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DHA recognizes 25 years of AFHSB's health surveillance journal

Medical technicians wearing masks and entering information on a computer Georgia Army National Guardsman Pfc. Loran Jones, a combat medic with the Marietta-based 248th Medical Company, 265th Chemical Battalion, updates patient medical records at Wellstar Atlanta Medical Center in Atlanta, Ga. In May, the Georgia National Guard strategically deployed medical support teams to hospitals to augment medical staff. (Photo by Spc. Isaiah Matthews.)

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Armed Forces Health Surveillance Division | Medical Surveillance Monthly Report

This year, the Armed Forces Health Surveillance Branch (AFHSB) celebrated the 25th anniversary of its peer-reviewed journal, the Medical Surveillance Monthly Report (MSMR). The MSMR offers readers evidence-based estimates of the health-related conditions and trends prevalent among U.S. military members and their associated populations.

“MSMR surveillance information and the published explanations of such information facilitate military leaders’ understanding of the public health measures that help to preserve the health and readiness of our armed forces,” said Dr. Francis O’Donnell, MSMR editor. Established in 1995, the MSMR was created as a flagship publication and public health authority within the Army Medical Surveillance Activity (AMSA), the forerunner of the AFHSB, a part of the Public Health Directorate at the Defense Health Agency.

“The 25 years of reports in the MSMR have dealt with a myriad of illnesses, injuries, and health threats that have challenged our military members. The rich historical record preserved in MSMR archives helps in assessments of the military importance of current health threats and in the development of policies to prevent or mitigate their medical and military operational impacts,” said Dr. John Brundage former editor and co-founder of the report.

Many studies in the MSMR are based on summaries of medical administrative data that are routinely provided to AFHSB and integrated into the Defense Medical Surveillance System (DMSS) for health surveillance purposes. The DMSS is an active database of health-related information on service members who have served in the military since 1990. It contains billions of records including medical encounters such as hospitalizations, outpatient visits, immunizations, reportable medical events, health risk appraisals, and deployment health assessments; demographic characteristics; and military experiences like deployments, assignments, and casualty information.

According to Brundage, Dr. Mark Rubertone, chief of AFHSB’s Data Management & Technical Support section, played an essential role in the production of the MSMR from its inception. Rubertone led the collection and assembly of military health surveillance-related data (initially, in the AMSA and then the Defense Medical Surveillance System) in the 1990s that allowed for a new method of statistical and epidemiologic analyses by military health surveillance professionals. “There would not have been a MSMR without the vision, dedication, and relentless efforts of Doctor Mark Rubertone,” credits Brundage.

“It has been a real pleasure witnessing the MSMR’s evolution to a peer-reviewed journal.  My association with the MSMR remains one of the efforts I am most proud of during my service in the DoD," stated Rubertone, as he expressed congratulations to the current and past MSMR staff on 25 years of tireless, comprehensive health surveillance reporting. This point-of-view was strongly supported by Dr. Jose “Toti” Sanchez, deputy chief, AFHSB, who since his early days at the Walter Reed Army Institute of Research in the early 1990’s saw the potential and relevance of this publication in providing a unique military-relevant perspective to the major public health problems faced by the U.S. military.

The MSMR is published on a monthly basis and is available online only in a downloadable PDF format. To subscribe to the MSMR, visit https://health.mil/msmr.

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Age-Period-Cohort Analysis of Colorectal Cancer Service Members Aged 20-59 Years Active Component U.S. Armed Forces, 1997 – 2016

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7/24/2017
Among cancers affecting both men and women, colorectal cancer is the third most common cancer and the second leading cause of death from cancer in the U.S. This report documents the time-varying elements of age, period, and birth cohort effects in the epidemiology of colorectal cancer among members of the active component.

This report documents the time-varying elements of age, period, and birth cohort effects in the epidemiology of colorectal cancer among members of the active component.

