blood Chemistry Plus* and relevant test sampling* Training/E ducation • NCOES/WOES/OES (ACCP) (Spouse /family orientation) (DOD Schools/ local HS with mil pop) • Embedded training (posters, Jody calls, etc.) • Diagnosis-based prescriptive (link to Ed Svcs) • Cooking classes in AAFES/Commissary/MWR Delivery • Evidence-based menu/recipes optimized for military environment • Timely access to meals within training OPTEMPO • Meal/snack frequency based on tissue needs • Warrior Bar, Warrior Pak, Warrior Drink R&D concepts • AAFES, MWR, and Commissary participation Supply Chain • Enhanced food/supplement inspection and sanitation counter-measures • Healthy food standards (e.g. salad-bar plus beef) • Food production guidelines and inspections (management-intensive grazing) * TBD
- 20. • Body iron stores were low pre-BCT (56%) and decreased further by graduation (84%) • Iron Anemia was correlated with poor PT performance • B vitamin levels were low normal pre-BCT and “decreased significantly over BCT.” • Menu was adequate in energy, but inadequate in B6, folic acid, calcium, magnesium, iron, and zinc. • Started Soldier Fueling Program. Source: “Health, Performance, and Nutritional Status of U.S. Army Women during Basic Combat Training,” (1995) (ADA302042) NOTE: Study BCT menu governed by the 1985 AR 40-251/26/10 20 Army BCT Female NutritionArmy BCT Female Nutrition
- 21. Naval Female Recruits Calcium and Vitamin D StudyNaval Female Recruits Calcium and Vitamin D Study • Stress fractures occur in 0.2-5.2 % of male recruits and 1.6-21.0% of female recruits. • Calcium Balance is compromised − Ca deficient diet upon entry in BT. Minimum recommended Ca 1,000mg/d Average Ca intake 19 – 30 yrs 600-700mg/d Median Ca intake of women during BT 700-900mg/d − High Ca losses occur in sweat during strenuous activity. Study with collegiate basketball players Klesges, et al. 1996. • Sample size: − Enrolled 4,647 − Discharged from Navy 355 − Withdrew from study 1,001 − Completed 2,803 • Treatment: − Randomized, Double Blind, Placebo Controlled − 2,000 mg Calcium & 800 IU Vit D • Results: Supplemented group had a 20% lower incidence of stress fractures than the control group. Naval Institute for Dental and Biomedical Research 1/26/10 21
- 22. 1/26/10 22 Vitamin D Deficiency/InsufficiencyVitamin D Deficiency/Insufficiency • Military population levels unknown (small USCG study = 60% <30 ng/ml). • Endpoint decision drives numbers (variation by race and latitude). • Militarily significant outcomes (AF Flu Outbreak cost $7M).
- 24. 1/26/10 24 Total Force Plus Life-Cycle Health Readiness System: Fitness Medica l Nutritio n Fitness Resilienc e Concept Functional/skill and team-based fitness within a quarterly periodization cycle. Monitoring • Annual with local quarterly periods. • Web-based PT & periodization designer & record system. Training/E ducation • Comprehensive injury prevention program (see Notes). • Fitness ASI. • Expanded Fitness School (includes injury prevention and rehab, nutrition, resilience, etc.). • Enhanced MWR staff skills. • Spouse /family orientation.24 Delivery • Unit-based. Multiple program choices. Combat parcourse. Prehabilitation exercises. • MWR programs ICW PT school & medical (safe lifting posters; muscle balance guidelines, etc.). • National gym contract for geographically separate Ss (e.g. USCG). • DOD Schools/ local HS with mil pop. • Portable gym equipment (e.g. Exergenie) and/or gyms (see CONEX- based Army BU slide ) (ICW AAFES/MWR). Supply Chain • Incentivize Troops-To-Teachers to support HS PT. • Army ‘theme’ (e.g. America Strong) (e.g. USMC Toys for Tots). • Expand JROTC.
