1401
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Sell TC, Clark NC, Wood D, Abt JP, Lovalekar M, Lephart SM. Single-Leg Balance Impairments Persist in Fully Operational Military Special Forces Operators With a Previous History of Low Back Pain. Orthop J Sports Med 2014; 2:2325967114532780. [PMID: 26535329 PMCID: PMC4555543 DOI: 10.1177/2325967114532780] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Single-leg balance (SLB) can be chronically impaired after low back pain (LBP). Impaired SLB is a risk factor for recurrent LBP and lower extremity injury. In the United States military, the special forces operator (SFO) deploys on high-risk missions under extreme conditions, and impaired SLB can potentially threaten SFO safety and mission success. Purpose: To compare SLB in fully operational SFOs with and without a history of LBP. The hypothesis was that SLB deficits would be present in SFOs with a history of LBP. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 226 SFOs were included in this analysis. Comparisons were made between SFOs with and without medical chart documented history of LBP (LBP group [n = 43]: mean age = 31.2 ± 10.3 years, mean height = 177.3 ± 7.2 cm, mean mass = 87.3 ± 11.8 kg; healthy group [n = 183]: mean age = 28.0 ± 6.0 years, mean height = 177.9 ± 6.0 cm, mean mass = 84.9 ± 8.8 kg). Bilateral SLB was tested (eyes open and eyes closed) in both groups using a force plate. The variability in the ground-reaction forces was averaged across 3 trials for each leg for both conditions. Comparisons were made between legs in the LBP and between the LBP and healthy group (α = .05). Results: There were significant between-group differences for each leg for both conditions, with the healthy group demonstrating better SLB compared with the LBP group. P values ranged from .01 to .03. Conclusion: Impaired SLB persists in SFOs with previously reported LBP. Balance assessments of individuals who report LBP may assist with designing targeted interventions to address potential deficits that may increase the risk of future injury. Clinical Relevance: SFOs with a known history of LBP would benefit from examination of SLB and may benefit from balance training to resolve any deficits that may be present to lower the potential risk for future injury.
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Affiliation(s)
- Timothy C Sell
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicholas C Clark
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - John P Abt
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mita Lovalekar
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Scott M Lephart
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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1402
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Haase L, Thom NJ, Shukla A, Davenport PW, Simmons AN, Stanley EA, Paulus MP, Johnson DC. Mindfulness-based training attenuates insula response to an aversive interoceptive challenge. Soc Cogn Affect Neurosci 2014; 11:182-90. [PMID: 24714209 DOI: 10.1093/scan/nsu042] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 03/03/2014] [Indexed: 12/22/2022] Open
Abstract
Neuroimaging studies of mindfulness training (MT) modulate anterior cingulate cortex (ACC) and insula among other brain regions, which are important for attentional control, emotional regulation and interoception. Inspiratory breathing load (IBL) is an experimental approach to examine how an individual responds to an aversive stimulus. Military personnel are at increased risk for cognitive, emotional and physiological compromise as a consequence of prolonged exposure to stressful environments and, therefore, may benefit from MT. This study investigated whether MT modulates neural processing of interoceptive distress in infantry marines scheduled to undergo pre-deployment training and deployment to Afghanistan. Marines were divided into two groups: individuals who received training as usual (control) and individuals who received an additional 20-h mindfulness-based mind fitness training (MMFT). All subjects completed an IBL task during functional magnetic resonance imaging at baseline and post-MMFT training. Marines who underwent MMFT relative to controls demonstrated a significant attenuation of right anterior insula and ACC during the experience of loaded breathing. These results support the hypothesis that MT changes brain activation such that individuals process more effectively an aversive interoceptive stimulus. Thus, MT may serve as a training technique to modulate the brain's response to negative interoceptive stimuli, which may help to improve resilience.
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Affiliation(s)
- Lori Haase
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Nate J Thom
- Warfighter Performance Department, Navel Health Research Center, San Diego, CA, USA
| | - Akanksha Shukla
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Paul W Davenport
- Department of Physiological Sciences, University of Florida, Gainesville, FL, USA
| | - Alan N Simmons
- Department of Psychiatry, University of California, San Diego, CA, USA, VA San Diego Healthcare System, San Diego, CA, USA and
| | - Elizabeth A Stanley
- Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
| | - Martin P Paulus
- Department of Psychiatry, University of California, San Diego, CA, USA, VA San Diego Healthcare System, San Diego, CA, USA and
| | - Douglas C Johnson
- Department of Psychiatry, University of California, San Diego, CA, USA, Warfighter Performance Department, Navel Health Research Center, San Diego, CA, USA
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1403
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Hoyt T, Wray AM, Rielage JK. Preliminary investigation of the roles of military background and posttraumatic stress symptoms in frequency and recidivism of intimate partner violence perpetration among court-referred men. J Interpers Violence 2014; 29:1094-110. [PMID: 24212979 DOI: 10.1177/0886260513506058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Significant rates of intimate partner violence (IPV) perpetration have been identified among men with military backgrounds. Research indicates posttraumatic stress symptoms place military men at increased risk for IPV perpetration, but may be negatively associated with IPV among nonmilitary samples. However, no previous studies have directly compared court-referred IPV offenders with and without military experience, which may have clinical implications if posttraumatic stress symptoms are differentially associated with IPV perpetration across these two samples. Twenty court-referred IPV offenders with military background were demographically matched with 40 court-referred IPV offenders without military background. As anticipated, self- and partner-report of physically assaultive acts and injurious acts during baseline assessment showed significantly greater physical assault and injury perpetrated by offenders with military background. However, 1-year follow-up data on convictions indicated a significantly lower rate of recidivism among offenders with military background than among nonmilitary offenders. As hypothesized, symptoms of posttraumatic stress at intake showed a significant positive correlation with IPV perpetration among offenders with military background; however, this relationship showed a negative correlation among offenders without military background. Clinical implications are discussed including treatment avenues, such as Veterans Courts and other incarceration diversion programs, which may be particularly appropriate for offenders with military backgrounds.
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Affiliation(s)
- Tim Hoyt
- Madigan Army Medical Center-Tacoma, WA, USA
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1404
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Abstract
Introduction: In recent years, considerable empirical attention has been devoted to examining the increased risk of suicide observed in some Veteran populations. This has led to a renewed focus on developing novel support options which can be used to respond to Veterans in distress, reducing their risk of suicide. Spirituality and religion, however, have been largely absent from any public discourse related to suicide prevention, not least of all in Veteran populations. Aim: The aim of this cross-sectional study is to compare the self-rated spiritual health of Veterans with and without suicide ideation. Identifying differences which may exist between these two groups could highlight the relevance of spiritual well-being to Veteran suicide prevention efforts. Materials and Methods: Data were collected using pencil-and-paper surveys, called Spiritual Assessments, distributed within the general population of in- and outpatients at a U.S. Department of Veterans Affairs Medical Center. Using Likert-type scales, this study examines the self-rated spiritual health, spiritual devotion, and significance ascribed to spirituality in a sample of 5378 Veterans. Statistical analysis took place using chi-squared to examine differences in the distribution of responses between ideators and non-ideators. Results: Ideators significantly more often rated their spiritual health as worse than that of non-ideators. Even with similar levels of spiritual devotion or significance ascribed to spiritual life, ideators continued to significantly more often rate their spiritual health as worse than that of non-ideators. Conclusion: The results show that Veterans with suicide ideation more often rate their spiritual health as worse than that of Veterans without suicide ideation. This suggests that spiritual well-being may indeed be relevant to suicide prevention efforts in Veteran populations.
