Magnitude, distribution, risk factors and care-seeking behaviour of acute, self-reported gastrointestinal illness among US Army Soldiers: 2015
Magnitude, distribution, risk factors and care-seeking behaviour of acute, self-reported gastrointestinal illness among US Army Soldiers: 2015
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DOI：
10.1017/s0950268818003187
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发表时间：
2019-01-01
影响因子：
4.2
通讯作者：
Hyatt, D. R.
中科院分区：
文献类型：
--
作者：
Mullaney, S. B.;Rao, S.;Hyatt, D. R.
纵观历史，急性胃肠道疾病（AGI）一直是美国军人发病和死亡的一个重要原因。我们使用基于网络的调查估计了现役美国陆军军人中 AGI 的程度、分布、风险因素和就医行为。调查询问了社会人口特征、就餐和食品采购历史以及过去 30 天内是否有腹泻经历。如果受访者报告腹泻，则会询问有关并发症状、患病持续时间、寻求医疗护理和粪便样本提交的其他问题。使用单变量和多变量逻辑回归来确定与 AGI 相关的因素以及与寻求护理和提交粪便样本相关的因素。 AGI 30 天患病率为 18.5%（95% CI 16.66-20.25），发病率为每人年 2.24 次 AGI 发作（95% CI 2.04-2.49）。风险因素包括居住地区、在餐饮设施就餐以及在其他岗位场所就餐。患有 AGI 的个人缺勤 2.7-3.7 天，这导致工资损失约为 847 451 629 美元。结果表明，美国陆军士兵每年有超过 100 万例 AGI 病例，这会对战备状态产生重大影响。我们发现美国陆军服役人员的 AGI 寻求护理行为与一般人群不同。患有 AGI 的陆军军人报告称，寻求护理和提交粪便样本的频率较低，特别是对于严重（血性）腹泻。与寻求护理相关的因素包括等级、出现呼吸道症状（喉咙痛、咳嗽）、出现呕吐以及因病缺勤。与提交粪便样本相关的因素包括 24 小时内出现超过 5 次稀便并且没有出现呼吸道症状。美国陆军基于实验室的监测低估了患有血性和非血性腹泻的军人。据我们所知，这是第一项评估陆军成员中 AGI 的程度、分布、风险因素和就医行为的研究。我们确定陆军军人的求医行为、AGI 风险因素和粪便样本提交率与一般人群不同，因此在使用 Scallan 等人的方法估计由特定食源性病原体引起的 AGI 负担时。 （2011），必须对这部分人口使用独特的乘数。该研究不仅证明了 AGI 在现役陆军中的重要性，还强调了公共卫生领导者有机会采取简单的策略来更好地捕捉 AGI 的影响，从而可以实施更现代的干预策略来减轻负担并间接提高整个企业的作战准备情况。
UThroughout history, acute gastrointestinal illness (AGI) has been a significant cause of morbidity and mortality among US service members. We estimated the magnitude, distribution, risk factors and care seeking behaviour of AGI among the active duty US Army service members using a web-based survey. The survey asked about sociodemographic characteristics, dining and food procurement history and any experience of diarrhoea in the past 30 days. If respondents reported diarrhoea, additional questions about concurrent symptoms, duration of illness, medical care seeking and stool sample submission were asked. Univariable and multivariable logistic regression were used to identify the factors associated with AGI and factors associated with seeking care and submitting a stool sample. The 30-day prevalence of AGI was 18.5% (95% CI 16.66-20.25), the incidence rate was 2.24 AGI episodes per person-year (95% CI 2.04-2.49). Risk factors included a region of residence, eating at the dining facility and eating at other on-post establishments. Individuals with AGI missed 2.7-3.7 days of work, which costs approximately $ 847 451 629 in paid wages. Results indicate there are more than 1 million cases of AGI per year among US Army Soldiers, which can have a major impact on readiness. We found that care-seeking behaviours for AGI are different among US Army Service Members than the general population. Army Service Members with AGI report seeking care and having a stool sample submitted less often, especially for severe (bloody) diarrhoea. Factors associated with seeking care included rank, experiencing respiratory symptoms (sore throat, cough), experiencing vomiting and missing work for their illness. Factors associated with submitting a stool sample including experiencing more than five loose stools in 24 h and not experiencing respiratory symptoms. US Army laboratory-based surveillance underestimates service members with both bloody and non-bloody diarrhoea. To our knowledge, this is the first study to estimate the magnitude, distribution, risk factors and care-seeking behaviour of AGI among Army members. We determined Army service members care-seeking behaviours, AGI risk factors and stool sample submission rates are different than the general population, so when estimating burden of AGI caused by specific foodborne pathogens using methods like Scallan et al. (2011), unique multipliers must be used for this subset of the population. The study legitimises not only the importance of AGI in the active duty Army population but also highlights opportunities for public health leaders to engage in simple strategies to better capture AGI impact so more modern intervention strategies can be implemented to reduce burden and indirectly improve operational readiness across the Enterprise.