- 25. Pre-BCT Training ProgramsPrograms are Effective 1. BLUF: The FTU PCU lowers overall discharge attrition by 500-800+ Soldiers (0.4-0.8+%), as well as lowers course attrition and injury rates. 2. 4%-7% of men and 10%-24% of women fail the RECBN 1-1-1 assessment historically. 50-75% of the PCU at GIT sites will be female. 3. PCU Results: a. Lower course attrition: In the “1-1-1 Fail No PCU” group, men are 2.5 times and women are 1.5 times more likely to attrit from BCT. b. Lower discharge attrition: In the “1-1-1 Fail No PCU” group, men are 3.0 times and women are 1.9 times more likely to be discharged from BCT. c. Lower injury rates. d. The USMA experimental PCU-X vice the traditional PCU improved female outcomes, but male outcomes were worse (but still better than no PCU). Recommendation is that USAPFS design a new PCU PT POI. e. Option: a 12 week BCT PCU company to maximize program flexibility, maintain bonding, provide non-PT training, get resourced, etc. 1/26/10 25
- 26. 26 Control Group Standardized PT Program Week 1 Week 3 Week 5 Week 9 Time (in weeks) Injury Rates 33% decrease Injury Control USAPFS Standardized PT ProgramUSAPFS Standardized PT Program Good PT design maintains/exceeds standards and lowers injury rates 1/26/10
- 27. 27 • BCT grads arrived at AIT with high injury rates (approx. 28% men; 48% women). • PT running was the primary cause of musculoskeletal injuries. • Changing the running program – Reduced Clinic Visits - 36.5% – Reduced Profiles - 48.6% – No difference in APFT Scores – Reduced APFT retakes - 50% – Saved 612 limited duty days/week/BN AMEDDC&S Operation Aegis Injury Control If implemented at all IET/AIT sites: $9M/yr & 1.5M limited duty days/yr Potential Savings 1/26/10
- 28. 28 0% 20% 40% 60% 80% 100% 1994 1995 1996 1997 1998 1999 Uninjured 1,834 Injuries Prevented Injured Results for Army Basic Training: Injury 0% 20% 40% 60% 80% 100% 1994 1995 1996 1997 1998 1999 Training Successes Discharged 1,260 Discharges Prevented Results for Army Basic Training: Attrition Defence Injury Prevention Program (DIPP) Australian Department Of DefenceAustralian Department Of Defence Defence Injury Prevention Program (DIPP) Australian Department Of DefenceAustralian Department Of Defence 1. Reducing injuries reduced attrition: 70% reduction over 4 years in rates of injury and attrition 2. Gives CDRs the tools; harnesses Commander’s knowledge and skills working together to address their own injury problems. 3. 95% reduction in pelvic stress fracture rates in female recruits. 1/26/10
- 29. Total Force Plus Life-Cycle Health Readiness System: Resilience Total Force Plus Life-Cycle Health Readiness System: Resilience 1/26/10 29 Medica l Nutrition Fitnes s Resilience Concept • Positive life skills to adapt to stress and hardships. • Integrated resilience, Battlemind, and CONOPS sequential and progressive by level. Monitoring Diagnostic test battery based training (e.g. Success Profiler) (individual as appropriate). Training/E ducation • Enhanced Beh Science Specialist MOS training Delivery • Pre-enlistment R&D (train in/screen out) • Pre-BCT ‘get ready’ training • Chaplain combat-style resilience training in IET • Embedded training (posters, Jody calls, etc.) • NCOES/WOES/OES • Spouse /family orientation Supply Chain • Incentivize Troops-To-Teachers to support HS Wellness program. • Army ‘theme’ (e.g. America Strong) (e.g. USMC Toys for Tots) • Expand JROTC.