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Heat Illness Prevention: Use the Buddy System to Stay Cool and Safe

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7/20/2017
Did you know that exposure to heat and heat-related illnesses can cause a spectrum of disorders that includes minor conditions such as heat cramps to the more severe condition known as heat stroke? To protect U.S. service members, it is important for commanders, small unit leaders, training cadre, and supporting medical personnel to encourage the use of the buddy system to prevent these conditions – especially during training at recruit centers and installations. The buddy system pairs service members to stay motivated and hold each other accountable of their physical limits during training exercises. Protecting Service Members from Heat Illness •	Do not exercise when sick. Intense workouts can increase susceptibility to illness, including infection and diarrhea. •	Dump heat by taking a cold shower or ice slush immersion before a workout. •	Wear a cooling vest to keep skin cool and dry in the heat. Learn more about heat illness prevention at Health.mil/AFHSB Stay cool. Stay hydrated. Stay informed. #BeatTheHeat Source: Dr. Francis G. O’Connor, a professor and chair of Military and Emergency Medicine and associate director for the Consortium on Health and Military Performance at the Uniformed Services University of the Health Sciences.

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Preventable and Treatable: Know the Signs of Heat Exhaustion

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7/20/2017
Warmer temperatures and strenuous physical activity put service members at higher risk of heat illnesses. It is important for commanders, small unit leaders, training cadre, and supporting medical personnel – particularly at recruit training centers and installations with large combat troop populations – to educate service members about the risks early signs and symptoms, and preventive treatment measures related to heat illnesses. Signs of Dehydration •	Light-headed/ Dizzy/ Headache •	Fever •	Lack of sweat •	Dark yellow urine •	Thirst Under the signs of dehydration section an image of a man experiencing these early signs and symptoms of heat illnesses. Staying Hydrated •	Hydrate with water and eat rich foods with water before, during, and after exercise. •	Decrease the intensity of the physical activity. Under the staying hydrated section graphics of a water bottle, glass of water, runner and cyclist appear. Signs of Heat Stroke •	Fatigue •	Combative •	Confused •	Muscle cramps Under the signs of heat stroke section, a man experiencing these symptoms of heat stroke displays. Effective Ways to Cool Off a Heat Stroke Victim •	Make an “ice burrito” by wrapping the victim in cold sheets, ice packs, and wet towels •	Immerse victim in cold water Images of ice and a man under a shower appear.  Ways to Treat Heat Exhaustion •	Use a rectal thermostat to read core body temperatures to diagnose and treat heat stroke •	Provide IV fluid replacement •	Spray with cool mist Image of rectal thermostat, man in a hospital bed with an IV and a man being sprayed with cool mist appear. Learn more about heat illness by reading MSMR Vol. 24 No. 3 – March 2017 at Health.mil/MSMR Source: Dr. Francis FG. O’Connor, a professor and chair of Military and Emergency Medicine and associate director for the Consortium on Health and Military Performance at the Uniformed Services University of the Health Sciences.

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Incidence of Escherichia Coli Intestinal Infections Active Component, U.S. Armed Forces, 2007 – 2016

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7/11/2017
Escherichia coli bacteria normally live in the lower intestines of healthy people and animals. Most varieties of E. coli are harmless, but certain types of E. coli are among the most frequent bacterial causes of diarrhea. This report summarizes the counts, rates, and trends of E. coli gastrointestinal infections in active component service members over the past 10 years. Findings: •	During 2007 – 2016, there were 290 incident cases of E. coli infection among active duty service members •	The overall incidence rate was 2.3 cases per 100,000 person-years (p-yrs) •	Annual incidence rates peaked at 4.7 cases per 100,000 p-yrs. in 2016 •	Cases were shown to peak during warmer months Overall rates were higher for: •	Persons aged 50 years or older •	Persons aged 25-29 years •	Females at twice the rate of males •	Non-Hispanic white service members •	Air Force members •	Service members in healthcare occupations Two graphs appear on infographic: One graph shows the annual numbers of incident cases and incidence rates of E. coli infection, active component, U.S. Armed Forces, 2007 – 2016. The second graph shows the cumulative number of incident cases of E. coli infection by calendar month, active component, U.S. Armed Forces, 2007 – 2016. Access the report in MSMR Vol. 24 No. 6 – June 2017 at Health.mil/MSMR

