Introduction
The question under analysis is air quality in military homes and how this can be a health issue. The study will attempt to reveal some of the solutions that could reduce military personnel susceptibility to asthma or upper respiratory conditions as a result of the air quality issues in their environments.
PICO format of the question
The PICO question being addressed is: “What can be done to reduce respiratory infections among persons living in military housing?” the latter problem can be summarized as follows
Problem – respiratory infections in the military
Interventions – effective use of vaccines
Comparison_ use of personal hygiene and air quality control measures
Outcomes _ reduced occurrence of respiratory infections
Patient problem
The major patient problem is respiratory infections among military personnel. This population has reported higher prevalence of respiratory infections than the civilian population. There is a need to examine why this is happening and what can be done about it.
The National institute of Environmental Health Science (NIEHS) discussed how long term exposure to air pollutants can increase the risk of respiratory diseases such as lung cancer, chronic pulmonary disease, allergies and asthma. This article brings out the fact that certain populations are highly susceptible to fine particles, air bone toxicants and ozone. One can therefore assert that poor air quality in any population is a health hazard as is the case with the military. (Jefferson et al, 2007)
NIEHS carried out a study among six Cities within the United States. In their research, they found that cardiovascular diseases and pulmonary infections were common among people living in polluted cities. These individuals also reported higher cases of hospitalization and they also ended up recording lower life expectations. The latter research was important in highlighting some of the benefits of living in clean air quality conditions. For instance, it was explained that curbing air pollution can save as much as two hundred post neonatal mortalities in one federal state. Also, it has been put forward that there can be forty thousand fewer cases of respiratory illnesses can be reported if air pollutants are dealt with adequately.
WHO explained a number of issues about chronic respiratory diseases? The latter organization was explaining some of the risk factors that can put one at risk of getting a chronic health disease (examples here include asthma, respiratory allergies, chronic obstructive pulmonary disease, pulmonary hypertension and occupational ling diseases). Tobacco smoking is top on the list, indoor and outdoor pollution was second and third on the risk factor list. Additionally, there allergies could also put one at risk and so could one’s vulnerability risks or occupational risks. In this regard, military personnel fall within the occupational risk category and therefore deserve special attention. (Jefferson et al, 2007)
WHO have shown that there is a global epidemic of chronic disease and that so much can be done to eliminate such a situation? There are close to a million cases of respiratory diseases that have been reported as of 2008. Three hundred million people suffer from asthma while two hundred and ten million suffer from chronic obstructive pulmonary disease.
Environmental and Workplace health explain the patient problem that members of the military are susceptible to when there are no interventions being made in this regard. In this regard, different individuals may be subjected to different air pollutants. Sometimes, it may be a s result of the extent to which one is exposed to pollutants or their genetics and health status. The military qualifies as one of the members in this regard because if they do not carry out their specific changes, then chances are that some physiological or biochemical changes may occur as a result. In this case, it should be noted that these changes may include;
· Wheezing
· Coughing
· Cardiac conditions
· Existing respiratory cases
These effects may cause a need for medication, emergency room visits and hospital admissions.
In the latter article, it has been asserted that heart and lung diseases can be exacerbated by increased levels of air pollution. For instance, hospital admissions can be heightened. Mortality rates may go up, asthma symptom days are also worth considering and so are acute respiratory symptoms and restricted activity days for the affected individuals.
The military needs special emphasis because most of the personnel working for the latter institution have reported high levels of respiratory infections and the kind of issues that thy must deal with are related to these. (Chmielewicz et al, 2005)
Acute respiratory infections are particularly common among the military because there are living in quarters that are quite crowded. Usually, military families may be found in some of their facilities. Also, actual members of the military may be living in dormitory like conditions. On top of that, it is often common to find that members of the military may be living in tents when operating in distant locations. Besides this, training centers and deployment areas are all common because of the crowded conditions.
Consequently, it can be asserted that there are certain opportunities for these infections to be transmitted. For instance, in training classrooms, these pathogens may be transmitted. Also, the dining facilities and other food related items are often shared. This can provide a lot of opportunities for infection. On top of that, members of the military frequently come into close contact with one another and they tend to be subjected to these populations.
Besides this, it has also been shown that there are certain members of the military that are more susceptible to respiratory infections than others. Seasoned soldiers tend to report lower levels of these conditions than newer recruits. The reason behind this assertion is that the new recruits normally emanate from different parts of the country. Consequently, most of them may become highly susceptible since they have to come in close contact with these different members.
Intervention
The main intervention strategy for this study is the use of vaccines. The best way of ensuring effectiveness of such vaccines will be examined in the research.
