Operational Medicine 2001
Standard First Aid Course
NAVEDTRA 13119

Health Education

In the Navy, health education is defined as "the process that informs, motivates, and helps people adapt and maintain healthful practices and life styles."

Specifically, the goals of this process are:

1. To assist individuals to acquire knowledge and skills that will promote their ability to care for themselves more adequately.

2. To influence individual attitudinal chances from a disease to a health orientation.

3. To support behavioral chances to the extent that individuals are willing and able to maintain their health.

Through good habits of cleanliness, regular exercise, and good nutrition you have control over your well-being. Good health is no accident, it comes with conscious effort and good health habits.

Personal Hygiene

Because of the close living quarters in the Navy, particularly aboard ship, personal hygiene is of major importance. Disease can spread and rapidly affect an entire compartment or division. Personal hygiene promotes health and prevents disease. Some military personnel tend to be lax in paying attention to their personal hygiene. Uncleanliness or disagreeable odors will affect the morale of your shipmates. A daily bath or shower will assist in the prevention of body odor and is absolutely necessary to maintain cleanliness. Shampoo the hair at least once a week using a commercial shampoo. Always wash your hands with soap and water after using the toilet and before eating. Proper foot care is a vital factor in the overall performance of personnel, both ashore and afloat. Clean and dry your feet regularly, especially between the toes; use foot powder to prevent chafing and to promote absorption; change socks and shoes regularly, especially in wet environments; and have foot problems medically evaluated and treated promptly. Proper exercise increases the body's resistance to certain diseases, promotes digestive and excretory function, and decreases your risk for atherosclerotic heart disease. Smoking and overindulgence in food and drink are detrimental and defeat the purpose of exercise. Proper nutrition is essential to supplying the body with all the elements it needs to function. Energy for activity and proteins, minerals, and vitamins for growth are all supplied by a proper diet. Proper sleep recharges nervous energy, repairs damaged cells, and regains the body's bounce. It is important to sleep undisturbed at regular hours and long enough to awaken refreshed. Continued physical and mental fatigue is detrimental to the maintenance of good health.

Dental Hygiene

Dental plaque is described as a soft deposit that consists of bacteria and bacterial products. Plaque utilizes the nutrients from food for growth, the most common is sugar. For this reason, nutrition plays an important part in preventive dentistry. Plaque must be removed from the oral structures. All plaque removal can be controlled by the individual. There is no one right method of plaque control. A toothbrush should conform to the need in size, shape and texture. It must be easily and efficiently manipulated with safety, easy to clean, and be durable. When you are finished brushing your teeth, brush the tongue and palate (roof of your mouth). The surface of the tongue is an ideal location for bacterial plaque and food debris to collect. Flossing is an effective and efficient way to remove plaque from the surface of the tooth.

1. Obtain a 12- to 24-inch piece of floss.

2. Stretch the floss tightly between the thumb and forefinger of both hands.

3. Pass the floss gently through each contact point with a gentle sawing motion.

4. Wrap the floss around the surface of one tooth, at the base.

5. Move the floss firmly along the tooth gently up and down. Repeat this stroke five or six times.

6. Continue procedures throughout the entire mouth.

Oral irrigators (water pics) clean by directing a stream of water between and around the teeth. Irrigators are especially useful for removing loose debris from areas that cannot be cleaned with a toothbrush. Oral irrigators remove only a small amount of plaque from the tooth surfaces. Mouthwashes are pleasant to use and make the mouth feel clean. Although some contain fluoride, there is no evidence that mouthwash alone can maintain good oral hygiene.

Health and Fitness

It is estimated that 50 percent of all deaths and illnesses in the United States directly relate to unhealthy lifestyle habits; primarily poor diet, lack of exercise, alcohol abuse, smoking, and unmanaged stress. Additional risks to good health and optimal productivity result from undiagnosed or inadequately controlled high blood pressure and significant incidence of low back injuries. Preventive maintenance principles and positive lifestyle changes can substantially reduce these threats to the health of the force.

Nutrition

Nutrition is a scientific term applied to the process by which food is taken into the body to produce energy for activity, rebuild body tissue, and assist in regulating body functions. To meet these needs, it is required that an individual's diet contain a proper balance from the Food Guide Pyramid.