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Incidence of Nontyphoidal Salmonella Intestinal Infections Active Component, U.S. Armed Forces, 2007 – 2016

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The term nontyphoidal salmonellae (NTS) refers to gram-negative bacteria of the genus Salmonella except for the specific strains S. typhi and S. paratyphi. NTS are a leading cause of foodborne illness in the U.S. and of acute gastrointestinal illness among members of the active component of the U.S. Armed Forces. This report summarizes the counts, rates, and trends of nontyphoidal Salmonella infections in active component service members during a 10-year surveillance period. Findings  •	During 2007 – 2016, there were 1,536 incident cases of nontyphoidal Salmonella infection among active duty service members •	The overall incidence rate was 12.4 cases per 100,000 person-years (p-yrs) •	In 2016, the annual incidence rates peaked at 15.9 cases p-yrs •	Cases were shown to peak during the summer months Graph displays highlighting findings above for annual numbers of incident cases and incidence rates of nontyphoidal salmonellosis, active, component, U.S. Armed Forces, 2007 – 2016.  Overall rates were higher in: •	 Females •	Persons Aged 25-29 years •	Aged 50 years or older Access the report in the MSMR Vol. 24 No. 6 – June 2017 at Health.mil/MSMR

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Estimate of the Incidence of Norovirus Infections Active Component, U.S. Armed Forces, 2007 - 2016

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7/11/2017
The norovirus (NoV) is a highly infective and easily transmitted pathogen that imposes a significant public health burden across geographic regions as the causative pathogen for approximately 18% of all diarrhea cases worldwide. This report estimates the incidence of NoV diagnoses among active component service members during a 10-year surveillance period using medical record documentation of diagnoses of NoV infection and of positive laboratory tests for the virus. Findings During the 10-year surveillance period, there were 709 incident cases of NoV infection among active duty service members. •	The overall incidence rate was 5.7 cases per 100,000 person-years (p-yrs) •	Annual incidence rates ranged from a low of 2.5 cases per 100,000 p-yrs in 2008 to a high 11.2 cases per 100,000 p-yrs in 2010 •	Higher numbers of diagnosed cases were reported during November-March Graph depicting the above information displays. Overall rates were highest in: •	Female service members •	Persons Aged 24 years or younger •	Army members •	Junior enlisted •	Recruits Comparing the results of this analysis to modeled estimates of the underreported incidence of the NoV infections demonstrated the limited utility of using only medical encounter diagnoses, reportable events, and laboratory data to report on NoV incidence. Access the report in MSMR Vol. 24 No. 6 June 2017 at Health.mil/MSMR

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Surveillance Snapshot: Respiratory Infections Resulting in Hospitalizations, U.S. Air Force Recruits, October 2010 – February 2017

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6/19/2017
A number of vaccine and non-vaccine interventions have been used to reduce the historically high burden of respiratory infections during military training. This snapshot displays the trend in hospitalizations for respiratory infections, stratified by major pathogens, and associated hospital days for all recruits in U.S. Air Force Basic Military Training at Joint Base San Antonio Lackland, TX. Preventive measures: •	Hand Hygiene •	“Head-to-toe” sleeping arrangements •	Liberal use of respiratory face masks •	Isolation of febrile trainees •	Stringent gas mask cleaning protocol •	Universal provision of seasonal influenza vaccine during non-summer months Interventions: •	Year-round adenovirus vaccine (Ad4 and Ad7) was reintroduced November 2011 •	Group A streptococcus chemoprophylaxis transitioned from oral penicillin to intramuscular benzathine penicillin January 2012 Surveillance Findings: •	No recruits have been hospitalized due to adenovirus or group A streptococcus since the respective interventions were implemented. •	The adenovirus vaccine and benzathine penicillin chemoprophylaxis decrease the likelihood of severe respiratory disease outbreaks •	Downward trend in respiratory infection hospitalizations Bar graph shows the number of hospitalized for respiratory infection  per 1 million training days as well as lost training days per 1 million training days (line graph) from October 2010 to February 2017. Color coding on chart: •	Orange for Adenovirus •	Gray is for Group A streptococcus •	Yellow is for Influenza •	Blue is for Other/ Unknown •	Red is for Lost Training Days Learn more at Health.mil/MSMR where you can find the surveillance snap shot from MSMR Vol. 24 No. 4 – May 2017. In background of infographic can see human body highlight the respiratory system.

