Letters to the editor

Military Medicine, Apr 2002 by Mazokopakis, Elias E

Dear Editor,

We read with interest the paper of Balcom and Moore, which was published in a recent issue of Military Medicine.1 In this study the authors have described the epidemiology of musculoskeletal and soft tissue injuries occurring to crew members aboard a U.S. Naval ship during a 90-day period. A prospective study, with the aim to determine the most common medical problems faced by naval medical officers, and the assessment of the health needs of the military personnel, was carried out on a warship of the Greek Armed Forces, which covered a 6-month period. The assessment of incidence, diagnoses, and associated causes of injuries among naval personnel was of particular concern.

Our study population included the warship's military personnel (285 males), aged between 19-38 years (mean age: 24.4 /- 4.4 years). Data on injuries was recorded on a structured form, which included socio-demographic data, health risk behaviors, medical history, clinical findings and diagnoses, and was recorded during the visits of the personnel to the sick-bay.

Diagnoses of injuries were classified according to International Classification of Diseases, Ninth Revision [ICD-9 codes 800 through 959].2 Injuries were categorized as onboard or ashore and occurring to officers (naval, warrant and petty officers) or conscripts (seamen, petty officers 1st and 3rd class). The mental health status of the warship personnel was also recorded using the 28-items Greek version of the General Health Questionnaire (GHQ-28).3

There was a total incidence of 1.58 injuries per 100 man--months, much lower in comparison with that of the U.S. study. Although, based on our study's findings, it is unclear as to which reasons could explain the observed differences.

The majority of injuries occurred on board (92.6 %), and the most frequent diagnoses were: sprains and muscle strains (ICD-9 / code 845, 32%), raw wounds (ICD-9 / codes 873 and 883, 36%), and burns (ICD-9 / codes 943 and 945, 32%). The most common causes for these injuries were: the use of machinery, tools and appliances (56%), followed by the lurching of the ship (28%), and ladders (16%). The majority of injured subjects were conscripts (73.9%) with a medium (unfinished or completed secondary education) educational level (78.3%) and GHQ-28 cases (60.990. The overall number of limited duty days as a result of these injuries was 46 days.

7.4% of the overall injuries occurred ashore (as a result of road accidents) to conscripts off duty, and the types of injuries were fractures (ICD-9 codes 823 and 824). The overall number of fractures caused a total of 193 days of sick leave.

In conclusion, although injuries occurring ashore were less frequent than injuries onboard, they contributed disproportionately to lost duty time. Potential factors associated with injuries in the study population (as demands of military life, level of knowledge and past experience of conscripts on assigned duties, mental health status, et al.), require further research. The development of a surveillance system could provide more accurate epidemiological data on injuries and it is expected to lead to the formulation of some measures of prevention in this setting.

References

1. Balcom TA, Moore JL: Epidemiology of musculoskeletal and soft tissue injuries aboard a U.S. Navy ship. Mil Med 165:921-924, 2000

2. Manual of the international statistical classification of diseases, injuries, and causes of death. Vol. 1. Geneva: Word Health Organization, 1977

3. Garyphallos G, Karastergiou A, Adamopoulou A, Moutzoukis C, Alagiozidou E, Mala D, Garyfallos A: Greek version of the General Health Questionnaire: accuracy of translation and validity. Acta Psychiatr Scand 84:371-378, 1991

Lieutenant J.G. (M.C.) Elias E. Mazokopakis H.N. Clinic of General Internal Medicine, University General Hospital Heraklion Crete P.O. Box 1352 Voutes, Heraklion Crete, Greece February 22, 2002