1. Grain Group (for fiber) - Furnishes significant amounts of protein, iron, and many of the B vitamins. Also included are carbohydrates that provide a quick energy source and supply the body with roughage. Foods of this group include all breads and cereals that are whole grained, restored, or enriched. Additionally, the group includes foods such as rice, oats, cooked cereals, and the pasta group.

2. Meat Group (for iron) - Provides a major source of protein, iron, and the B-complex vitamins. Foods in this group include beef, veal, lamb, pork, and the organ nutrients such as liver and kidney. Fish, poultry, and eggs are also included. Foods such as beans, peas, and nuts are alternative sources of protein.

3. Milk Group (for calcium) - Supplies the body with calcium, some high-quality protein, and vitamins A and riboflavin. Foods in this group include whole, evaporated, skim, and dry milk, buttermilk, ice cream, yogurt, and a variety of cheeses.

4. Vegetable Group (for vitamin A) - Provides a major source of vitamin A and minerals. Foods in this group include vegetable juice, raw and cooked vegetables, raw leafy vegetables, and potatoes.

5. Fruit Group (for vitamin C) - Provides a major source of vitamin C and minerals. Foods in this group include fruit juices, raw, canned, or cooked fruit, apples, bananas, oranges, pears, cantaloupe, grapefruit, and dried fruits.

Some foods don't have enough nutrients to fit in any of the five food groups. These foods are called "Others," and are okay to eat in moderation. They should not replace foods from the five food groups. Foods in this group include fats, oils, sweets, salty snacks, alcohol, other beverages, and condiments.

Each day a healthy adult requires 6-11 servings from the grain group, 2-3 servings from the meat group, 2-3 servings from the milk group, 3-5 servings from the vegetable group, and 2-4 servings from the fruit group.

1 .Plan a well-balanced diet around familiar foods.

2. Learn to judge portions, start measuring your foods.

3. Don't skip meals, this helps to prevent hunger and overeating later in the day.

4. Eat slowly, start with a salad and/or broth.

5. Cook to save calories, avoid fried foods and trim visible fat from meat, preferably before you cook it. Broil, bake, roast or boil meats and vegetables. Eat fresh fruits and canned fruits without syrup.

6. Keep a supply of crisp, raw vegetables on hand for between meal snacks. Some good "nibbling" foods are celery sticks, tomato slices, radishes, green pepper rings, cucumber slices, lettuce wedges, and dill pickles.

7. Learn to stop eating before you feel full.

8. Weigh yourself regularly at the same time once each week.

Figure 12-1 - Food Guide Pyramid

Physical Fitness

Physical fitness may be divided into four major components: aerobic fitness, musculoskeletal fitness, flexibility, and body composition. These fitness components are not necessarily interrelated. For example, a marathon runner with a high level of aerobic fitness may not possess a high degree of upper body muscular strength.

Aerobic fitness is the ability to participate in sustained, vigorous physical activity for extended periods of time. It is related to the efficiency of the heart, lungs, and blood vessels to deliver oxygen to the working muscles. The Navy field tests to measure this component of fitness are the 1.5-mile run/walk and 500-yard swim.

Musculoskeletal fitness is a combination of muscular strength and muscular endurance. Muscular strength is often represented as the maximal amount of weight lifted during a single repetition. Muscular endurance is the ability to sustain repeated repetitions without undue fatigue. Curl-ups and push-ups are the Navy field tests to determine muscular endurance.

Flexibility is the ability to move joints through their entire range of motion. Lack of flexibility of the hamstring muscles and the muscles/ligaments of the back is related to an increased risk of lower back injury. The Navy field test to assess this component of fitness is the sit-reach test.

Body composition is the relative amount of total body weight made up of fat and lean tissue. The Navy uses a percent body fat standard to assess body composition. The percent body fat value is determined from circumference measurements. There are several reasons for measuring percent body fat rather than using height/weight tables. Obesity is an excess of body fat frequently resulting in a significant impairment of health. Excess body fat is associated with high blood pressure, diabetes, and heart disease. Fat is clearly the culprit, not total body weight. Although height/weight tables are sometimes used to assess the extent of "over-weightness" based on age and body size, these tables do not accurately measure an individual's body fat content.