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Viral Hepatitis A, Active Component, U.S. Armed Forces, 2007 - 2016

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Hepatitis A is a liver infection caused by the hepatitis A virus (HAV). An estimated 1.4 million cases are reported worldwide each year. HAV is highly contagious and is a concern of the U.S. military as widespread outbreaks can occur due to contaminated food or water and spread by unsanitary food and water handling practices. This report estimates the frequencies, incidence rates, trends, and correlates of risk of hepatitis A among active component service members of the U.S. military during 2007 – 2016. Findings: During the 10-year surveillance period, there were 237 incident diagnoses of acute hepatitis A. The overall incidence rate was 1.88 cases per 100,000 person-years (p-yrs.). In 2012, rates peaked at 2.94 per 100,000 p-yrs. Rates dipped to 1.41 per 100,000 p-yrs. in 2015 and increased to 2.22 per 100,000 p-yrs in 2016. The graph shows the incident cases and incidence rates of acute Hepatitis A, by gender, active component, U.S. Armed Forces, 2007 – 2016. The bars on the graph show the number of individuals diagnosed and the lines show incidence rates per 100,000 p-yrs. See on page 3 FIGURE 1. Incident cases and incidence rates of acute hepatitis A, by gender, active component, U.S. Armed Forces, 2007–2016 of the  May 2017 MSMR Vol. 24 No. 5. Key chart includes: pink bar for number of female service members, blue bar for number of male service members, solid yellow line for incidence rate, and dash line for U.S. population rate. Source: www.cdc.gov/hepatitis/statistics/2014surveillance/index.htm#tabs-1170596-1  High Risks of Hepatitis A •	Youngest age group of service members •	Service members who work in healthcare occupations •	Air Force and Navy members •	Unknown race/ethnicity and non-Hispanic black service members HAV vaccines in current use are highly effective. Learn more at Health.mil/MSMRArchives  Small figure of male is seen on graphic with a circle highlighting his liver.

This infographic documents the frequencies, incidence rates, trends, and correlates of risk of hepatitis A among active component service members of the U.S. military during 2007-2016.

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Risk Factors for Tinea Pedis Infections (Athlete’s Foot) among U.S. Armed Forces

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6/19/2017
Athlete’s foot is a chronic fungal infection of the feet and toes that is common among military service members. Risk factors for infection include: •	High-intensity training •	Heavy sweating •	Protracted shoe/boot wearing •	Less frequent sock changes During field training exercises or deployment, service members may be exposed to additional risk factors for athlete’s foot including hot and humid ambient weather, poor skin hygiene, and close-quarter living. The condition’s most common clinical presentation is infection in the space between the toes. If left untreated this pattern of infection may cause… •	Softening and breaking down of skin resulting from prolonged exposure to moisture (maceration) •	Reddening of skin caused by congestion of the capillaries in the lower layers of the skin (erythema) •	Fissures of the skin These changes in the skin increase the risk of cellulitis, a serious bacterial infection of the skin capable of spreading to other parts of the body. Read this brief report “Tinea Pedis, Active Component, U.S. Armed Forces, 2000 – 2016,” which summarizes the impact of the condition among U.S. active component service members. Access the report in MSMR Vol. 24 No. 5 – May 2017 at Health.mil/MSMR.  Background graphic of the infographic is a pair of feet diagnosed with athlete’s foot but instead of showing breakage of skin we see the leg and foot of a military service member walking through water.