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Affiliation(s)
- Marek S Kopacz
- VISN 2 Center of Excellence for Suicide Prevention, US Department of Veterans Affairs , Canandaigua , NY , USA
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1405
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Ellis MW, Schlett CD, Millar EV, Wilkins KJ, Crawford KB, Morrison-Rodriguez SM, Pacha LA, Gorwitz RJ, Lanier JB, Tribble DR. Hygiene strategies to prevent methicillin-resistant Staphylococcus aureus skin and soft tissue infections: a cluster-randomized controlled trial among high-risk military trainees. Clin Infect Dis 2014; 58:1540-8. [PMID: 24633684 DOI: 10.1093/cid/ciu166] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Effective measures are needed to prevent methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) in high-risk community settings. The study objective was to evaluate the effect of personal hygiene-based strategies on rates of overall SSTI and MRSA SSTI. METHODS We conducted a prospective, field-based, cluster-randomized trial in US Army Infantry trainees from May 2010 through January 2012. There were 3 study groups with incrementally increased education and hygiene-based interventions: standard (S), enhanced standard (ES), and chlorhexidine (CHG). The primary endpoints were incidence of overall SSTI and MRSA SSTI. RESULTS The study included 30 209 trainees constituting 540 platoons (168 S, 192 ES, and 180 CHG). A total of 1203 (4%) participants developed SSTI, 316 (26%) due to MRSA. The overall SSTI rate was 4.15 (95% confidence interval [CI], 3.77-4.58) per 100 person-cycles. SSTI rates by study group were 3.48 (95% CI, 2.87-4.22) for S, 4.18 (95% CI, 3.56-4.90) for ES, and 4.71 (95% CI, 4.03-5.50) for CHG. The MRSA SSTI rate per 100 person-cycles for all groups was 1.10 (95% CI, .91-1.32). MRSA SSTI rates by study group were 1.0 (95% CI, .70-1.42) for S, 1.29 (95% CI, .98-1.71) for ES, and 0.97 (95% CI, .70-1.36) for CHG. CONCLUSIONS Personal hygiene and education measures, including once-weekly use of chlorhexidine body wash, did not prevent overall SSTI or MRSA SSTI in a high-risk population of military trainees. CLINICAL TRIALS REGISTRATION NCT01105767.
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1406
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Bardack S, Dalgard CL, Kalinich JF, Kasper CE. Genotoxic changes to rodent cells exposed in vitro to tungsten, nickel, cobalt and iron. Int J Environ Res Public Health 2014; 11:2922-40. [PMID: 24619124 PMCID: PMC3987013 DOI: 10.3390/ijerph110302922] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/21/2014] [Accepted: 02/25/2014] [Indexed: 12/03/2022]
Abstract
Tungsten-based materials have been proposed as replacements for depleted uranium in armor-penetrating munitions and for lead in small-arms ammunition. A recent report demonstrated that a military-grade composition of tungsten, nickel, and cobalt induced a highly-aggressive, metastatic rhabdomyosarcoma when implanted into the leg muscle of laboratory rats to simulate a shrapnel wound. The early genetic changes occurring in response to embedded metal fragments are not known. In this study, we utilized two cultured rodent myoblast cell lines, exposed to soluble tungsten alloys and the individual metals comprising the alloys, to study the genotoxic effects. By profiling cell transcriptomes using microarray, we found slight, yet distinct and unique, gene expression changes in rat myoblast cells after 24 h metal exposure, and several genes were identified that correlate with impending adverse consequences of ongoing exposure to weapons-grade tungsten alloy. These changes were not as apparent in the mouse myoblast cell line. This indicates a potential species difference in the cellular response to tungsten alloy, a hypothesis supported by current findings with in vivo model systems. Studies examining genotoxic-associated gene expression changes in cells from longer exposure times are warranted.
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Affiliation(s)
- Stephanie Bardack
- Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, D.C. 20201, USA.
| | - Clifton L Dalgard
- Department of Anatomy, Physiology, and Genetics, School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - John F Kalinich
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
| | - Christine E Kasper
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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1407
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Boroujeni AM, Yousefi E, Moayednia A, Tahririan MA. Effects of 8 weeks of military training on lower extremity and lower back clinical findings of young Iranian male recruits: A prospective case series. Adv Biomed Res 2014; 3:20. [PMID: 24600600 PMCID: PMC3929018 DOI: 10.4103/2277-9175.124655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 08/06/2013] [Indexed: 11/25/2022] Open
Abstract
Background: In this prospective case series we have assessed the clinical effects of 8 weeks military training on the lower extremity of the recruits. Materials and Methods: Military recruits who met the eligibility criteria and gave informed consent were entered into the study. They were asked to fill out a self-reporting pain and functionality questionnaire before and after their training. They were also examined by a physician before and after their military training. The questionnaire and examination were concentrated on three blocs: lower back, knee, and foot. Results: Three-hundred and seventy-three study subjects were evaluated. The study showed that there is a significant difference in reporting lower back pain after the training compared to the rate of complaints prior to the training (P < 0.001), knee pain, and foot pain also increased significantly (P < 0.1 and P < 0.0001, respectively) The difference was most prominent in foot complaints. Physical examination also showed significant increase in lower extremity findings following the training (P < 0.05). Conclusion: Our study shows that there is a need for a new approach to military training of male recruits in Iran in order to minimize the adverse health effects.
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Affiliation(s)
- Amir Momeni Boroujeni
- Faculty of Medicine, Isfahan University of Medical Sciences, Postgraduate, Isfahan, Iran
| | - Elham Yousefi
- Faculty of Medicine, Isfahan University of Medical Sciences, Postgraduate, Isfahan, Iran
| | - Amir Moayednia
- Resident of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Ali Tahririan
- Department of Orthopedics, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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1408
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Prescott MR, Tamburrino M, Calabrese JR, Liberzon I, Slembarski R, Shirley E, Fine T, Goto T, Wilson K, Ganocy S, Chan P, Derus A, Serrano MB, Sizemore J, Kauffman J, Galea S. Validation of lay-administered mental health assessments in a large Army National Guard cohort. Int J Methods Psychiatr Res 2014; 23:109-19. [PMID: 24615746 PMCID: PMC6878484 DOI: 10.1002/mpr.1416] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 12/07/2012] [Accepted: 01/16/2013] [Indexed: 11/05/2022] Open
Abstract
To report the reliability and validity of key mental health assessments in an ongoing study of the Ohio Army National Guard (OHARNG). The 2616 OHARNG soldiers received hour-long structured telephone surveys including the post-traumatic stress disorder (PTSD) checklist (PCV-C) and Patient Health Questionnaire - 9 (PHQ-9). A subset (N = 500) participated in two hour clinical reappraisals, using the Clinician-Administered PTSD Scale (CAPS) and the Structured Clinical Interview for DSM (SCID). The telephone survey assessment for PTSD and for any depressive disorder were both highly specific [92% (standard error, SE 0.01), 83% (SE 0.02)] with moderate sensitivity [54% (SE 0.09), 51% (SE 0.05)]. Other psychopathologies assessed included alcohol abuse [sensitivity 40%, (SE 0.04) and specificity 80% (SE 0.02)] and alcohol dependence [sensitivity, 60% (SE 0.05) and specificity 81% (SE 0.02)].The baseline prevalence estimates from the telephone study suggest alcohol abuse and dependence may be higher in this sample than the general population. Validity and reliability statistics suggest specific, but moderately sensitive instruments.