Tobacco Products

The Surgeon General of the United States has determined that tobacco use is the single most preventable cause of illness and death. There can be no question that the use of tobacco products decreases the health and readiness of the Navy. Research has consistently shown that the use of tobacco products increases the risk of cancer, heart disease, and other major illnesses. This is the most avoidable public health hazard we face. Medical and dental health care providers will advise tobacco users of the risks associated with tobacco use and refer them, if agreeable, to locally available smoking cessation programs. They also will emphasize to all pregnant tobacco users the special risks to the unborn child caused by smoking.

Drug Abuse

The Navy has established a "zero tolerance" standard for drug usage. The major emphasis is on detection and deterrence of illicit drug use. Drug abuse is the constant or excessive use of drugs for purposes or in quantities for which they were not intended. When abused, drugs become a source of "poison" to the body. They can lead to serious illness, dependency, and death.

Once someone has a dependency for drugs, drug rehabilitation may be necessary!

Narcotics

Narcotics include the most effective and widely used pain killers in existence. Continual use of narcotic drugs, even under medical supervision, leads to physical and psychological dependence. The most common narcotics are opium, morphine, heroin, codeine, and methadone. Next to codeine, heroin is the most popular narcotic drug, because of its intense euphoria and long-lasting effects. It is far more potent than morphine but has no legitimate use in the United States. Codeine, although milder than heroin and morphine, is sometimes abused as an ingredient in cough preparations. Symptoms of abuse include slow shallow breathing, unconsciousness, constriction (narrowing) of the pupils, drowsiness, confusion, and slurred speech.

Barbiturates

The legitimate use of barbiturates is primarily to induce sleep and to relieve tension. They are depressants (downers), and statistically they are the most lethal of the abused drugs. The most common barbiturates are Phenobarbital, amobarbital (blues), pentobarbital (yellows), and secobarbital (reds). Overdose potential is extremely high and can occur accidentally. Symptoms of abuse include slurred speech, faulty judgment, poor memory, staggering, tremors, rapid movement of the eyes, rapid shallow breathing, shock, and coma.

Stimulants

Stimulants (uppers) directly affect the central nervous system by increasing mental alertness and combating drowsiness and fatigue. The amphetamines, known as "speed," are the most commonly abused and include Benzedrine, Dexedrine, Dexamyl, Desoxyn, and Methedrine. Symptoms include hyperactivity, increased respiration, dilated (large) pupils, increased alertness, sweating, elevated temperature, decreased appetite, and convulsions. The "comedown" is so unpleasant that the temptation to take repeated doses is overwhelming and sometimes results in the abuser going on 'speed runs," which can last up to a week. Then the abuser may sleep several days before waking depressed and extremely hungry.

Hallucinogens

Hallucinogens affect the central nervous system by altering the user's perception of self and environment. The most common hallucinogens include lysergic acid diethylamide (LSD), mescaline, dimethoxy-methylarnphetaniine (STP), and phencyclidine (PCP). Symptoms include dilated (large) pupils, flushed face, increased heartbeat, and a chilled feeling. In addition, the person may display a distorted sense of time and self, show emotions ranging from ecstasy to horror, and experience changes in depth perception. Even though no longer under the direct influence of a hallucinogenic drug, a person who has formerly used one of the drugs may experience a spontaneous recurrence (flashback) of some aspect of the drug experience.

Cannabis

Cannabis sativa, commonly known as marijuana, is widely abused and can best be classified as a mild hallucinogen. Symptoms include dryness of the mouth, irritation of the throat, bloodshot eyes, increased appetite, and dizziness or sleepiness. Adverse reactions to the drug include anxiety, fear, dry mouth, depression, suspicion, delusions, and, in rare cases, hallucinations.

Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) are among the most common communicable diseases. Because of embarrassment or lack of education, many cases go unreported and untreated. Changes in sexual behavior, and the fact that many people have no symptoms, have added to the problems of control. Education is a primary tool in controlling the spread of STDs. The best approach is one that is straightforward, factual, and non-moralistic, but which at the same time does not condone promiscuity. Abstinence is the only sure method of prevention. Condoms should be used to prevent infections but it should be pointed out that condoms are not foolproof. The best method of combating and containing a disease is to prevent it.

