Stigma towards mental illness represents a significant challenge. No specific anti-stigma military training curricula currently exists. An infantry division sought to reduce stigma by inviting 2 guest speakers to address Soldiers. The intervention was designed on social contact theory and executed as a quality improvement project. The intervention was speakers self-disclosing their own mental health struggles and having the audience contact with persons from the stigmatized group. Postintervention evaluation (N=361) demonstrated significant reduction in stigma scores (t=8.128, df=329, P<.001, 2-tailed, d=0.3), and effect size was greatest (d=1.17) among those with greater baseline stigma scores. Soldiers also reported positive perceptions of help-seeking behaviors. Given these findings, other units could conduct these type of training events to target stigma toward mental illness.
A 33 year old female healthcare worker with a history of cough variant asthma presented with 2 weeks of dyspnea and cough that she believed to be due to recurring exposure to skunk spray in her work environment. The employee was working in a temporary structure outside the primary hospital campus. During the preceding 2 weeks, at least one striped skunk was observed multiple times by staff members to be crawling under the structure. The employee's symptoms were not initially considered serious by her supervisors who felt that the appreciable "skunk smell" was merely a nuisance odor. Repeated pre- and postexposure spirometry noted a 350 mL and 11% reduction in forced expiratory volume at one second (FEV1). A review of organic chemistry literature found that 2 thiols, also known as mercaptans, produced in striped skunk spray are structurally related to 1-butanethiol, a chemical workplace hazard and known respiratory irritant with established occupational exposure limits. The observation of the chemical similarities between these skunk-derived thiols and workplace thiols was the key factor in getting the employee temporarily removed from a hazardous, albeit unique, working environment.
Sexual dimorphism describes differences in biologic response between males and females due to inherent chromosomal differences. These differences similarly affect orthopaedic-related injuries and treatment outcomes as seen with femoroacetabular impingement, an abnormal hip morphology where females have shown worse hip function scores than male counterparts before and after surgery. Potential dimorphic factors that increase susceptibility of females to injury and/or worse outcomes may include joint laxity, hip morphology, and osseous biology. This article reviews the relevant literature of prevalence, presentation, management, and outcomes that characterize sexual dimorphism as it relates to femoroacetabular impingement.
The current medical readiness category (CAT) status system used for military working dogs (MWDs) simply outlines the deployability of an MWD. This system, however, does not detail any other restrictions or the reason for assigning the current CAT status. The question is often raised as to whether the MWD can continue to work and perform everyday duties despite not being a CAT I. Using the Physical Profile Record system established for human providers, a system was adapted for MWDs. This system will allow Veterinary Corps Officers to give specific instructions to the handler and owning unit about the nature, progression, and details of injury or dysfunction beyond the CAT status. Furthermore, the ability to track chronic conditions and duration of illness will increase overall readiness of a kennel.
Outcomes of extracorporeal shockwave therapy (ESWT) vary due to the heterogeneity of application protocols and patient characteristics. United States military medical facilities offer a unique environment to study the effects of ESWT due to the large use, consistent protocol, and ability to care for young active individuals. A retrospective review was conducted from November 2008 to March 2015 to assess types of musculoskeletal conditions treated by ESWT in US military medical treatment facilities, the demographics of patients treated with ESWT (age and gender), the trend throughout the time in question, and the protocols implemented. A literature review was performed to compare the use in US military facilities to reported data. In this study we report how US military medical facilities are using ESWT to treat musculoskeletal conditions and outcomes reported in literature. The purpose of our research is to raise awareness of this treatment modality and areas for further research within the US military medical facilities.
With unprecedented expansion of the roles of women in the military and the longest period of continuous active combat in US history, it is time that research expanded, including the nutritional and hydration requirements of the female tactical athlete. Dehydration has a negative effect on athletic performance, most significantly in high intensity, aerobic endurance activities. There is evidence female athletes may be more prone to the potentially lethal effects of over hydration. The purpose of this article is to provide a review of the literature to ascertain optimal hydration strategies for the female tactical athlete.
Heterotopic ossification is the formation of ossified bone in soft tissue, particularly after soft tissue trauma. Heterotopic ossification is known cause of pain, prosthetic/orthotic malfit, and reoperation following combat extremity injury. The purpose of this research was to examine injury and treatment characteristics that are associated with heterotopic ossification in a broader population of deployment-injured subjects. The Department of Defense Trauma Registry and Military Orthopaedic Trauma Registry was queried for a sample of deployment-injured subjects and the complication of heterotopic ossification. Heterotopic ossification was identified in 15% of subjects following 5% of all injuries. Symptoms attributed to the heterotopic bone were present in 40% of subjects with diagnosed with heterotopic ossification. Heterotopic ossification was not associated with injury severity or aggressiveness of open wound treatment. However, infection was the only positive predictor of heterotopic ossification resulting in two-times greater odds of heterotopic bone formation. This finding is consistent with prior research suggesting that heterotopic ossification requires persistent inflammation to be present in at-risk soft tissue. Among all wounds sustained during deployment injury, heterotopic may not be abundantly common; however, the risk may be further minimized by focused infection control.
