What is the value of screening for heart disease with an exercise stress test (EST) in an asymptomatic person?

There is insufficient evidence to recommend for or against an EST for screening asymptomatic individuals of any age. (Grade of Recommendation: C, based on case series.

The physical and mental health of a large military cohort: baseline functional health status of the Millennium Cohort

<p>Abstract</p> <p>Background:</p> <p>The US military is currently involved in large, lengthy, and complex combat operations around the world. Effective military operations require optimal health of deployed service members, and both mental and physical health can be affected by military operations.</p> <p>Methods:</p> <p>Baseline data were collected from 77,047 US service members during 2001–2003 as part of a large, longitudinal, population-based military health study (the Millennium Cohort Study). The authors calculated unadjusted, adjusted, and weighted means for the Medical Outcomes Study Short Form 36-item Survey for Veterans physical (PCS) and mental component summary (MCS) scores over a variety of demographic and military characteristics at baseline.</p> <p>Results:</p> <p>The unadjusted mean PCS and MCS scores for this study were 53.4 (95% confidence interval: 53.3–53.4) and 52.8 (95% confidence interval: 52.7–52.9). Average PCS and MCS scores were slightly more favorable in this military sample compared to those of the US general population of the same age and sex. Factors independently associated with more favorable health status included male gender, being married, higher educational attainment, higher military rank, and Air Force service. Combat specialists had similar health status compared to other military occupations. Having been deployed to Southwest Asia, Bosnia, or Kosovo between 1998 and 2000 was not associated with diminished health status.</p> <p>Conclusion:</p> <p>The baseline health status of this large population-based military cohort is better than that of the US general population of the same age and sex distribution over the same time period, especially in older age groups. Deployment experiences during the period of 1998–2001 were not associated with decreased health status. These data will serve as a useful reference for other military health studies and for future longitudinal analyses.</p

Stigma doesn’t discriminate: physical and mental health and stigma in Canadian military personnel and Canadian civilians

Abstract Background Illness-related stigma has been identified as an important public health concern. Past research suggests there is a disproportionate risk of mental-health stigma in the military, but this same finding has not yet been established for physical-health stigma. The current study aimed to assess the independent contribution of mental and physical health on both enacted stigma (discriminatory behaviour) and felt stigma (feelings of embarrassment) and to determine whether these associations were stronger for military personnel than civilians. Methods Data were obtained from the 2002 Canadian Community Health Survey - Mental Health and Well-being and its corresponding Canadian Forces Supplement. Logistic regressions were used to examine a potential interaction between population (military [N = 1900] versus civilian [N = 2960]), mental health, and physical health in predicting both enacted and felt stigma, with adjustments made for socio-demographic information, mental health characteristics, and disability. Results Mental health did not predict enacted or felt stigma as a main effect nor in an interaction. There was a strong link between physical health and enacted and felt stigma, where worse physical health was associated with an increased likelihood of experiencing both facets of stigma. The link between physical health and enacted stigma was significantly stronger for military personnel than for civilians. Conclusions Physical health stigma appears to be present for both civilians and military personnel, but more so for military personnel. Elements of military culture (e.g., the way care is sought, culture of toughness, strict fitness requirements) as well as the physical demands of the job could be potential predictors of group differences

The psychometric properties of the 10-item Kessler Psychological Distress Scale (K10) in Canadian military personnel.

The psychometric properties of the ten-item Kessler Psychological Distress scale (K10) have been extensively explored in civilian populations. However, documentation of its psychometric properties in military populations is limited, and there is no universally accepted cut-off score on the K10 to distinguish clinical vs. sub-clinical levels of distress. The objective of this study was to examine the psychometric properties of the K10 in Canadian Armed Forces personnel. Data on 6700 Regular Forces personnel were obtained from the 2013 Canadian Forces Mental Health Survey. The internal consistency and factor structure of the K10 (range, 0-40) were examined using confirmatory factor analysis (CFA). Receiver Operating Characteristic (ROC) analysis was used to select optimal cut-offs for the K10, using the presence/absence of any of four past-month disorders as the outcome (posttraumatic stress disorder, major depressive episode, generalized anxiety disorder, and panic disorder). Cronbach's alpha (0.88) indicated a high level of internal consistency of the K10. Results from CFA indicated that a single-factor 10-item construct had an acceptable overall fit: root mean square error of approximation (RMSEA) = 0.05; 90% confidence interval (CI):0.05-0.06, comparative fit index (CFI) = 0.99, Tucker-Lewis Index (TLI) = 0.99, weighted root mean square residual (WRMR) = 2.06. K10 scores were strongly associated with both the presence and recency of all four measured disorders. The area under the ROC curve was 0.92, demonstrating excellent predictive value for past-30-day disorders. A K10 score of 10 or greater was optimal for screening purposes (sensitivity = 86%; specificity = 83%), while a score of 17 or greater (sensitivity = 53%; specificity = 97%) was optimal for prevalence estimation of clinically significant psychological distress, in that it resulted in equal numbers of false positives and false negatives. Our results suggest that K10 scale has satisfactory psychometric properties for use as a measure of non-specific psychological distress in the military population

Sociodemographic and military characteristics.

<p>Sociodemographic and military characteristics.</p

Fit indices for confirmatory factor analyses.

<p>Fit indices for confirmatory factor analyses.</p

Model 2 for confirmatory factor analysis of K10 items.

<p>Note: Factor 1 = Anxiety; Factor 2 = Depression.</p