Changes in physical performance during British Army Junior Entry, British Army Standard Entry and Royal Air Force Basic Training

INTRODUCTION

The purpose was to quantify physical performance in men and women during British Army Junior Entry (Army-JE), British Army Standard Entry (Army-SE) and Royal Air Force (RAF) basic training (BT).

DESIGN

Prospective longitudinal study.

METHODS

381 participants ((339 men and 42 women) n=141 Army-JE, n=132 Army-SE, n=108 RAF) completed a 2 km run, medicine ball throw (MBT) and isometric mid-thigh pull (MTP), pre-BT and post-BT. To examine changes in pre-BT to post-BT physical test performance, for each course, paired Student t-test and Wilcoxon test were applied to normally and non-normally distributed data, respectively, with effect sizes reported as Cohen's D and with rank biserial correlations, respectively. A one-way between-subjects analysis of variance (ANOVA) (or Welch ANOVA for non-normally distributed data) compared performance between quartiles based on test performance pre-BT. Where the main tests statistic, p value and effect sizes identified likely effect of quartile, post hoc comparisons were made using Games-Howell tests with Tukey's p value. Data are presented as mean±SD, with statistical significance set at p<0.05.

RESULTS

During BT, 2 km run time improved by 13±46 s (-2.1%±8.1%), 30±64 s (-4.8%±12.3%) and 24±27 s (-4.5%±5.1%) for Army-JE, Army-SE and RAF, respectively (all p<0.005). MBT distance increased by 0.27±0.28 m (6.8%±7.0%) for Army-JE (p<0.001) and 0.07±0.46 m (2.3%±10.9%) for Army-SE (p=0.040), but decreased by 0.08±0.27 m (-1.4%±6.0%) for RAF (p=0.002). MTP force increased by 80±281 n (10.8%±27.6%) for Army-JE (p<0.001) and did not change for Army-SE (-36±295 n, -0.7%±20.6%, p=0.144) or RAF (-9±208 n, 1.0±17.0, p=0.603). For all tests and cohorts, participants in the lowest quartile of pre-BT performance scores demonstrated greater improvements, compared with participants in the highest quartile (except Army-JE MBT, ∆% change similar between all quartiles).

CONCLUSIONS

Changes in physical performance were observed for the three fitness tests following the different BT courses, and recruits with the lowest strength and aerobic fitness experienced greatest improvements.

1073 Sleep Disorders Contribute To Anger In Service Members With Posttraumatic Stress Disorder

Introduction

The emotion of anger and behavioral acts of aggression can lead to severe negative consequences, including family violence, legal charges, and death. Anger can be a symptom of posttraumatic stress disorder (PTSD), particularly in service members. Service members report difficulties managing their anger and trouble with the subsequent results. Factors that differentiate service members with PTSD who have anger related problems from those who do not are still unknown. Impaired sleep is associated with negative mood states in the general population and may be a risk factor for anger in those with PTSD. This project examines how sleep disorders commonly diagnosed in service members (i.e., obstructive sleep apnea and insomnia) relate to PTSD and anger.

Methods

Ninety-three service members with comorbid PTSD, insomnia, and nightmares (mean age = 35.86 years, SD = 8.38, 27% female, 45% white) completed polysomnography and other measures as part of a clinical trial. A multiple regression model examined how total Apnea Hypopnea Index (AHI), AHI during REM sleep, insomnia (Insomnia Severity Index), age, and race related to PTSD symptoms (Clinical Administered PTSD Scale-5: CAPS-5). A second multiple regression model examined the same variables’ associations with anger (Dimensions of Anger Reactions-5; DAR-5).

Results

More than a third of the sample (37%) met criteria for OSA (AHI scores&gt;5) and 99% met criteria for insomnia (ISI&gt;10). Total AHI and REM AHI were not associated with CAPS-5 scores or ISI. Across OSA and PSG indices, only greater REM AHI (b=.07, p&lt;.05) and Insomnia (b=.43, p&lt;.05) were positively associated with DAR-5 anger scores. Total AHI was unrelated to anger.

Conclusion

Elevated REM AHI and insomnia were associated with greater anger in service members with PTSD. Current treatments for anger are only moderately effective. Assessing and treating comorbid sleep disorders may reduce anger and enhance successful PTSD treatment.

Support

Consortium to Alleviate PTSD (W81XWH-13-2-0065), DVA (I01CX001136-01), GDHS (W91YTZ-13-C-0015) for DVBIC.

Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases

Background

The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.

Methods

Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).

Results

Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.

Conclusion

Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.

Cycle helmet ownership and wearing; results of a survey in South Staffordshire

BACKGROUND

Despite increasing evidence indicating that wearing cycle helmets can reduce the severity of head injuries, particularly in children, there is a paucity of local data on cycle helmet ownership and wearing rates. These data together with an understanding of the factors which influence these rates are important in developing appropriate health promotion programmes.

METHOD

The objectives were to (1) establish patterns of cycle helmet ownership and wearing rates, and (2) determine factors influencing these rates. A descriptive survey involving a self-completed questionnaire was undertaken and a series of focus groups were also established. The setting was two high schools and four primary schools in each of the six boroughs or district councils within South Staffordshire involving 932 Year 6 and 2005 Year 10 children.

RESULTS

The response ratio was 70.9 per cent from Year 6 and 80.9 per cent from Year 10, giving an overall response rate of 77.8 per cent. Most children (86.6 per cent) rode a bicycle and of these 42.8 per cent owned a cycle helmet. Just over a third (36.8 per cent) of Year 6 cyclists wore a helmet always or nearly always, compared with 13.7 per cent of Year 10 cyclists. Although the protective effect of cycle helmets was appreciated, many children did not see themselves as being personally at risk, particularly on short journeys. The appearance and comfort of the helmet appeared to be stronger factors influencing the uptake of helmets compared with cost. Both year groups were similarly concerned with comfort, but Year 10 children appeared more concerned with appearance than Year 6 children.

CONCLUSIONS

Cycle helmet ownership and wearing is still disappointingly low, especially amongst older children. The factors influencing patterns of ownership and wearing are numerous and the interrelationships between them are complex, requiring a co-ordinated approach from a range of agencies. Cycle helmet legislation should be considered by the Government.

The Mid-Staffordshire survey. Getting consumers' views of maternity services

In 1991 Mid-Staffordshire Health Authority surveyed a sample of 639 women living in the district who had given birth approximately seven to eight weeks previously. The response rate was 80%. Approximately three-quarters of women were satisfied with the care they had received from the maternity services, but the responses highlighted several areas for improvement. Main criticisms were lack of information, attitudes of some staff, and of staff having too little time to talk to them. Fewer women than expected were breast feeding, both in hospital and at home, and women reported having problems and wanting more help than they received.

CT scanning in meningitis

Twelve paediatric cases of acute meningitis were reviewed retrospectively. Findings on CT scan were compared with the clinical course and resulting neurological sequelae. Complications detected by CT scanning include subdural effusion, empyema, hydrocephalus, cerebral atrophy, oedema and infarction. The CT scan results adequately correlated with neurological signs in most cases. Infarction was a reliable indicator of neurological sequelae. Cerebral atrophy alone, however, did not correlate well with the clinical sequelae.