Chlamydial Genital Infections

The infectious agent is chlamydia trachomatis, with an incubation period of 5 to 10 days or longer. It is transmitted through sexual intercourse, and the period of communicability is unknown. Males experience an opaque discharge and burning or itching when urinating. Females experience symptoms similar to gonorrhea with inflammation and infection of the cervix. Females are at risk of infertility.

Genococcal Infections

The infectious agent is the bacterium Neisseria gonorrhoea, with an incubation period of 2 to 7 days. The period of communicability ranges from days to months in untreated individuals. Males experience a purulent (pus) discharge with burning when urinating. Females may or may not experience a discharge and pain. Females are at risk of infertility. Arthritis from systemic spreading may cause permanent joint damage if treatment is delayed.

Herpes Simplex

Herpes simplex virus (HSV) types I and 2 usually produce distinct symptoms, depending on the port of entry. HSV type 2 usually produces genital herpes, with an incubation period from 2 to 12 days. The most common sites of the lesions are the genital area, legs, and buttocks. Primary genital lesions are infective for 7 to 12 days. Vaginal delivery of women with an active genital herpes infection presents a risk of serious infection to the newborn. Infection in women is a possible risk factor associated with cervical cancer.

Syphilis

The infectious agent is Treponema pallidum, a spirochete, with an incubation period of 10 days to 10 weeks. The period of communicability is variable and indefinite.

Primary - A papule (small, solid elevation of the skin), appears within 3 weeks at the site that often erodes to form an indurated painless ulcer (chancre).

Secondary - After 4 to 6 weeks the chancre heals and a flat, reddish, and patchy rash appears on the chest, back, arms, and legs. The rash is characteristically seen on the palms and soles.

Tertiary - After 5 to 20 years of untreated disease, the lesions can invade and destroy tissue in the skin, bone, central nervous system, and heart. Individuals should avoid sexual contact until lesions clear with proper antibiotic treatment.

Acquired Immune Deficiency Syndrome (AIDS)

The onset of AIDS is gradual with symptoms that are nonspecific, such as fatigue, fever, chronic diarrhea, loss of appetite, weight loss, and involvement of the lymph nodes. A serologic test for antibodies to the AIDS virus is being used for screening for evidence of past or present infection among civilian and military personnel. The infectious agent is a virus designated as either human immune virus (HIV), human T-lymphotrophic virus, type III (HTLV-3), or lymphadenopathy associated virus (LAV). The incubation period is unknown; evidence suggests from 6 months to 5 years with an average of about 2 years for transfusion associated cases. AIDS is primarily transmitted by promiscuous sexual contact (especially homosexual intercourse), sharing unclean needles, and through contaminated blood transfusions or blood products. It also may occur with heterosexual contact. This is not to say that only these populations are at risk; all personnel who engage in sexual activity with an unknown partner are at risk. The period of communicability for AIDS is unknown, and may extend from a symptom free period until the appearance of disease. There is no specific treatment for the immune deficiency. Personnel with AIDS require intensive medical support, and the prognosis for long-term survival is poor. Preventive measures are very important. Personnel should be educated that having promiscuous sexual behavior and multiple random sexual partners increases the probability of contacting AIDS.

Rape and Sexual Assault

Sexual offenses, including rape, may be associated with serious injury, pregnancy, and sexually transmitted diseases and are criminal offenses. Rape is the fastest growing crime in the United States, a woman is sexually assaulted every seven minutes. In addition, countless children and men are raped or sexually assaulted each year. Rape is often committed by a relative, friend, boyfriend, date, or shipmate. Most rape victims go into acute emotional shock during or shortly after an attack. Rape precautions include using the buddy system, letting others know where you are going, walking in well-lit areas, and staying in well-populated areas. The victim of sexual assault should not change their clothes, clean themselves, douche, or urinate, because important evidence will be destroyed. Immediately refer all sexual assault victims to the nearest medical treatment facility. It is the responsibility of the command to contact NIS and the responsibility of the Medical Department to provide medical care. BUMEDINST 6320.57 series, Family Advocacy Program, provides guidelines on managing sexual offenses.

References

1. NAVEDTRA 10670-C, Hospital Corpsman 1 & C

2. NAVEDTRA 10669-C, Hospital Corpsman 3 & 2

3. NAVEDTRA 12570, Dental Assistant, Basic.

Department of the Navy
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Washington, DC 20372-5300

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Operational Medicine 2001
Health Care in Military Settings

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