Suchergebnisse

BACKGROUND: The COVID-19 pandemic has been associated with significant spread in congregate settings and various forms of non-pharmaceutical interventions (NPI) have been implemented to prevent spread. Basic Military Training at Joint Base-San Antonio is the entrance to the US Air Force and has been associated with respiratory outbreaks in the past. A two-week arrival quarantine was implemented in March 2020. Effects on subsequent testing for COVID-19 after an arrival quarantine is unknown. METHODS: The first four weekly cohorts of trainees who underwent an arrival quarantine between March 16-April 13 were monitored during their 7 week training for COVID-19 symptoms. Symptoms, medical testing, and days removed from training were collected on every patient with possible COVID-19 symptoms including cough, shortness of breath, or fever. Testing during the two-week arrival quarantine were compared to the subsequent five weeks of training. Nominal variables were compared by chi squared or Fisher's exact test as appropriate. Continuous variables were compared by Mann-Whitney U Test. RESULTS: A total of 2,573 started training during study period, 89 (3.4%) had symptoms concerning for COVID-19 and were tested. 5 (6%) patients tested positive, all of whom in the arrival quarantine. Compared to patients who completed quarantine (n=29), patients in the arrival quarantine who tested negative for COVID-19 (n=54) were tested more often (26 trainees a week vs. 5.8 later in training, p=< 0.0001), and received more rapid flu tests (74% vs. 38%, p=0.001) and multiplex respiratory PCR (15% vs. 0%, p=0.05). Trainees in quarantine were isolated longer for symptoms than patients who completed quarantine (median 3 vs. 2, p=0.01). There was no difference in presenting symptoms for trainees in quarantine or after quarantine. CONCLUSION: Arrival quarantine appears to be an effective NPI, which in conjunction with other interventions prevented any COVID-19 transmission after quarantine completion. For those who went through arrival ...

CONTEXT: Musculoskeletal injury is the leading cause of attrition from military training. OBJECTIVE: To assess the effect of an embedded athletic training musculoskeletal care model within a basic military training unit. DESIGN: Cluster randomized trial. SETTING: United States Air Force Basic Military Training, Joint Base San Antonio—Lackland. PATIENTS OR OTHER PARTICIPANTS: Military recruits randomly assigned to 1 of 3 training squadrons, 2 control and 1 experimental, between January 2016 and December 2018. INTERVENTION(S): A sports medicine care model was established in 1 squadron by embedding 2 certified athletic trainers overseen by a sports medicine fellowship-trained physician. The athletic trainers diagnosed and coordinated rehabilitation as the primary point of contact for recruits and developed interventions with medical and military leadership based on injury trends. MAIN OUTCOME MEASURE(S): Recruit attrition from basic training due to a musculoskeletal injury. Secondary outcomes were all-cause attrition, on-time graduation, rates of lower extremity injury and stress fracture, rates of specialty care appointments, and fiscal costs. RESULTS: Recruits in the athletic training musculoskeletal care arm experienced 25% lower musculoskeletal-related attrition (risk ratio = 0.75 [95% CI = 0.64, 0.89]) and 15% lower all-cause attrition (risk ratio = 0.85 [95% CI = 0.80, 0.91]), translating to a net saving of more than $10 million. The intervention reduced the incidence of lower extremity stress fracture by 16% (rate ratio = 0.84 [95% CI = 0.73, 0.97]). CONCLUSIONS: An embedded athletic training musculoskeletal care model outperformed usual care across operational, medical, and fiscal outcomes.

We describe the public health response to a military trainee who developed serogroup B meningococcal disease while sharing underwater breathing equipment. Despite high transmission risk, with rapid isolation and postexposure prophylaxis administration, there were no secondary cases. This case supports carefully weighing serogroup B meningococcal vaccination in high-risk settings.