Military medicine
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Back pain is a major reason for sick leaves and disability pension in primary health care. The prevalence of back pain among adolescents and young adults is believed to be increasing, and back pain during military service predicts unspecified back pain during later life. The aim of this study was to investigate the prevalence and risk factors of back pain among conscripts in compulsory Finnish military service during the period 1987-2005. ⋯ The prevalence of back pain among male Finnish military service conscripts has not changed in the last 25 years. Twenty percent of conscripts suffer from back-related problems during their military service. The majority of the visits to health centers occurred in the first service months. The risk factors for back pain include smoking, low education level, and musculoskeletal disorders in general. Educating the young people about harms of tobacco and supporting education is a way to influence the back pain prevalence. Strength of this study is a good generalized population sample of young Finnish adult males because of the fact that the Finnish military service is compulsory for all men. All medical records of all visits to the Garrison Health Care Centre were available, and all the conscripts filled the same pre-service questionnaire, minimizing the possibility of selection bias. The sample size was also large. Weakness of this study is that the service time changed during the study period and in the latest conscript group born in 1989, data collection and the data available for this cohort was limited, because nearly half of the conscripts had not yet started their service. The Finnish military service is compulsory only for men and because of the low number of female conscripts, they were excluded from this study. Diagnoses were also missing from 70% of the back-related visits, and these visits were recorded as back pain-related visits according to the reason for seeking care.
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Active duty service women (ADSW) constitute 16% of the force. The prevalence of alopecia, a dermatologic condition characterized by hair loss, is understudied in regard to hairstyle regulations across the U.S. military services. Alopecia has several causes; one of which is due to tension on the scalp secondary to tight hairstyles. In the U.S., alopecia has a lifetime prevalence of 1.7-2.1%; no previous studies which evaluated this condition in service women were found. ⋯ The prevalence of alopecia in ADSW is slightly higher than that in civilian populations and is most likely underreported. It is more commonly diagnosed in Black women than would be expected based on ratios of this population in military service. Policy changes to ensure that traction alopecia is a qualifying medical condition for Veterans Affairs disability compensation, mechanisms are in place for more specific coding in the electronic medical record, and treatment options to be covered by TRICARE are recommended. All U.S. military services should consider updating and evaluating regulations to improve the health and quality of life of ADSW.
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Anal cancer is a rare malignancy with an estimated 8,580 new cases each year in the USA where hematochezia, a common condition, is often the initial presenting sign. We describe a 51-year-old woman who presented with painful hematochezia, with a delayed diagnosis of anal cancer in the setting of missed and misdiagnosed digital rectal exams in an otherwise low-risk patient. This case highlights the importance of maintaining a broad differential diagnosis for hematochezia and the utility of thorough physical exams.
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Editorial Comment Letter
A Comment on "COVID-19 Vaccine Hesitancy and Physician-led Intervention".
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Early identification of patients with coronavirus disease 2019 (COVID-19) who are at risk for hospitalization may help to mitigate disease burden by allowing healthcare systems to conduct sufficient resource and logistical planning in the event of case surges. We sought to develop and validate a clinical risk score that uses readily accessible information at testing to predict individualized 30-day hospitalization risk following COVID-19 diagnosis. ⋯ The prediction tool developed in this study demonstrated that it could identify patients with COVID-19 who are at risk for hospitalization. This could potentially inform clinicians and policymakers of patients who may benefit most from early treatment interventions and help healthcare systems anticipate capacity surges.