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Affiliation(s)
- Marta R Prescott
- Columbia University, New York, USA; University of Michigan, Ann Arbor, MI, USA
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1409
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Carlsson D, Burström L, Lilliesköld VH, Nilsson T, Nordh E, Wahlström J. Neurosensory sequelae assessed by thermal and vibrotactile perception thresholds after local cold injury. Int J Circumpolar Health 2014; 73:23540. [PMID: 24624368 PMCID: PMC3929118 DOI: 10.3402/ijch.v73.23540] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/14/2014] [Accepted: 01/20/2014] [Indexed: 11/24/2022] Open
Abstract
Background Local freezing cold injuries are common in the north and sequelae to cold injury can persist many years. Quantitative sensory testing (QST) can be used to assess neurosensory symptoms but has previously not been used on cold injury patients. Objective To evaluate neurosensory sequelae after local freezing cold injury by thermal and vibrotactile perception thresholds and by symptom descriptions. Design Fifteen patients with a local freezing cold injury in the hands or feet, acquired during military training, were studied with QST by assessment of vibrotactile (VPT), warmth (WPT) and cold (CPT) perception thresholds 4 months post-injury. In addition, a follow-up questionnaire, focusing on neurovascular symptoms, was completed 4 months and 4 years post-injury. Results QST demonstrated abnormal findings in one or both affected hands for VPT in 6 patients, for WPT in 4 patients and for CPT in 1 patient. In the feet, QST was abnormal for VPT in one or both affected feet in 8 patients, for WPT in 6 patients and for CPT in 4 patients. Freezing cold injury related symptoms, e.g. pain/discomfort when exposed to cold, cold sensation and white fingers were common at 4 months and persisted 4 years after the initial injury. Conclusions Neurosensory sequelae after local freezing cold injury, in terms of abnormal thermal and/or vibration perception thresholds, may last at least 4 months after the initial injury. Symptoms such as pain/discomfort at cold exposure, cold sensations and white fingers may persist at least 4 years after the initial injury.
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Affiliation(s)
- Daniel Carlsson
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; Department of Occupational and Environmental Medicine, Sundsvall Hospital, Sundsvall, Sweden
| | - Lage Burström
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Tohr Nilsson
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; Department of Occupational and Environmental Medicine, Sundsvall Hospital, Sundsvall, Sweden
| | - Erik Nordh
- Division of Clinical Neurophysiology, Umeå University, Umeå, Sweden
| | - Jens Wahlström
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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1410
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Summers JA, Stanley J, Baker MG, Wilson N. Risk factors for death from pandemic influenza in 1918-1919: a case-control study. Influenza Other Respir Viruses 2014; 8:329-38. [PMID: 24490663 PMCID: PMC4181481 DOI: 10.1111/irv.12228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 11/29/2022] Open
Abstract
Background Despite the persisting threat from future influenza pandemics, much is still unknown about the risk factors for death from such events, and especially for the 1918–1919 influenza pandemic. Methods A case–control study was performed to explore possible risk factors for death from pandemic influenza among New Zealand military personnel in the Northern Hemisphere in 1918–1919 (n = 218 cases, n = 221 controls). Data were compiled from a Roll-of-Honour dataset, a dataset of nearly all military personnel involved in the war and archived individual records. Results In the fully adjusted multivariable model, the following were significantly associated with increased risk of death from pandemic influenza: age (25–29 years), pre-pandemic hospitalisations for a chronic condition (e.g. tuberculosis), relatively early year of military deployment, a relatively short time from enlistment to foreign service, and having a larger chest size (e.g. adjusted odds ratio for 90–99 cm versus <90 cm was 2·45; 95% CI=1·47–4·10). There were no significant associations in the fully adjusted model with military rank, occupational class at enlistment, and rurality at enlistment. Conclusions This is one of the first published case–control studies of mortality risk factors for the 1918–1919 influenza pandemic. Some of the findings are consistent with previous research on risk factors (such as chronic conditions and age groups), but others appear more novel (e.g., larger chest size). As all such historical analyses have limitations, there is a need for additional studies in other settings as archival World War One records become digitalised.
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Affiliation(s)
- Jennifer A Summers
- Division of Health and Social Care Research, King's College London, London, UK; Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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1411
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Sherman S, Fostick L, Zohar J. Comparison of criminal activity between Israeli veterans with and without PTSD. Depress Anxiety 2014; 31:143-9. [PMID: 23913346 DOI: 10.1002/da.22161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 07/01/2013] [Accepted: 07/03/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The literature, based on US Vietnam veterans, suggests that posttraumatic stress disorder (PTSD) is associated with increased criminal activity, especially violence, alcohol, and drug abuse, although more recent studies, which tested data from the United States as well as the United Kingdom, suggest a more moderate effect for this relationship. The current study examines Israeli veterans, who differ socioeconomically and have lower rates of substance abuse than veterans in previous studies. METHODS In this study, the social security numbers of 2,235 male veterans with PTSD and 2,235 matched control male veterans without a PTSD diagnosis were checked for criminal records in the Israeli Police criminal records database. Severity measures were also obtained for 273 veterans who are currently treated for PTSD by the Ministry of Defense. RESULTS PTSD diagnosed veterans, as compared to controls, were slightly more likely to have criminal records (43%, n = 957/2235 versus 36%, n = 803/2235, Chi- square = 22.23, P < 0.001, OR = 1.33). This was due to a small difference in "Violence" and "Crimes against public order and legal authority." No difference was found in drugs or any other categories. In addition, criminal activity was not related to symptoms severity. More veterans with PTSD had their first criminal record after the traumatic event. CONCLUSIONS Contrary to previous findings, in this large national cohort, only slight association was found between PTSD and criminal activity. The unique sample of Israeli veterans might account for this difference and suggest that PTSD per se might not be linked to increased criminal activity, violence, or substance abuse.
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Affiliation(s)
- Shany Sherman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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1412
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Schnall BL, Hendershot BD, Bell JC, Wolf EJ. Kinematic analysis of males with transtibial amputation carrying military loads. J Rehabil Res Dev 2014; 51:1505-14. [PMID: 25815769 DOI: 10.1682/jrrd.2014.01.0022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 09/18/2014] [Indexed: 11/05/2022]
Abstract
The biomechanical responses to load carriage, a common task for dismounted troops, have been well studied in nondisabled individuals. However, with recent shifts in the rehabilitation and retention process of injured servicemembers, there remains a substantial need for understanding these responses in persons with lower-limb amputations. Temporal-spatial and kinematic gait parameters were analyzed among 10 male servicemembers with unilateral transtibial amputation (TTA) and 10 uninjured male controls. Participants completed six treadmill walking trials in all combinations of two speeds (1.34 and 1.52 m/s) and three loads (none, 21.8, and 32.7 kg). Persons with TTA exhibited biomechanical compensations to carried loads that are comparable to those observed in uninjured individuals. However, several distinct gait changes appear to be unique to those with TTA, notably, increased dorsiflexion (deformation) of the prosthetic foot/ankle, less stance knee flexion on the prosthetic limb, and altered trunk forward lean/excursion. Such evidence supports the need for future work to assess the risk for overuse injuries with carried loads in this population in addition to guiding the development of adaptive prosthetic feet/components to meet the needs of redeployed servicemembers or veterans/civilians in physically demanding occupations.