- 30. 1/26/10 30 • Our current cohorts of DoD recruits arrive at IET with significant developmental experiences: – 40% come from ‘non-traditional’ homes without two consistent parenting figures* – 19% of HS students had seriously considered attempting suicide during a 12 month period** – 8% of HS students reported making a suicide attempt in the preceding 12 month period** • Our current cohorts of DoD recruits arrive at IET with significant developmental experiences: – 40% come from ‘non-traditional’ homes without two consistent parenting figures* – 19% of HS students had seriously considered attempting suicide during a 12 month period** – 8% of HS students reported making a suicide attempt in the preceding 12 month period** Source: Charles W. Hoge, COL, MC, Chief, Department of Psychiatry and Behavioral Sciences, Walter Reed Army Institute of Research Civilian Population
- 31. 31 *Wolfe, J. (1996-2000). Adaptation to First-Term Enlistment Among Women in the Marine Corps. DAMD 17-95-1-5047. 1. More ACE factors increase risk. 2. Associated high-risk behaviors (sex, drugs, smoking,, etc.) 3. Associated impacts (health, disease, poor job performance, depression, etc.). 4. Diminished brain development. 5. Treatable. Adverse Childhood Experiences (ACE)Adverse Childhood Experiences (ACE) USMC Sample National Samples Men Women Men Women Child physical 26.7 38.3 3.2 4.8 Child sexual 14.7 51.0* 3-16 12-27 Table shows only 2 factors. Having 3+ factors does increase risk somewhat, but does not automatically mean all are ruined. 1/26/10
- 32. 1/26/10 32 Alcohol abuse 23.5% 33.0% Mental illness 17.5% 21.1% Battered mother 11.9% 6.8% Exposures Civilian Army Infantry Childhood Abuse Civilian Army Infantry Psychological 10.0% 20.0% Physical 4.9% 13.8% Sexual 19.3% 3.8% Adverse Childhood Experiences (ACEs) are Common in Civilian and Military Populations •Data from civilian population from CDC ACE study (n=9,508). Infantry population based on AC combat unit (n=4,602)(WRAIR OIF /OEF behavioral health research project). Note: Data does not adjust for differences in population demographics. Source: Charles W. Hoge, COL, MC, Chief, Department of Psychiatry and Behavioral Sciences, Walter Reed Army Institute of Research
- 33. 33 The Dark Side AttitudesAttitudes 1. G1 Insist-Assist Study showed leaders’ attitudes affected attrition rates. a. “High Attrition Leaders” believe they were ‘gate guarders.’ b. “Low Attrition Leaders” believed they were developing Soldiers. 2. Emotional Events (‘high fear events,’ ‘food deprivation’, ‘sleep deprivation,’ ‘extreme PT,’ etc.) may be mis-perceived by some as preparing Soldiers for war, or strengthening them to cope with stress. 1/26/10
- 34. no TLAC training and no OIF/OEF experience no TLAC training and OIF/OEF experience TLAC training (with classroom instructor) but no OIF/OEF experience Training critical thinking works! Source: ARI Adaptive ThinkingAdaptive Thinking 1/26/10 34 Expert Patterns of Battlefield Thinking Keep a focus on mission accomplishment and higher commander's intent. Model a thinking enemy. Consider effects of terrain. Use all elements/systems available. Include considerations of timing. Exhibit visualizations that are dynamic and proactive. Consider contingencies and remain flexible. Consider how your fight fits into the bigger picture from friendly and enemy perspectives.