WHO assert that some of the ways to deal with these challenges is by instating better surveillance procedures that could analyze the magnitude of chronic respiratory diseases among populations that may be particularly vulnerable as is the case with the military? On top of that, it is important to asses the level of exposure to risk factors among certain populations and deal with these levels of exposure through adequate vaccination. (Chmielewicz et al, 2005)
Recent trials have shown that the use of vaccines can be an effective way of curbing this disease. This can only be implemented if the required cultures are available. Additionally, more than one vaccine ought to be combined in order to prevent these situations. However, this intervention strategy has been chosen owing to the fact that the effectiveness of these vaccines has been questions by a number of experts. There is a need to examine why they are not very effective and an establishment of the best way to administer this intervention strategy should be sought.
Comparison
Some of the alternative interventions that have been identified in various studies include
· Personal protection
· Hygiene
· Barriers
· Social distancing
· Quarantine
· Isolation
Non vaccine alternatives have been tried for decades. These interventions can range from simple mechanisms such as restricting the number of soldiers living within a tent. In other instances, it is possible to prevent respiratory conditions through institution of engineering controls. Additionally, the manner in which barracks have been laid out can play a crucial role in curbing these diseases. Also, military personnel can be reminded about coughing etiquette so as to minimize the spread of air pathogens. This also means that other related methods such as respiratory masks may also work for these respective groups. (Chmielewicz et al, 2005)
Epidemiological evidence shows that washing hands can go a long way in preventing respiratory diseases within community settings. This can be achieved through antiseptics that come in the form of gels, hand rubs, pre-moistened novelettes and foams. The Centre for Disease Control asserts that alcohol based hand rubs can go long way in preventing the spread of bacteria and viruses that lead to respiratory infections. The latter may be used as a supplement for traditional hand washing or in cases where hands posses certain visible dirt.
Outcomes
Some of the outcomes that can be measured include; admissions to hospitals -If the number of military patients admitted for respiratory infections reduces, then chances are that there may be less attendance. Also, it is likely that the overall numbers of respiratory infections among these target groups may be substantially reduced. Lastly, it is likely that those who fall ill may report less severity. Also, the study may also be useful in reducing other measures of burden related to respiratory illnesses brought on to the state.
Search for related articles to the PICO format
It has been known that the search for articles at Medline for ‘respiratory diseases’ produced one hundred and thirty articles. A narrower search on “respiratory disease in the military” found approximately twenty one articles. The first ten articles were chosen because they contained studies that directly related to the question compared to all others. The first one by Gray el (1999) was a study on emerging respiratory disease agents, loss of vaccines and increased antibiotic resistance and how these threatened the occurrence of respiratory diseases among military personnel. The latter study dwelt on six pathogens that were most prevalent among military personnel. Additionally, the impact of these pathogens among the concerned population was also analyzed. A thorough analysis of previous attempts to manage the diseases was also done and treatment and surveillance strategies were also done with an identification of the limitations in vaccine and diagnostic testing being done. This article was found in the following website http://www.ncbi.nlm.nih.gov/pubmed/10341174
The search of articles in the CINAHL database entailed all journals between 1990 to the year 2006. This search resulted in fifty three major items. No language restrictions were applied to this study. Additionally, design filters of the cross over studies, cohort and trials before and after the time series were also done in order to ensure that adequate information was covered. An analysis of the items for all relevant studies was done in order to ensure that the study conformed to what was being analyzed. The article chosen from this database was one written by McNeill, K. et al (1999) entitled “Large, persistent epidemic of adenovirus type 4 associated acute respiratory disease in US Army trainees; Emerge Infect Dis 798-80. This article can be found on the following website; http://infectious-diseases.jwatch.org/cgi/content/full/2000/201/7.
The latter study had been conducted in a military training centre in South Carolina known as Fort Jackson. It was a case controlled study intending on assessing the impact of vaccinations on military personnel. The authors dealt with Adenovirus 4 and they dealt with one thousand and eighteen patients; military trainees that had been hospitalized. Sixty percent of these trainees were adenovirus positive at the beginning of the research when adenovirus vaccines had just been interrupted. Afterwards, a vaccination process was enacted in the centre and it was found that these cases rapidly diminished i.e. only twenty two percent of the trainees were hospitalized as a result of the respiratory infections thus indicating that vaccines can be an effective way of curbing respiratory infections is administration is not interrupted.
In the Google Scholar Database, the search for “respiratory infections” revealed ninety three search results. The search was further narrowed down to respiratory infections in the military; this yielded thirty three of these. The search as further narrowed down to the kind of research processes being done. For instance, if cohorts before and after the design were not done adequately, then that article was not considered. On top of that, possible interventions had to have been identified in the articles of choice. Most studies that were den involved children and the elderly in terms of respiratory infections. Also, greater precedence was given to those studies in which compliance to intervention strategies were done. For instance, if an intervention strategy like the use of iodine to maintain personal hand hygiene was used, then such researches were disregarded because iodine stains the participants and it is unlikely that the participants would adhere to these kinds of interventions. The article chosen for this study was one conducted by Dudding et al (1973): respiratory Disease in military trainees; American Journal of Epidemiology. The website chosen for this study was http://www.aje.oxfordjournals.org/cgi/content/abstract/97/3/187
These authors conducted a comprehensive study on available data about military respiratory infections. The population studies were military personnel within the United States/. Particular attention was given to recruit sites owing to the fact that the latter personnel are more susceptible to the infections compared to long standing members. Additionally, referral medical centers were also chosen as a source of the population of interest since they were in a position to detect any unusual patterns in the detection of these strains.