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Affiliation(s)
- Barri L Schnall
- Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD
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1413
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Abstract
Suicides in the U.S. military continue to rise at a rapid rate. Identification of protective factors that reduce risk for suicidal thoughts and behaviors among military personnel are therefore needed. Agency--the sense that one is competent, effective, and in control of one's life--has shown to reduce the effects of hopelessness and emotional distress on suicidal thoughts and attempts in non-military populations. The current study explores the association of agency with suicidal ideation in a sample (n = 273) of active duty Air Force Security Forces personnel. Results of generalized regression modeling suggest that agency is directly associated with decreased emotional distress and severity of suicidal ideation, but does not moderate the effect of emotional distress on suicidal ideation.
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Affiliation(s)
- Craig J Bryan
- a National Center for Veterans Studies , The University of Utah , Salt Lake City , Utah , USA
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1414
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Abstract
Suicide is the leading cause of soldier death in the Israeli Defense Forces (IDF) in peace time. Suicide attempt (SA) and non-suicidal self-injury (NSSI) are risk factors for death by suicide in civilian studies and therefore their predictive value needs to be determined in the military. All army screening, psychometric and demographic data on consecutive cases of IDF soldier self-harm during the years 2010-2011 were analyzed. The Columbia Suicide Severity Rating Scale was used retrospectively to classify self-harm as suicidal or NSSI. The Suicide Ideation Scale and the Suicide Intent Scale were scored retrospectively by trained clinical psychologists. A total of 107 soldiers reported self-harm during the study period, comprising 70 SA and 37 with NSSI. The most prevalent diagnosis was personality disorder (n = 48). Soldiers with any mood/anxiety disorders comprised the smallest group (n = 21) and included major depression, dysthymia, anxiety, and posttraumatic stress disorder. Soldiers with NSSI (n = 37) did not differ in any of the characteristics from those who attempted suicide (n = 70). Unlike the well-known female dominance in both SA and NSSI patients in other settings, males dominated this army sample in both groups. Soldiers with self-harm (both SA and NSSI) cannot be easily distinguished by any demographics or specific psychological attributes detectable at induction, and the scales used in suicide research cannot predict an attempt or NSSI. Unlike civilian samples, males dominated attempter and NSSI groups and the reason for this may be multifactorial. These retrospective findings, if replicated, indicate the need for different screening strategies at induction into the military.
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Affiliation(s)
- Leah Shelef
- a Mental Health Unit, Medical Corpses, Israeli Defense Forces
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1415
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Chou HW, Tzeng WC, Chou YC, Yeh HW, Chang HA, Kao YC, Tzeng NS. Psychological morbidity, quality of life, and self-rated health in the military personnel. Neuropsychiatr Dis Treat 2014; 10:329-38. [PMID: 24570587 PMCID: PMC3933722 DOI: 10.2147/ndt.s57531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The mental health of military personnel varies as a result of different cultural, political, and administrative factors. The purpose of this study was to evaluate the psychological morbidity and quality of life of military personnel in Taiwan. MATERIALS AND METHODS This cross-sectional study utilized the World Health Organization Quality of Life Instrument, brief version, Taiwan version, the General Health Questionnaire-12, Chinese version, and the Visual Analog Scale (VAS) in several military units. RESULTS More than half of the subjects (55.3%) identified themselves as mentally unhealthy on the General Health Questionnaire-12, Chinese version; however, a higher percentage of officers perceived themselves as healthy (57.4%) than did noncommissioned officers (38.5%) or enlisted men (42.2%). Officers also had higher total quality of life (QOL) scores (83.98) than did enlisted men (79.67). Scores on the VAS also varied: officers: 72.5; noncommissioned officers: 67.7; and enlisted men: 66.3. The VAS and QOL were positively correlated with perceived mental health among these military personnel. CONCLUSION Our subjects had higher rates of perceiving themselves as mentally unhealthy compared to the general population. Those of higher rank perceived themselves as having better mental health and QOL. Improving mental health could result in a better QOL in the military. The VAS may be a useful tool for the rapid screening of self-reported mental health, which may be suitable in cases of stressful missions, such as in disaster rescue; however, more studies are needed to determine the optimal cut-off point of this measurement tool.
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Affiliation(s)
- Han-Wei Chou
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine ; Department of Psychiatry, Tri-Service General Hospital, Beitou Branch, National Defense Medical Center, Taipei, Taiwan; ; Department of Psychiatry, Tao-Yuan General Hospital, Tao-Yuan, Taiwan
| | - Wen-Chii Tzeng
- Department of Nursing, Tri-Service General Hospital, School of Nursing ; Student Counseling Center
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Hui-Wen Yeh
- Department of Nursing, Tri-Service General Hospital, School of Nursing ; Department of Nursing, School of Nursing, Kang-Ning Health Care and Management College, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine ; Student Counseling Center
| | - Yu-Cheng Kao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine ; Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine ; Student Counseling Center
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1416
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Abstract
The extent to which animal studies can be relevant to military posttraumatic stress disorder (PTSD) continues to be a matter of discussion. Some features of the clinical syndrome are more easily modeled than others. In the animal literature, a great deal of attention is focused on modeling the characteristics of military exposures and their impact on measurable behaviors and biological parameters. There are many issues to consider regarding the ecological validity of predator, social defeat or immobilization stress to combat-related experience. In contrast, less attention has been paid to individual variation following these exposures. Such variation is critical to understand how individual differences in the response to military trauma exposure may result to PTSD or resilience. It is important to consider potential differences in biological findings when comparing extremely exposed to non-exposed animals, versus those that result from examining individual differences. Animal models of military PTSD are also critical in advancing efforts in clinical treatment. In an ideal translational approach to study deployment related outcomes, information from humans and animals, blood and brain, should be carefully considered in tandem, possibly even computed simultaneously, to identify molecules, pathways and networks that are likely to be the key drivers of military PTSD symptoms. With the use novel biological methodologies (e.g., optogenetics) in the animal models, critical genes and pathways can be tuned up or down (rather than over-expressed or ablated completely) in discrete brain regions. Such techniques together with pre-and post-deployment human imaging will accelerate the identification of novel pharmacological and non-pharmacological intervention strategies.