- 35. Positive LeadershipPositive Leadership USMA Peak Performance Model: Training the Warrior Pentathlete Peak Performance Attention Control Cognitive Foundation s Goal Setting Visualizatio n = Stress & Energy Mgmt ARI – Infantry Forces Research Unit United States Olympic Committee 1998 The most critical training that prepared Soldiers for efficient and effective task accomplishment under life- threatening, fast-paced, and stressful conditions are: • Time management • Command of the basics • skill mastery • Combat focus • Visualization • Repetition, and • Use of job aids Human performance at elite levels is heavily dependent upon intangible, mental factors, i.e. • Confidence despite setbacks, • Concentration amidst distractions, • Composure during times of stress. Physical Technical Tactical Mental Emotional Self Regulating Instinctive Adaptive Agile Mental Effort Warrior Mindset Build confidence Control attention Recover energy ‘See’ the battlefield Combat PT 8-Step AAR Rote Repetition Self critical Analytical Judgmental Physical effort 1/26/10 35
- 36. 1/26/10 36 • Force mission accomplished • Force ready and deployable • Force manpower levels met • Costs equal or lower Total Force Plus Life-Cycle Health Readiness System: Outcomes Total Force Plus Life-Cycle Health Readiness System: Outcomes One Team; One Fight
Editor's Notes
- Meet the Army’s mission, manpower and quality objectives. Graduate Soldiers who can “mobilize, deploy, fight, sustain, and win any conflict” as units with Warrior Ethos and Values. Graduate Soldiers who are physically healthy, task-relevant physically fit, mentally resilient, and deployable.
- Bombs and bullets aren&apos;t soldiers&apos; biggest dangers WAR: Injuries and illness take more soldiers away from battlefields in Iraq and Afghanistan. BY DREW BROWN KNIGHT RIDDER NEWSPAPERS WASHINGTON - Enemy bombs are the biggest killer of U.S. troops in Iraq, but the armed forces have lost more men and women to illnesses and noncombat injuries than they have to enemy fire. Despite advances in technology, top-notch training and equipment, state-of-the-art medical care and a 2003 order by Defense Secretary Donald Rumsfeld to cut the number of preventable accidents in half, broken bones and bad health have taken more U.S. soldiers off the battlefield than combat has. By mid-December, more than 25,803 American service members had been evacuated from Iraq since the war began nearly three years ago, according to Pentagon officials. Nearly 80 percent of them were shipped out because of routine illnesses and injuries unrelated to combat. Historically, accidents have caused about half of the U.S. military&apos;s wartime injuries and deaths. But Rumsfeld&apos;s 2003 directive has had an effect, said David Chu, the undersecretary of defense for personnel. As a result, &quot;about 26 percent of the losses (in Iraq) result from preventable mishaps,&quot; Chu told the Senate Armed Services Committee last February. Pentagon health officials said the decline was the result of better medical care and efforts to prevent accidents and illnesses. Still, vehicle accidents have killed more troops than insurgent mortar and rocket attacks. According to Pentagon statistics through mid-December, at least 158 American service members in Iraq have died in vehicle accidents since the war began. Mortar and rocket attacks have killed 156 U.S. service members and wounded more than 1,900. Enemy fire has wounded more than 16,000 American troops in Iraq. More than half of those returned to duty within three days. Nonbattle injuries and disease had caused the evacuations of 20,449 U.S. troops from Iraq through mid-December, Pentagon statistics show. Officials estimate that about 25 percent of those who are evacuated for injuries or illnesses eventually return to the combat zone. As dangerous and unsanitary as battlefield conditions are, better medical care and preventive medicine mean that the rates of nonbattle injuries and disease &quot;have been lower than in any other conflict,&quot; Chu said in February.