Injuries are a leading health and readiness concern for the US Army. For effective prevention planning, details concerning circumstances associated with injuries are needed. Over 5,000 Soldiers were surveyed to collect demographic and injury details (type, body part, mechanism, activity, limited duty days); 874 reported an injury within 6 months of survey administration. The greatest proportion of limited duty time was associated with knee (19.2%), ankle (14.8%), and lower back injuries (12.9%). Overexertion was the leading injury mechanism (43.9%), followed by falls, jumps, trips, and slips (35.2%), which accounted for the highest average limited duty days per injury (42±43 days). Running was the leading activity associated overexertion injuries (39.3%) and falls (30.5%). Running also accounted for the greatest total limited duty days (5,844 days, 29.8%). For Army infantry units, results suggested a focus of prevention activities on running-related injuries resulting in overexertion or falls. Healthcare providers can facilitate injury prevention with contributions to initiatives providing details on injury mechanisms and activities associated with injuries.
The purpose of this study was to assist military communities of interest to more accurately identify service members who may have emotional and behavior disorders. Specifically, this study identifies service members' perceptions of the Department of Defense Post-Deployment Health Reassessment (PDHRA) screening instrument for posttraumatic stress disorder (PTSD). Findings were that responses to the PDHRA were related to how it was administered and the respondents' perceptions of how the PTSD diagnosis could affect the ability to obtain jobs and obtain promotions. Recommendations include implementing a screening environment free of distractions, involving family members, and assuring a confidential PTSD diagnosis.
This investigation aimed to identify risk factors for lower extremity sprain/strain injuries in physically active men. Lower extremity (LE) sprain/strain injuries are a significant source of morbidity among physically active populations. Data on and risk factors for injuries, including personal characteristics, and physical training and fitness were obtained from male Soldiers in an operational US Army division (N=6,865) by survey. Injury risks, risk ratios (RR), odds ratios (OR), and 95% confidence intervals (95% CI) were calculated. Multivariate analysis utilized logistic regression. Self-reported injury incidence for the prior 12 months was 43% (n=2,939), with 30% (n=878) of injuries attributed to LE sprains/strains. Lower extremity sprain/strain injuries were most commonly caused by falls, jumps, trips, or slips (49.4%), occurred while running (30.6%), and often resulted in limited duty profiles (64%). Higher risk of LE sprain/strain injury was independently associated with higher body mass index (ORoverweight/normal=1.2, 95% CI: 1.0-1.5), (ORobese/normal=1.4, 95% CI: 1.1-1.9), lower aerobic endurance (from 2-mile run time) (ORQuartile 2 (Q2)/Quartile 4 (Q4)=1.4, 95% CI: 1.0-1.8), (ORQuartile 1 (Q1)/Q4=1.6, 95% CI: 1.3-2.1), and lower core strength (sit-up repetitions) (ORQ1/Q4=1.4, 95% CI: 1.1-1.8). Lower risk of LE sprain/strain injury was associated with performing unit resistance training 3 or more times per week (OR3 times/none=0.5, 95% CI: 0.3-0.8). LE sprain/strain injuries contribute a significant portion of injuries among US Army Soldiers. Emphasis on aerobic fitness, core strength, and resistance training may help reduce the risk of LE sprain/strain injury among physically active men.
The NU-FlexSIV Socket provided greater hip motion across a variety of tasks without adversely affecting other movement mechanics but did not consistently improve socket comfort. Variability in the liners and socket materials used may have contributed to variability in results. Overall, the design was a viable alternative to traditional ischial containment sockets for some individuals with transfemoral amputation.
OBJECTIVE:This report outlines a multispecialty implementation effort which included 12 specialty practices and 28 clinicians within Regional Health Command Europe (RHCE) and Landstuhl Regional Medical Center (LRMC) to pilot an in-home virtual health (VH) program using existing resources.METHODS AND MATERIALS:Synchronous VH encounters were performed using an Acano desktop conferencing client (Cisco Systems, Inc, San Jose, CA) and a USB web camera at the provider (distant) site and the patient's own computer or device in the home. A web real-time conferencing (Web RTC) server provided the connections.RESULTS:Between October 2016 and May 2018, 310 synchronous VH appointments to patients' homes in 23 geographic locations in 9 countries on 3 different continents were completed; 28 skill type I and II specialty providers at LRMC, SHAPE Belgium Army Health Clinic (AHC), and Vilseck AHC, Germany Primary Care Clinic participated. The providers represented 9 distinct specialties and primary care. Appointment types were as follows: 85 (39%) follow-up type appointments; 70 (32%) group type appointments; 65 (30%) initial specialty care appointments. The 3 most active clinics were Pediatric Gastroenterology with 88 (28%), the Nutrition Clinic with 82 (26%), and the Traumatic Brain Injury Clinic with 63 (20%) encounters. Full audio and video connectivity rate was 97%, excluding reconnects after dropped calls which occasionally occurred. Patient satisfaction scores were high 16/17 (94%) with 5% of patients surveyed.CONCLUSION:Low complexity synchronous VH appointments were successfully accomplished across a broad spectrum of health care services and appointment types. Landstuhl RMC specialists received consults from sites across a vast geographic area including Europe, the Middle East, and Africa. An in-home VH option gives providers a special tool to extend services far beyond traditional boundaries. This pilot project helped RHCE and LRMC providers gain valuable experience extending care to the home and will provide foundational knowledge for future VH efforts targeting groups and outcomes.