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Affiliation(s)
- Nikolaos P Daskalakis
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA ; Mental Health Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, USA
| | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA ; Mental Health Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, USA
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1417
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Yehuda R, Vermetten E, McFarlane AC, Lehrner A. PTSD in the military: special considerations for understanding prevalence, pathophysiology and treatment following deployment. Eur J Psychotraumatol 2014; 5:25322. [PMID: 25206950 PMCID: PMC4138707 DOI: 10.3402/ejpt.v5.25322] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2014] [Indexed: 11/29/2022] Open
Abstract
Given the unique context of warzone engagement, which may include chronic threat, multiple and lengthy deployments, and loss, there is a need to understand whether and to what extent knowledge about PTSD derived from studies of civilian trauma exposure is generalizeable to the military. This special issue on PTSD in the military addresses a range of issues and debates related to mental health in military personnel and combat veterans. This article provides an overview of the issues covered in selected contributions that have been assembled for a special volume to consider issues unique to the military. Several leading scholars and military experts have contributed papers regarding: 1) prevalence rates of PTSD and other post-deployment mental health problems in different NATO countries, 2) the search for biomarkers of PTSD and the potential applications of such findings, and 3) prevention and intervention approaches for service members and veterans. The volume includes studies that highlight the divergence in prevalence rates of PTSD and other post-deployment mental health problems across nations and that discuss potential causes and implications. Included studies also provide an overview of research conducted in military or Veteran's Affairs settings, and overarching reviews of military-wide approaches to research, promotion of resilience, and mental health interventions in the Unites States and across NATO and allied ISAF partners.
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Affiliation(s)
- Rachel Yehuda
- James. J. Peters Veterans Affairs Medical Center, New York, NY, USA ; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands ; Arq Psychotrauma Expert Group, Diemen, The Netherlands ; Military Mental Health Research, Department of Defense, Utrecht, The Netherlands
| | - Alexander C McFarlane
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amy Lehrner
- James. J. Peters Veterans Affairs Medical Center, New York, NY, USA
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1418
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Salai S, Rohrer JE, Peoples GE, Stoodt G, Danawi H. Comparing Stage at Diagnosis Among Patients With Breast Cancer Served by Military and Civilian Medical Care Systems. Health Serv Res Manag Epidemiol 2014; 1:2333392814533660. [PMID: 28462242 PMCID: PMC5278822 DOI: 10.1177/2333392814533660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Breast cancer (BC) remains one of the top causes of cancer-related deaths in women in the United States, and little is known about the differences in access to health care between military and civilians. This study compared the differences in access to health care between military and civilian female patients with BC. In particular, this study examined whether patients with BC, in an equal access health care system such as the military, are diagnosed at an earlier stage of disease process in comparison to the patients with BC in the civilian health care system. Methods: Independent variables included military versus civilian care and demographic variables. Dependent variable was the stage of cancer at diagnosis. This cross-sectional study of 2 groups included data from 2198 women with BC (439 military and 1759 civilian) for years 2004 through 2008. Multiple logistic regression was used to analyze the data. Results: There was no difference in the early BC stage (0, I, and II) diagnosis prevalence rate between the military and the civilian groups (95% confidence interval [CI], P = .15). The logistic regression analysis indicated that both the health systems had equal performance with respect to the stage at diagnosis indicator but found that black patients had higher odds of being in the late stage (III and IV) BC group at diagnosis (1.62 OR, 1.14-2.30 CI, P = .0068) than white patients. Conclusions: Although no difference was found between the performance of the 2 health systems in the early (0, I, and II) versus late stage (III and IV) at diagnosis indicator, this study further confirms the existence of racial disparities in late-stage BC regardless of whether the patient was diagnosed in the civilian or military health system. More research is needed to further investigate the potential explanations of racial disparities other than just differences in access to health care.
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Affiliation(s)
| | - James E Rohrer
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
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1419
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Hooff MV, McFarlane AC, Davies CE, Searle AK, Fairweather-Schmidt AK, Verhagen A, Benassi H, Hodson SE. The Australian Defence Force Mental Health Prevalence and Wellbeing Study: design and methods. Eur J Psychotraumatol 2014; 5:23950. [PMID: 25206944 PMCID: PMC4138701 DOI: 10.3402/ejpt.v5.23950] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/23/2014] [Accepted: 05/21/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study (MHPWS) is the first study of mental disorder prevalence in an entire military population. OBJECTIVE The MHPWS aims to establish mental disorder prevalence, refine current ADF mental health screening methods, and identify specific occupational factors that influence mental health. This paper describes the design, sampling strategies, and methodology used in this study. METHOD At Phase 1, approximately half of all regular Navy, Army, and Air Force personnel (n=24,481) completed self-report questionnaires. At Phase 2, a stratified sub-sample (n=1,798) completed a structured diagnostic interview to detect mental disorder. Based on data from non-responders, data were weighted to represent the entire ADF population (n=50,049). RESULTS One in five ADF members met criteria for a 12-month mental disorder (22%). The most common disorder category was anxiety disorders (14.8%), followed by affective (9.5%) and alcohol disorders (5.2%). At risk ADF sub-groups were Army personnel, and those in the lower ranks. Deployment status did not have an impact on mental disorder rates. CONCLUSION This study has important implications for mental health service delivery for Australian and international military personnel as well as contemporary veterans.
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Affiliation(s)
- Miranda Van Hooff
- Centre for Traumatic Stress Studies, The University of Adelaide, South Australia
| | | | - Christopher E Davies
- Data Management and Analysis Centre, Discipline of Public Health, The University of Adelaide, South Australia
| | - Amelia K Searle
- Centre for Traumatic Stress Studies, The University of Adelaide, South Australia
| | | | - Alan Verhagen
- Mental Health, Psychology and Rehabilitation Branch, Joint Health Command, Department of Defence, Canberra, Australian Capital Territory, Australia
| | - Helen Benassi
- Mental Health, Psychology and Rehabilitation Branch, Joint Health Command, Department of Defence, Canberra, Australian Capital Territory, Australia
| | - Stephanie E Hodson
- Department of Veterans' Affairs, Canberra, Australian Capital Territory, Australia
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1420
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Brown A, Joshi M. Intimate partner violence among female service members and veterans: information and resources available through military and non-military websites. Soc Work Health Care 2014; 53:714-738. [PMID: 25255337 DOI: 10.1080/00981389.2014.944249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
With the expansion of women's roles in the military, the number of female service members and veterans has increased. Considerable knowledge about intimate partner violence (IPV) in civilian couples exists but little is known about IPV among female service members and veterans. Prevalence rates of IPV range from 17% to 39% for female service members, and 21.9% to 74% for veterans. Most service members and veterans indicated using the Internet at least occasionally and expressed willingness to seek information about services via the Internet. Informed by data, we conducted a systematic review of military (Army, Navy, Air Force, and Marine Corps) and non-military (Veterans Affairs and Google) websites to explore the availability and presentation of information and resources related to IPV. The websites search revealed a variety of resources and information available, and important differences between sites with regard to what and how information is presented. Implications for practice and further research are discussed.