This infographic documents the risk factors for tinea pedis infections (athlete’s foot).

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Tinea Pedis (Athlete’s Foot) U.S. Armed Forces, 2000-2016

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6/19/2017
Athlete’s foot is a common problem among military service members. Known by the medical term, Tinea Pedis, the condition causes a chronic fungal infection of the feet and toes. It is the most common dermatophyte infection among adults. Up to 25% of the global population is affected by tinea pedis at any given time. Findings: During the 17-year surveillance period there were a total of 193,432 medical encounters for tinea pedis. Of these total encounters, 91% were ambulatory visits. Of 459 hospitalization records that contained diagnoses of athlete’s foot during the surveillance period, a total of 275 (59.9%) had a primary diagnosis of cellulitis or abscess of the foot or leg during the incident tinea pedis hospitalization. Where this information displays two feet are seen. The pie chart shows in an orange pie slice the 59.9% or 275 military service members that had a primary diagnosis of cellulitis or abscess of the foot or leg during the incident tinea pedis hospitalization. The rest of the pie chart shows in purple the 184 other hospitalization records. Background of the pie chart shows a foot.  High Risks for tinea pedis infections: •	Males – overall incident rate 17.4% higher than females •	Service members younger than 20 years of age •	Black, non-Hispanic and Hispanic service members •	Junior enlisted service members Given these costs, prevention efforts such as training and education about foot and skin health warrant continual emphasis, especially during initial entry training and in preparation for field exercises and deployments to warm locations. Learn more at Health.mil/MSMR Top of image shows foot with tinea pedis (athlete’s foot).

This infographic summarizes the counts, rates, trends and demographic characteristics of diagnoses of tinea pedis among U.S. active component service members during 2000 -2016.

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Healthcare Burdens Attributable to Various Mental Disorders, U.S. Armed Forces 2016

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5/25/2017
Did you know…? In 2016, mood disorders and substance abuse accounted for 25.9% of all hospital days. Together, four mental disorders – mood, substance abuse disorders, adjustment, and anxiety – and two maternal conditions – pregnancy complications and delivery – accounted for 53.6% of all hospital bed days. And 12.4% of all hospital bed days were attributable to injuries and poisonings. Here are the mental disorders that affected U.S. Armed Forces in 2016: Pie Chart titled Bed days for mental disorders in 2016: •	Mood Disorder (46,920 bed days) – the orange pie slice. •	Substance Abuse Disorders (44,746 bed days) – the blue pie slice. •	Adjustment Disorder (30,017 bed days) – the purple pie slice. •	Anxiety Disorder (20,458 bed days) – the gray pie slice. •	Psychotic Disorder (6,532 bed days) – the light blue pie slice. •	All other mental disorders (3,233 bed days) – the violet pie slice. •	Personality disorder (2,393 bed days) – the forest green pie slice. •	Somatoform (552 bed days) – the lime green pie slice. •	Tobacco dependence (2 bed days) – the white pie slice. Bar graph shows percentage and cumulative percentage distribution, burden “conditions” that accounted for the most hospital bed days, active component, U.S. Armed Forces 2016.  % of total bed days (bars) for mood disorder, substance abuse disorders, adjustment disorder, pregnancy complications; delivery; anxiety disorder; head/neck injuries, all other digestive diseases, other complications NOS; other back problems, all other signs and symptoms; leg injuries, all other maternal conditions; all other neurologic conditions; all other musculoskeletal diseases; all other skin diseases;  back and abdomen; appendicitis; all other infectious and parasitic diseases; all other cardiovascular diseases; all other mental disorders; all other respiratory diseases; arm/shoulder injuries; poisoning, drugs; foot/ankle injuries; other gastroenteritis and colitis; personality disorder; lower respiratory infections; all other genitourinary diseases; all other malignant neoplasms; cerebrovascular disease.  See more details on this bar graph in the Medical Surveillance Monthly Report (MSMR) April 2017 Vol. 24 No. 4 report, page 4. This annual summary for 2016 was based on the use of ICD-10 codes exclusively. Read more on this analysis at Health.mil/MSMR. #LetsTalkAboutIt Background of graphic is a soldier sitting on the floor in a dark room.