- 2005: Lappe Joan; Davies Kennard; Recker Robert; Heaney Robert Quantitative Ultrasound: Use In Screening For Susceptibility To Stress Fractures In Female Army Recruits. Journal Of Bone And Mineral Research, 2005;20(4):571-8. Evaluation Of A Progressive Unit-based Running Program During Advanced Individual Training, Col Valerie J. Berg Rice Et Al, Department Of Medical Science, U.S. Army Medical Department Center And School, Ft. Sam Houston, San Antonio, TX 78234-6000, November 2001 A COMBINED MACRO ERGONOMICS & PUBLIC HEALTH APPROACH TO INJURY PREVENTION: TWO YEARS LATER Valerie J. Berg Rice, Phd And Clayton Gable, Phd* Human Research And Engineering Directorate U.S. Army Research Laboratory U.S. Army Medical Department Center And School Ft. Sam Houston, San Antonio, Texas Calcium And Vitamin D Supplementation Decreases Incidence Of Stress Fractures In Female Navy Recruits Joan Lappe,1 Diane Cullen,1 Gleb Haynatzki,1 Robert Recker,1 Renee Ahlf,2 And Kerry Thompson2 JOURNAL OF BONE AND MINERAL RESEARCH Volume 23, Number 5, 2008 Published Online On February 4, 2008; Doi: 10.1359/Jbmr.080102 © 2008 American Society For Bone And Mineral Research Health, Performance, And Nutritional Status Of US Army Women During Basic Combat Training, Westphal Et Al, 1995, USARIEM, DTIC Prevalence Of Iron Deficiency And Iron Deficiency Anemia Among Three Populations Of Female Military Personnel In The US Army, Mcclung Et Al, Journal Of The American College Of Nutrition, Vol 25, No. 1, 2006. Randomized, Double-blind, Placebo-controlled Trial Of Iron Supplementation In Female Soldiers During Military Training: Effects On Iron Status, Physical Performance, And Mood1–5 James P Mcclung, Am J Clin Nutr 2009;90:1–8.
- Only 3 out of 10 are fully qualified without waivers. That’s BEFORE we consider propensity to join!
- The ‘obesity epidemic’ has a dramatic effect on the recruitable population, especially diversity.
- If fatness trends continue, this is the impact on recruiting in 2015-2020. One option is to adjust our standards, There is no validity to the current age-adjusted BF standards. Our current ARMS study shows OW folks doing very well.
- JOURNAL OF BONE AND MINERAL RESEARCH, Volume 20, Number 4, 2005 Published online on December 6, 2004; doi: 10.1359/JBMR.041208 © 2005 American Society for Bone and Mineral Research Quantitative Ultrasound: Use in Screening for Susceptibility to Stress Fractures in Female Army Recruits, Joan Lappe, Kennard Davies, Robert Recker, and Robert Heaney FRAX Bone Treatment Algorithm: A Revised Clinician&apos;s Guide to the Prevention and Treatment of Osteoporosis- commentary The Journal of Clinical Endocrinology & Metabolism July 2008 Vol. 93, No. 7 2463-2465 Bess Dawson-Hughes on behalf of the National Osteoporosis Foundation Guide Committee Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts 02111 INTRODUCTION Osteoporosis is an important health problem now, and the incidence of fractures and their associated costs are rising rapidly as our population ages (1). The National Osteoporosis Foundation (NOF) has estimated that by 2010, 12 million men and women in the United States will have osteoporosis and over 40 million more will have low bone mass (2). There is little controversy about whether individuals who present with osteoporosis should be considered for pharmacotherapy. Among patients with low bone mass, however, we need better discrimination of those at high risk for fracture, to maximize the benefit while limiting the risks and costs that accompany treatment. In this spirit, the NOF has collaborated with the World Health Organization (WHO) to adapt its newly developed fracture prediction algorithm (FRAX) to the U.S. population (3), performed an economic analysis to identify levels of fracture risk above which it is cost-effective to consider pharmacotherapy in this country (4), and revised the NOF Clinician&apos;s Guide for the Prevention and Treatment of Osteoporosis (www.NOF.org). This Commentary provides a brief overview of this process, a summary of the key recommendations of the Guide, and a consideration of work that remains. The U.S.-adapted FRAX algorithm is available on the NOF website (www.NOF.org) and atwww.shef.ac.uk/FRAX. The Committee also performed a cost-effectiveness analysis to estimate the levels of fracture risk above which it is reasonable to consider treatment (4). The practical implications of this analysis are described in a companion paper (3). The new NOF Clinician&apos;s Guide (available on the NOF website at www.NOF.org) indicates 10-yr fracture risk thresholds above which it is reasonable to consider pharmacological treatment. Work is now underway to evaluate the potential impact of the Guide by estimating the number of men and women who are expected to meet the new treatment criteria.