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Affiliation(s)
- Amy Brown
- a School of Social Work , University of South Florida , Tampa , Florida , USA
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1421
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Ivanov I, Yehuda R. Optimizing fitness for duty and post-combat clinical services for military personnel and combat veterans with ADHD-a systematic review of the current literature. Eur J Psychotraumatol 2014; 5:23894. [PMID: 25206949 PMCID: PMC4138706 DOI: 10.3402/ejpt.v5.23894] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/10/2014] [Accepted: 07/02/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Attention deficit hyper activity disorder (ADHD) is a developmental disorder, most often diagnosed in childhood, and characterized by hyperactivity and inattention that negatively impacts one's ability to function and fulfill social and personal obligations. Individuals with past history of ADHD may enlist in the military under certain conditions, however the full impact of military training and deployment of later in life ADHD symptoms is unclear. It is of particular interest how military experience may affect ADHD in remission and if such individuals might be at elevated risk for relapse of ADHD symptoms. METHOD We performed a systematic review f the available literature including the Department of Defense (DOD) guidelines for both eligibility to enlist and fitness for deployment based on reported history and current symptomatology of ADHD. RESULTS The after care for veterans with ADHD relapse is inconsistent and presents with number of challenges. We evaluate the DOD policies regarding the implications of ADHD for fitness for military service and post-combat mental health. CONCLUSION The full extend of the interaction between pre-existing ADHD and post-combat PTSD are not fully understood. The development of comprehensive and clear algorithms for diagnosing and treating ADHD in the military before and after deployment will have a strong positive impact on the quality of care delivered to soldiers and veterans.
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Affiliation(s)
- Iliyan Ivanov
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Yehuda
- Department of Psychiatry, James J. Peters VA Medical Center, Bronx, NY, USA
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1422
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Accepted Common Interest Community (CIC) Proposals. Int J Yoga Therap 2014; 24:48-59. [PMID: 25645135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
These are the 18 accepted proposals for the three Common Interest Community (CIC) sessions at IAYT's Symposium on Yoga Therapy and Research (SYTAR), June 5-8, 2014, in Austin, Texas and published in the Final Program Guide and CIC Works for SYTAR 2014. The sessions were CIC#1 Rehab Professionals: Bridging the Past with the Future and CIC#2a & CIC#2b Mental, Emotional and Spiritual Health.
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1423
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Accepted scientific research works (abstracts). Int J Yoga Therap 2014; 24:18-38. [PMID: 25645134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
These are the 39 accepted abstracts for IAYT's Symposium on Yoga Research (SYR) September 24-24, 2014 at the Kripalu Center for Yoga & Health and published in the Final Program Guide and Abstracts.
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1424
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Becker SJ, Swenson R, Esposito-Smythers C, Cataldo A, Spirito A. Barriers to Seeking Mental Health Services among Adolescents in Military Families. ACTA ACUST UNITED AC 2014; 45:504-513. [PMID: 25574070 DOI: 10.1037/a0036120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Military families with adolescents experience high levels of stress associated with parental deployment, but many of these families do not seek or utilize mental health services. The current qualitative study was designed to better understand barriers to mental health treatment experienced by adolescents in military families. Focus groups and individual interviews were conducted with military adolescents (n = 13), military (non-enlisted) parents (n = 12), and mental health service providers who treat adolescents in military families (n = 20). Discussions primarily explored barriers to seeking treatment, with supplemental questions assessing the ideal elements of mental health services for this population. Seven barriers to engaging in mental health services were identified: four internal (confidentiality concerns, stigma, ethic of self-reliance, lack of perceived relevance) and three external (time and effort concerns, logistical concerns, financial concerns). Challenges engaging military adolescents in mental health services are discussed and several recommendations are offered for service providers attempting to work with this population.
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Affiliation(s)
- Sara J Becker
- Dept. of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University ; Dept. of Child and Family Psychiatry, Rhode Island Hospital
| | - Rebecca Swenson
- Dept. of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University ; Dept. of Child and Family Psychiatry, Rhode Island Hospital
| | | | - Andrea Cataldo
- Dept. of Child and Family Psychiatry, Rhode Island Hospital
| | - Anthony Spirito
- Dept. of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
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1425
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Abstract
The costs of addiction are well documented, but the potential benefits of recovery are less well known. Similarly, substance use issues among both active duty military personnel and veterans are well known but their recovery experiences remain underinvestigated. Furthermore, little is known about whether and how addiction and recovery experiences differ between veterans and non-veterans. This knowledge can help refine treatment and recovery support services. Capitalizing on a national study of individuals in recovery (N = 3,208), we compare addiction and recovery experiences among veterans (n = 481) and non-veterans. Veterans' addiction phase was 4 years longer than non-veterans and they experienced significantly more financial and legal problems. Dramatic improvements in functioning were observed across the board in recovery with subgroup differences leveling off. We discuss possible strategies to address the specific areas where veterans are most impaired in addiction and note study limitations including the cross-sectional design.
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Affiliation(s)
- Alexandre Laudet
- Center for the Study of Addictions and Recovery, National Development and Research Institutes, Inc., New York City, NY
| | - Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System and Stanford University Medical Center, Palo Alto, CA
| | - Thomas Hill
- Faces and Voices of Recovery, Washington, DC
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1426
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Abstract
The U.S. Army adopted forward surgical hospitals (SHs) during World War I on the advice of the British and French armies. The purposes were not just to save lives, but to benefit the military by returning more patients to duty and reducing the size of the hospital system through fewer infections and shorter hospital stays. The Army examined the utility of the units at the end of the war and retained them for any future conflicts, but opposition also survived. The question was the utility for the Army: was it worth making a substantial investment, and reducing care for other wounded soldiers, for the most grievously wounded, perhaps 1 percent of the total? Devising an effective way to organize forward SHs was a problem in the interwar years and early in World War II (WWII). But from the late 1930s, the Army never reexamined whether it should provide forward surgery, only how to do so, including pushing surgeons even further forward on the battlefield. At the end of WWII, the Mobile Army Surgical Hospital (MASH) was created to perform the mission, although the MASH was only the latest format.
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Affiliation(s)
- Sanders Marble
- U.S. Army Medical Department Center of History and Heritage, Office of Medical History, 2748 Worth Road, Fort Sam Houston, TX 78234
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1427
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Abstract
Military mental health nurses are tasked with providing psychiatric liaison to British forces deployed to combat zones. This forms part of a wider effort to maintain the combat effectiveness of the fighting force. During a recent deployment, I maintained a reflexive journal of my experience of liaising with the British Chain of Command. I then used line by line coding via the NVIVO 9 software package to formulate the core themes that became a framework for this autoethnography. My personality and social anxieties shaped how I performed the psychiatric liaison role. I was able to develop a template for liaison that accounted for both 'me' and my need to feel authentic or credible as a nurse, yet still enabled me to communicate effectively with the Chain of Command. One template for psychiatric nursing liaison with British combat forces is to focus upon key stakeholders within the Chain of Command, specifically, the Officer Commanding, the Sergeant Major, the Trauma Risk Management co-ordinator (usually the Sergeant Major) and the embedded medical asset. Further research is needed to establish how other nurses approach psychiatric nursing liaison.
