Although widespread, the use of disease-based employment medical standards is poorly understood or researched. A probabilistic model and threshold value are developed and applied to a military (Canadian Forces [CF]) medical standard for anaphylaxis. Frequency estimates of prevalence, occurrence, and impairing reactions are determined from the literature for military applicants and from medical chart review of military members identified by prescriptions for self-administered epinephrine. The prevalence of prescriptions is 1.13% (CI 1.05, 1.22) and 0.86% (CI 0.72, 1.00) in the CF Regular Force and applicant populations, respectively. The proposed model predicts the annual risk of an impairing allergic reaction in the CF population ranges from 0.1% to 0.16%/year, well below the proposed threshold of 0.5%. The majority of this risk arises from new cases and not recurrences. Requirement for care increases with recurrence. This model allows a useful method of disease-based medical standard review.
The Canadian Forces (CF) adopted the EPINATO surveillance system in 1996 to monitor disease and injury morbidity in deployed settings. The Directorate of Force Health Protection, CF Health Services Group initiated an evaluation of EPINATO in Task Force Bosnia-Herzegovina in August 2003. Two methods were used to assess coding reliability: a chart audit and Sick Parade Register review. Stakeholder interviews were conducted evaluating data flow, reporting structure, and key system attributes. Reliability (K, 95% confidence interval) was good in 4 of 24 categories--sexually transmitted diseases, K = 0.75 (0.50, 1.00); eye disorders, K = 0.51 (0.15, 0.88); ears/nose/ throat, K = 0.51 (0.33, 0.69); lower respiratory infections, K = 0.49 (95% confidence interval 0.34, 0.65)-but otherwise was poor. EPINATO is not an effective, reliable tool for CF deployment health surveillance. An improved health surveillance system is required to ensure disease and injury aberrations are detected and optimal preventive programs and policies are in place for deployed CF military members.
Western militaries deploying to international locations are often confronted with the threat of malaria. For the Canadian military, the consequent response has been prescriptive-any risk of malaria warrants use of personal protective measures and chemoprophylaxis. In reality, however, malaria risk is highly variable and a one-size-fits-all strategy to mitigation may not be appropriate. In line with this, the Canadian military has revised its approach to malaria risk assessment and preventive response. More effort is now spent on predictive modeling and, where risk is deemed to be low, chemoprophylaxis may not be recommended. We describe here an application of the revised methodology to the recent Canadian military deployment to Kandahar province, Afghanistan.
The principle problems of improving the work of ambulatory-and-polyclinic link in 2007 include the analysis of its efficiency, the development of measures to improve the medical service quality, the introduction of modern methods for patient investigation and treatment. Besides it is necessary to control the realization of rights of Army and Navy veterans as well as the members of their families and other person groups to be treated on favorable terms. The main efforts should be concentrated on the link "medical station--polyclinic--hospital" avoiding the repeated diagnostic investigation, exclusion of polypragmasy. It is reasonable to widen the system of day hospitals and to transfer the medical service gravity center from hospital to ambulatory-and-polyclinic stage.