Selection of 2 articles and reasons for choosing those articles
The first article that was selected is one written by Gray et al (1999) known as “Respiratory Diseases Among US Military Personnel: Countering Emerging Threats”. This article specifically addressed the subject matter because it was a study done among the population of interest i.e. the military and military families. Additionally, this article candidly connected the respiratory diseases to the population under consideration. Consequently, it is in a position to offer sound outcomes and interventions.
Grey et al (1999) explain that thirty percent of the infectious disease hospitalizations occurring within the military are as a result of respiratory infections. They claim that most of these cases are brought on by the air quality issues in military environments. For instance, it is common to find them living in crowded living conditions. Additionally, their work environment is rather stressful and these staff members are highly exposed to respiratory pathogens. The latter assertions can be validated by examining the statistics on new trainees within the military. It has been shown that four out five recruits are susceptible to respiratory infections and that twenty percent of these individuals have to seek medical attention.
However, the military has come a long way in terms of controlling respiratory infections. However, statistics still show that the prevalence of these conditions is much more in the military than in civilian populations. This assertion is especially true because adenovirus vaccines have been lost. New respiratory pathogens keep emerging and the susceptibility of pathogens to drugs is also reducing.
The latter study was secondary research owing to the fact that no specific measures were done first hand. This was advantageous in that a comparison of all available data could be done a reasonable conclusion drawn form them. The interventions suggested in this journal article include accurate laboratory diagnosis of the disease, institution of early warning system that would assist in detection of any changes within the population of interest. Additionally, there was a need to shift from the current approach to treatment of military respiratory infections since the current approach is empirically based i.e. use of penicillin and microcline is quite common. Also, a global surveillance system needs to be established in which training and education should be directed towards areas that report such high levels of infection. Additionally, all military training camps and special facilities need to have special surveillance programs that will assist on detection of adenovirus S., influenza, pyroxenes and pneumonia. (Grey et al, 1999)
The results found in this study revealed that military personnel entering the force often receive adenovirus 4 & 7 vaccines when entering service. Additionally, they normally undergo mass chemoprophylaxis to prevent respiratory disease or to control epidemics- special emphasis is normally given to S. pyroxenes infections. Also, annual influenza vaccines and periodic tuberculosis screening are also done. However, the study also found that most military barracks may not be in apposition to control respiratory diseases owing to the fact that no culture was available for influenza, adenovirus and Bordetella pertussis. Also, the research revealed that rapid diagnostic tests were still needed for the following;
-streptococcus pneumonia
-influenza, adenovirus
-bordetella pertussis
Also, it was asserted that vaccines for the following were urgently needed
-streptoccus pyogenes
-mycoplasma pneumoniae
-bordetella pertussis
The latter study is quite relevant to the PICO question because it revolved around the study population. Interventions suggested in the research are vaccine related. Other alternatives include the utilization of early detection systems. The outcomes revealed in this research entail the use of more vaccines in crowded military areas compared to the civilian population.
The second article chosen for the analysis was one written by Dudding et al (1973). This study was a quantitative study conducted among military trainees to determine the level of effectiveness of the Adenovirus Surveillance Program. This was a program that had been initiated among basic combatant trainees operating at that time. The setting was such that all the posts considered were supposed to be report on a weekly basis about the progress of their training units and the number of hospitalizations that were carried out with regard o the ARD program. It should be noted that the major aim of the program was to analyze the effectiveness of the Adv 4 vaccine in the latter populations.
The study found that the use of one vaccine for controlling ARD was not very effective; in this case adv 4 and adv 7 were utilized. However, it was found that when two vaccines were combined, then chances of success were much higher. This was seen by reports of ARD before and after administration of the vaccines. The latter results were found to be true in all the recruitment posts used in the study. (Duding et al, 1973)
The latter artc8le was chosen because it involved the population under study. It also dealt with a respiratory infection and examined intervention strategies that would be most applicable for this program. On top of that, this study is important in validating the fact that respiratory infections are high in the military population and was also important in showing the most effective ways of dealing with them.
Conclusion
Past strategies on the use of vaccines t curb respiratory interventions in military environments have not been very effective because they have been used in isolation. Instead, greater emphasis should be given to a combination of these methodologies. For instance, related vaccines need to be utilized. On top of that, preventive strategies need to be adopted. Education and training among medical personnel working in the military. This can go a long way in ensuring that cultures are made available and that vaccines are done effectively.
If carried out effectively, then this can go a long way in eliminating some of the challenges facing the military today. It should also be noted that some of these strategies can also be combined with non vaccine interventions. Military personnel may be sensitized on how to curb occurrences of the problem with special emphasis being given to recruits versus the more seasoned soldier.