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Affiliation(s)
- D Whybrow
- Mental Health Rehabilitation Service, Royal Navy, Portsmouth, UK
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1428
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Tran BR, Thomas AG, Vaida F, Ditsela M, Phetogo R, Kelapile D, Haubrich R, Chambers C, Shaffer R. An intervention study examining the effects of condom wrapper graphics and scent on condom use in the Botswana Defence Force. AIDS Care 2013; 26:890-8. [PMID: 24266459 DOI: 10.1080/09540121.2013.860420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Free condoms provided by the government are often not used by Botswana Defence Force (BDF) personnel due to a perceived unpleasant scent and unattractive wrapper. Formative work with the BDF found that scented condoms and military-inspired (camouflage) wrapper graphics were appealing to personnel. A non-randomized intervention study was implemented to determine whether condom wrapper graphics and scent improved condom use in the BDF. Four military sites were selected for participation. Two sites in the south received the intervention condom wrapped in a generic wrapper and two sites in the north received the intervention condom wrapped in a military-inspired wrapper; intervention condoms were either scented or unscented. Two hundred and eleven male soldiers who ever had sex, aged 18-30 years, and stationed at one of the selected sites consented to participate. Sexual activity and condom use were measured pre- and post-intervention using sexual behavior diaries. A condom use rate (CUR; frequency of protected sex divided by the total frequency of sex) was computed for each participant. Mean CURs significantly increased over time (85.7% baseline vs. 94.5% post-intervention). Adjusted odds of condom use over time were higher among participants who received the intervention condom packaged in the military wrapper compared with the generic wrapper. Adjusted odds of condom use were also higher for participants who reported using scented vs. unscented condoms. Providing scented condoms and condoms packaged in a military-inspired wrapper may help increase condom use and reduce HIV infection among military personnel.
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Affiliation(s)
- Bonnie Robin Tran
- a Department of Defense HIV/AIDS Prevention Program , Naval Health Research Center , San Diego , CA , USA
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1429
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Waterman BR, Liu J, Newcomb R, Schoenfeld AJ, Orr JD, Belmont PJ. Risk factors for chronic exertional compartment syndrome in a physically active military population. Am J Sports Med 2013; 41:2545-9. [PMID: 23911700 DOI: 10.1177/0363546513497922] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chronic exertional compartment syndrome (CECS) is a common source of lower extremity pain in physically active military service members. While anatomic risk factors of CECS have been proposed, there is no existing study that evaluates the correlation of demographic and occupational risk factors and the overall incidence rate of CECS in an active military population. HYPOTHESIS Young, enlisted service members in the United States (US) ground military forces would demonstrate higher incidence rates of CECS in the study population because of greater exposure to at-risk dismounted activity on the battlefield and in training. STUDY DESIGN Cohort study (prevalence); Level of evidence, 2. METHODS A retrospective study of all US active military service members with diagnosed nontraumatic exertional compartment syndrome of the lower extremity (code 729.72 in the International Classification of Diseases, 9th Edition) between 2006 and 2011 was performed using the Defense Medical Epidemiology Database. Demographic and occupational risk factors such as sex, age, race, branch of military service, and military rank were individually subcategorized, and cumulative and subgroup incidence rates of CECS were calculated using a multivariate Poisson regression model. RESULTS A total of 4100 diagnosed cases of CECS were identified within an at-risk population of 8,320,201, which correlates to an incidence rate of 0.49 cases per 1000 person-years. The annual adjusted incidence rate of CECS increased from 0.06 cases per 1000 person-years in 2006 to 0.33 cases per 1000 person-years in 2009. Increasing chronological age, female sex, white race, junior enlisted rank, and Army service were significantly correlated with an elevated risk for CECS. CONCLUSION This study systematically evaluated the epidemiology of CECS among an idealized subset at risk for this condition. Sex, age, race, military rank, and branch of service were all important factors associated with the incidence of CECS in this physically active population.
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Affiliation(s)
- Brian R Waterman
- Brian R. Waterman, Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79920-5001.
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1430
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Abstract
PURPOSE Little is known about veterans service organizations (VSOs) and their perspectives on veterans smoking or military tobacco control. Veterans have high smoking rates and many started smoking in the military, where a culture promoting use exists. DESIGN A qualitative content analysis of VSO Web sites was conducted to classify health topics and identify tobacco-related information. SETTING Web sites were coded by trained raters from January to June of 2011. Data were entered, cleaned, and analyzed from July 2011 to January 2012. SUBJECTS Twenty-four active VSO Web sites meeting inclusion criteria were rated independently. MEASURES A comprehensive form was used to code 15 veteran-relevant health topics across multiple content areas/domains within the Web sites. Raters achieved 94.5% interrater agreement over nearly 5000 data points. ANALYSIS Health content was coded as present or not within multiple VSO Web site areas/domains. The frequency of coverage by each VSO Web site and the number of VSO Web sites that mentioned a health topic in different Web site areas/domains were tabulated. RESULTS A total of 277 health topics were addressed, with the top five being insurance/Tricare/Veterans Administration issues (28.2%), posttraumatic stress disorder (PTSD; 15.5%), disability/amputation/wounds (13.4%), Agent Orange (10.5%), and traumatic brain injury (9.0%). Tobacco was mentioned four times (1.4%) across all 24 VSO Web sites, and smoking cessation was never addressed. CONCLUSION VSO Web sites provide little information on tobacco-related topics and none offered information about smoking cessation. Given the high rates of tobacco use among veterans and active-duty service members, and the interaction between smoking and PTSD symptoms and treatment outcomes, VSOs should consider making tobacco control and smoking cessation higher-priority health issues on their Web sites.
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Affiliation(s)
- Walker S.C. Poston
- Institute for Biobehavioral Health Research, National Development and Research Institutes, Inc., 1920 West 143 Street, Suite 120, Leawood, KS 66224, Phone: 913-681-0300 office,
| | - Christopher K. Haddock
- Institute for Biobehavioral Health Research, National Development and Research Institutes, Inc., 1920 West 143 Street, Suite 120, Leawood, KS 66224, Phone: 913-681-0300 office,
| | - Sara A. Jahnke
- Institute for Biobehavioral Health Research, National Development and Research Institutes, Inc., 1920 West 143 Street, Suite 120, Leawood, KS 66224, Phone: 913-681-0300 office,
| | - Nattinee Jitnarin
- Institute for Biobehavioral Health Research, National Development and Research Institutes, Inc., 1920 West 143 Street, Suite 120, Leawood, KS 66224, Phone: 913-681-0300 office,
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1431
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Dretsch MN, Coldren RL, Kelly MP, Parish RV, Russell ML. No Effect of Deployment Environment in Establishing Baseline Neurocognitive Scores in U.S. Army Soldiers. Appl Neuropsychol Adult 2013; 20:272-276. [PMID: 30567045 DOI: 10.1080/09084282.2012.715110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
With heavy reliance on neurocognitive testing for concussion status assessments in the U.S. warfighter, there is a need to investigate the impact of testing environment on neurocognitive functioning. The current study compared scores on computerized neurocognitive tests of 166 soldiers who were deployed to Iraq. Predeployment baseline scores (n = 53) were compared to baseline scores collected while deployed (n = 113) on the battery of tests. There was no significant difference between baseline scores acquired from the predeployment group versus the deployed group. Furthermore, only one subtest revealed a significant difference in change scores from the follow-up test session when comparing the location of initial baseline testing. The results suggest that testing environment does not significantly influence baseline neurocognitive testing. The findings also provide support for the use of neurocognitive testing in a deployment environment.