BACKGROUNDUS Army initial entry training (IET) trainees engage in intense physical activities for 10 or more weeks prior to their assignment to operational units. Many trainees succumb to injury during IET. Injuries to the lower extremities and back have historically been the most common, and thus have been the focus of routine health surveillance.OBJECTIVESThe primary goal of this analysis was to verify the training-related injuries of greatest concern and to update the clinical diagnostic codes (ICD-10-CM) used in surveillance. The investigation also aimed to develop a sense of the financial magnitude of these injuries.METHODSThe distribution of all IET injuries was determined using a comprehensive injury taxonomy. Injuries were categorized based on causal energy source (mechanical, thermal, radiant, nuclear, chemical, or electrical). Mechanical energy transfers included acute trauma and cumulative microtrauma ("overuse"). Injury ICD-10-CM codes were identified in calendar year 2016 IET trainees' electronic healthcare records. Injury frequencies were reported for gender, body region, and injury type. Costs were calculated from medical encounters and estimated lost training time using the most frequently injured anatomical site as a baseline.RESULTSAmong 106,367 trainees, 65,026 separate injuries were identified. Mechanical energy transfers to lower extremities caused 75% of all injuries; most (65%) were cumulative microtraumatic. The most frequently injured anatomical site (the knee, 20% of injuries), is estimated to have cost over $39 million.CONCLUSIONSLower extremity injuries, followed by those of the low back continue to be leading "training-related injuries". This suggests the need to ensure distances and/or frequencies of weight-bearing activities (running, foot-marching) are not increased too rapidly or too excessively, and that trainees' fitness prior to IET is adequate. Medical costs and lost training time should be included in future monitoring.
New materials are constantly being created to address the operational needs of the US Army. These materials provide challenges to occupational health practitioners by presenting unknown health risks and possible effects to workers they evaluate. The responsibility for developing a medical surveillance exam, as part of a comprehensive workplace surveillance program, may become the responsibility of the provider working in a clinic on a military installation where manufacturing, testing, and/or use of the material is being conducted. Insensitive munitions explosive (IMX) has presented such an opportunity for Army occupational medicine providers within the last few years. This article describes the course of action taken by the occupational health clinics, personnel of Army ammunition plants producing IMX-101, and the US Army Public Health Center-Army Institute of Public Health to address the situation of developing a medical surveillance examination during a time when little to no information existed about the components of this new explosive compound.
Mosquito surveillance data can be used to develop bionomic profiles of vector species to inform abatement plans. Thus, surveillance was conducted in the months following Allied occupation of Japan at the conclusion of World War II. Mosquito surveillance in Nagasaki, Japan, began one month after the nuclear bomb destroyed much of the city. The resulting specimens housed within the US National mosquito collection are documented here for the first time. Specimen labels were digitized and specimens were photographed to record specimen condition as part of the process for making them readily available to researchers.
demic.1,2(pp92-97) The consequences of this serious problem are well established and potentially devastating. Conditions associated with an elevated body mass include diabetes, hypertension, coronary heart disease, and certain malignancies.2(pp97-100),3 For many, obesity and elevated body mass are a consequence of decreased physical activity; industrial advancements (eg, convenient transportation, technological advancements, and decreased need for manual labor) have contributed to an overall decrease in physical activity worldwide.4
We report findings of field surveillance for disease vectors and the prevalence of Orientia tsutsugamushi, the causative agent for scrub typhus, and other Rickettsial species that cause murine typhus and spotted fever group rickettsioses, in chigger mites and small rodents; and Leptospira in rodent kidney, urine, and environmental water samples. The study sites included various Royal Thai Army military installations and other training sites, and surrounding areas where the multinational military training exercise Cobra Gold was conducted in Thailand in 2017 and 2018. The overall prevalence of O. tsutsugamushi and Rickettsia infection in chiggers was 1.3% (20/1,594) and 7.5% (119/1,594), respectively. Serum samples of the captured rodents indicated previous exposure to O. tsutsugamushi infection with a seropositive rate of 12.2%. Leptospira species were isolated from rodent kidneys and water samples collected from catchment areas as well as tap water used for hand washing. Findings from this surveillance are important in determining the potential for scrub typhus, rickettsioses, and leptospirosis risk to military and US government personnel, as well as for informing regional and combatant commanders for prevention, correct diagnosis, prompt treatment, and timely and focused implementation of vector control and personal protective measures.