This infographic documents the mental disorders that affected U.S. Armed Forces in 2016.

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Erectile Dysfunction among Male Active Component Service members

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5/25/2017
Erectile dysfunction (ED) is defined as the persistent inability to achieve and sustain an erection that is adequate for sexual intercourse. ED can result from a problem with any of the above: •	Hormones •	Emotions •	Nerves •	Muscles •	Blood vessels These factors are required for an erection include. Picture is a brain (left) and a male figure (right) showing the heart and main arteries of the body. The top three most common ED diagnoses are: 1.	Psychosexual dysfunction 2.	Hypoactive sexual desire disorder 3.	Male orgasmic disorder Image shows a couple outside together during sunset. House displays in background. Causes of ED (Shows cut out of male body highlighting areas of the body where causes happen) •	Unrealistic sexual expectations •	Depression/ Anxiety/ Stress or other mental health issues •	High blood pressure •	Diabetes •	Obesity •	Injuries that affect the pelvic area or spinal cord •	Low testosterone •	Aging, Substance Abuse Demographics: •	Incidence rate of erectile dysfunction are higher among black, non-Hispanic servicemen when compared to other race/ethnicity groups. •	Black non-Hispanic service members have higher incidence rates of several conditions known to be risk factors for erectile dysfunction, including hypertension, obesity and diabetes. •	Separated, divorced and widowed servicemen had a higher incidence rate of ED than servicemen never married. •	Servicemen never deployed had the highest crude incidence rate of erectile dysfunction. Get the facts •	Erectile dysfunction is the most common sexual complaint reported by men to healthcare providers •	Among male service members nearly half of erectile dysfunction cases related predominantly or exclusively to psychological factors. •	Incidence rates of psychogenic erectile dysfunction are greater than organic erectile dysfunction for service members. •	Organic erectile dysfunction can result from physical factors such as obesity, smoking, diabetes, cardiovascular disease or medication use. •	Highest incidence rates were observed in those aged 60 years or older. •	Those 40 years or older are most commonly diagnosed with erectile dysfunction. Effective against erectile dysfunction •	Regular exercise  ( Shows soldier running) •	Psychological counseling (Shows two soldiers engaging in mental health counseling. They are seating on a couch).  •	Quit smoking ( shows lit cigarette)  •	Stop substance abuse ( Shows to shot glasses filled with alcohol) •	Nutritional supplements ( Shows open pill bottle of supplements) •	Surgical treatment ( Shows surgical instruments) Talk to your partner Although Erectile Dysfunction (ED) is a difficult issue for sex partners to discuss, talking openly can often be the best way to resolve stress and discover underlying causes. If you are experiencing erectile dysfunction, explore treatment options with your doctor. Learn more about ED by reading ‘Erectile Dysfunction Among Male Active Component Service Members, U.S. Armed Forces, 2004 – 2013.’ Medical Surveillance Monthly Report (MSMR) Vol. 21 No. 9 – September 2014 at www.Health.mil/MSMRArchives. Follow us on Twitter at AFHSBPAGE. #MensHealth

Erectile dysfunction (ED) is defined as the persistent inability to achieve and sustain an erection that is adequate for sexual intercourse. This infographic provides details on the ways ED impacts male active component services members of the U.S. Armed Forces.