- Corrected deficits Increased ham/quad ratio from 51% to 60% Improved ham/quad ratio 13% dominant side; 26% non-dominant side Decreased landing forces Landing force from jump: 22% Knee adduction and abduction moments: 50% Increased power, strength, jump height Ham power 44% dominant side, 21% non-dominant side Mean vertical jump:10%
- Schools shifted to soda machines and fast food restaurants instead of cafeterias to defray costs. Teens rarely drink milk anymore, preferring sodas. Teenage women may have severely unbalanced diets which can result in anemias. You see here that 56% entered iron anemic. However, you also see the Army diet was inadequate and their status worsened. We are currently doing a study at Fort Jackson to try and correct. We can ask the same questions about MREs.
- CALCIUM AND VITAMIN D SUPPLEMENTATION REDUCES INCIDENCE OF STRESS FRACTURES IN NAVY RECRUITS +*Lappe, J.M.; *Cullen, D.M.;**Thompson, K.; **Ahlf, R. +*Creighton University, Omaha NE jmlappe@creighton.edu NOTE: Bone as living tissue needs a variety of nutrients.
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- Rudzki SJ. Injuries in Australian army recruits. Part I: Decreased incidence and severity of injury seen with reduced running time. Military Medicine. 1997 162(7), 472-476. Rudzki, SJ. Injuries in Australian army recruits. Part II: Location and cause of injuries seen in recruits. Military Medicine. 1997 162(7), 477-480. Rudzki, SJ. Injuries in Australian army recruits. Part III: The accuracy of a pretraining orthopedic screen in predicting ultimate injury outcomes. Military Medicine. 1997 162(7), 481-483. Knapik, JJ, Rieger, W, Palkoska, F, Van Camp, S, and Darakjy, S. United States Army physical readiness training: rationale and evaluation of the physical training doctrine. J Strength Cond Res 23(4): 1353-1362, 2009 Epidemiologic Reviews 24:228-247 (200Johns Hopkins Bloomberg School of Public Health Prevention of Lower Extremity Stress Fractures in Athletes and Soldiers: A Systematic Review Bruce H. Jones1, Stephen B. Thacker2, Julie Gilchrist1, C. Dexter Kimsey, Jr.3 and Daniel M. Sosin2 2005: Lappe Joan; Davies Kennard; Recker Robert; Heaney Robert Quantitative ultrasound: use in screening for susceptibility to stress fractures in female army recruits. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 2005;20(4):571-8. USACHPPM Report No. 21-KK-08QR-08, Recommendations for Prevention of Physical Training (PT)-Related Injuries: Results of a Systematic Evidence-Based Review by the Joint Services Physical Training Injury Prevention Work Group (JSPTIPWG) Rice, V. J., Connolly, V., and Mays, M. Z. (2001). A comparison of traditional vs. &quot;new&quot; physical training: The rest of the story. In A.Bittner, P Champney, and S. Morrissey (Eds.) Advances in Occupational Ergonomics and Safety, Washington, DC: IOS Press, 297-303.
- Evaluation of the TRADOC Standardized PT Program for BCT And Evaluation of the Effectiveness of The Fitness Assessment Program, Joseph J. Knapik, Salima Darakjy, Keith Hauret, Sara Canada, Roberto Marin, Shawn Scott, William Rieger, Frank Palkoska, Steven VanCamp, Gene Piskator , US Army Center for Health Promotion and Preventive Medicine US Army Physical Fitness School US Army Training Center (Ft Jackson SC) US Army Center for Accessions Research
- Experts learn what information is critical and what is not. The role of simple practice cannot be underestimated. We have to ask ourselves where a LT or squad leader gets 20 repetitions on ‘how to fight’ tasks?
- Positive leadership and training resilience are force multipliers. Soldiers regardless of their backgrounds can learn to ‘bounce back’ and overcome obstacles.