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Medical encounters, by condition, U.S. Armed Forces 2016

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5/25/2017
This infographic documents the three burden of disease related conditions that accounted for the most medical encounters among the active component of the U.S. Armed Forces in 2016. LONG FORM: In 2016, the three burden of disease related conditions accounted for the most medical encounters were: •	Other back problems •	All other musculoskeletal diseases •	Knee injuries Altogether they accounted for 25.1% of all illness-and injury-related medical encounters overall. More Findings The top nine conditions that accounted for the most medical encounters accounted for 53.1% of all illness-and-injury –related medical encounters overall. In general, the conditions that accounted for the most medical encounters were predominantly musculoskeletal disorders such as the back) injuries to the knee, arm, shoulder, foot or ankle, and mental disorders like anxiety and adjustment conditions. View more findings at www.Health.mil/MSMR    Graphic details This graphic displays the musculoskeletal of a male service member’s body to show the bones of the back and knees.

This infographic documents the three burden of disease related conditions that accounted for the most medical encounters among the active component of the U.S. Armed Forces in 2016.

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Accidental Drownings Among U.S. Service Members

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5/25/2017
Military members are at risk for unintentional drownings during training, occupational activities and off-duty recreation. Increase your awareness today to lower your risks: Drowning prevention: Water-related recreational activities in or near water can be potentially dangerous – particularly for non-swimmers and weak swimmers – in hazardous conditions and settings (e.g., storms, currents, riptides), and when safety measures are not observed. Military members are at risk for unintentional drownings during training, occupational activities and off-duty recreation. Here are four ways you can prevent unintentional drowning: •	Wear life jackets. •	Take swim lessons to become a stronger swimmer. •	Swim with a buddy; never swim alone. •	Be knowledgeable of water environments you are in. Increase your awareness and lower your risks by reading the Medical Surveillance Monthly Report (MSMR) Vol. 22 No. 6 – June 2015 report “Update: Accidental drownings, active component, U.S. Armed Forces, 2005 – 2014 at www.Health.mil/MSMR  #SwimSafe Follow us on Twitter for more information at AFHSBPAGE. Also check out hashtag #SwimSafe. Source: Defense Health Agency, Armed Forces Health Surveillance Branch. Graphic shows: •	Man swimming in pool •	Mom with three children swimming in pool. •	Woman swimming in pool

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Absolute and Relative Morbidity Burdens Attributable to various illnesses and injuries: Non-service member beneficiaries of the Military Health System, 2016

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5/18/2017
Individuals who are eligible for care through the Military Health System (MHS) are known as beneficiaries. MHS beneficiaries include family members of active component service members, the National Guard and Reserve service members, retirees and eligible family members of retirees. In 2016, there were approximately 9.4 million beneficiaries eligible for health care in the MHS. Findings: •	In 2016, a total of 6,589,843 non-service member beneficiaries of the MHS had 86,486,080 medical encounters. •	On average, each individual who accessed care from the MHS had 13.1 medical encounters over the course of the year. •	The top three morbidity-related categories accounted for 34.5% of all medical encounters. Top Three Morbidity-Related Categories Pie Chart •	Injuries and poisonings (10.5%) – pie slice shown in the color of lavender.  •	Signs, symptoms, and ill-defined conditions (11.9%) – pie slice shown in green. •	Musculoskeletal diseases (12.2%) - pie slice shown in dark blue. •	Orange of pie chart indicates the other morbidity related categories (make up approximately 65.4% of the pie chart). Signs, symptoms, and ill-defined conditions, injuries and poisonings, and disorders of the sense organs were the illness/injury categories that affected the most individuals (44.9%, 34.7%, and 30.3% of all beneficiaries who received any care, respectively). Learn more at Health.mil/MSMR Other images seen on graphic:  Father and baby daughter at medical appointment with a family doctor from the MHS.

Individuals who are eligible for care through the Military Health System (MHS) are known as MHS beneficiaries. This graphic provides information on the absolute and relative morbidity burdens attributable to various illnesses and injuries among non-service member beneficiaries of the MHS in 2016.

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Armed Forces Health Surveillance Division
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