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Affiliation(s)
- Michael N Dretsch
- a Warfighter Health Division, U.S. Army Aeromedical Research Laboratory , Fort Rucker , Alabama
| | - Rodney L Coldren
- b Department of Preventive Medicine and Biometrics , Uniformed Services University of the Health Sciences , Bethesda , Maryland
| | - Mark P Kelly
- c Department of Psychology, Neuropsychology Health Services Assessment Division , Walter Reed National Military Medical Center , Bethesda , Maryland
| | | | - Michael L Russell
- e Rehabilitation and Reintegration Division, Office of the Surgeon General , San Antonio , Texas
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1432
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Abstract
This narrative review examines injuries sustained by soldiers undertaking occupational load carriage tasks. Military soldiers are required to carry increasingly heavier occupational loads. These loads have been found to increase the physiological cost to the soldier and alter their gait mechanics. Aggregated research findings suggest that the lower limbs are the most frequent anatomical site of injury associated with load carriage. While foot blisters are common, other prevalent lower limb injuries include stress fractures, knee and foot pain, and neuropathies, like digitalgia and meralgia. Shoulder neuropathies (brachial plexus palsy) and lower back injuries are not uncommon. Soldier occupational load carriage has the potential to cause injuries that impact on force generation and force sustainment. Through understanding the nature of these injuries targeted interventions, like improved physical conditioning and support to specialised organisations, can be employed.
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Affiliation(s)
- Robin Marc Orr
- a Bond Institute of Health and Sport , Bond University , Gold Coast , QLD 4229 , Australia
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1433
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Sehm B, Ragert P. Why non-invasive brain stimulation should not be used in military and security services. Front Hum Neurosci 2013; 7:553. [PMID: 24058339 PMCID: PMC3766817 DOI: 10.3389/fnhum.2013.00553] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 08/21/2013] [Indexed: 11/21/2022] Open
Affiliation(s)
- Bernhard Sehm
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig Leipzig, Germany
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1434
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Hatch SL, Harvey SB, Dandeker C, Burdett H, Greenberg N, Fear NT, Wessely S. Life in and after the Armed Forces: social networks and mental health in the UK military. Sociol Health Illn 2013; 35:1045-1064. [PMID: 23356827 DOI: 10.1111/1467-9566.12022] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study focuses on the influence of structural aspects of social integration (social networks and social participation outside work) on mental health (common mental disorders (CMD), that is, depression and anxiety symptoms, post-traumatic stress disorder (PTSD) symptoms and alcohol misuse). This study examines differences in levels of social integration and associations between social integration and mental health among service leavers and personnel still in service. Data were collected from regular serving personnel (n=6,511) and regular service leavers (n=1,753), from a representative cohort study of the Armed Forces in the UK. We found that service leavers reported less social participation outside work and a general disengagement with military social contacts in comparison to serving personnel. Service leavers were more likely to report CMD and PTSD symptoms. The increased risk of CMD but not PTSD symptoms, was partially accounted for by the reduced levels of social integration among the service leavers. Maintaining social networks in which most members are still in the military is associated with alcohol misuse for both groups, but it is related to CMD and PTSD symptoms for service leavers only.
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Affiliation(s)
- Stephani L Hatch
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, London UK Department of War Studies, King's College London, UK King's Centre for Military Health Research, King's College London, UK Academic Centre for Defence Mental Health, King's College London, UK School of Psychiatry, University of New South Wales, Sydney, Australia
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1435
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Kaplow JB, Layne CM, Saltzman WR, Cozza SJ, Pynoos RS. Using multidimensional grief theory to explore the effects of deployment, reintegration, and death on military youth and families. Clin Child Fam Psychol Rev 2013; 16:322-40. [PMID: 23760905 PMCID: PMC4651441 DOI: 10.1007/s10567-013-0143-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To date, the US military has made major strides in acknowledging and therapeutically addressing trauma and post-traumatic stress disorder (PTSD) in service members and their families. However, given the nature of warfare and high rates of losses sustained by both military members (e.g., deaths of fellow unit members) and military families (e.g., loss of a young parent who served in the military), as well as the ongoing threat of loss that military families face during deployment, we propose that a similar focus on grief is also needed to properly understand and address many of the challenges encountered by bereaved service members, spouses, and children. In this article, we describe a newly developed theory of grief (multidimensional grief theory) and apply it to the task of exploring major features of military-related experiences during the phases of deployment, reintegration, and the aftermath of combat death--especially as they impact children. We also describe implications for designing preventive interventions during each phase and conclude with recommended avenues for future research. Primary aims are to illustrate: (1) the indispensable role of theory in guiding efforts to describe, explain, predict, prevent, and treat maladaptive grief in military service members, children, and families; (2) the relevance of multidimensional grief theory for addressing both losses due to physical death as well as losses brought about by extended physical separations to which military children and families are exposed during and after deployment; and (3) a focus on military-related grief as a much-needed complement to an already-established focus on military-related PTSD.
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Affiliation(s)
- Julie B Kaplow
- Department of Psychiatry and Depression Center, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109-5765, USA.
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1436
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Crum-Cianflone NF, Jacobson I. Gender differences of postdeployment post-traumatic stress disorder among service members and veterans of the Iraq and Afghanistan conflicts. Epidemiol Rev 2013; 36:5-18. [PMID: 23988441 DOI: 10.1093/epirev/mxt005] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite the marked expansion of roles for women in the US military over the last decade, whether differences by gender exist in regard to the development of mental health conditions postdeployment is unclear. This comprehensive review of the literature (2001-2012) examined whether US servicewomen were more likely than men to experience post-traumatic stress disorder (PTSD) after returning from deployments to the Iraq and Afghanistan conflicts. Findings from 18 studies from 8 unique study populations were reviewed. Seven studies found that women had a higher risk for screening positive for PTSD compared with men, including prospectively designed studies that evaluated new-onset PTSD among members from all service branches. Although results from studies with Veterans Affairs samples found women at decreased risk in 4 analyses, these studies used the same source databases, were conducted in treatment-seeking populations, and were mostly unable to account for combat experience. Seven studies detected no differences by gender. In summary, women appeared to have a moderately higher risk for postdeployment PTSD, although there was a lack of consensus among the studies, and even those with the most rigorous methods were not designed specifically to evaluate potential gender differences. Given the limitations of the published literature, further research should use longitudinal study designs and comprehensive evaluations of deployment experiences while adjusting for predeployment factors to confirm that gender differences exist with regard to postdeployment PTSD.
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Affiliation(s)
- Nancy F Crum-Cianflone
- Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; MST, military-related sexual trauma; OEF, Operation Enduring Freedom; OIF, Operation Iraqi Freedom; PCL-C, PTSD Checklist Civilian Version; PTSD, post-traumatic stress disorder; VA, Veterans Administration
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1437
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Neuhaus SJ. Australia's female military surgeons of World War I. ANZ J Surg 2013; 83:713-8. [PMID: 23924307 DOI: 10.1111/ans.12334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2013] [Indexed: 11/28/2022]
Abstract
The war service of Lilian Violet Cooper, the first female surgeon of the Royal Australasian College of Surgeons, is well recognized. Not so well known however, are the other pioneering female doctors who also undertook work as military surgeons during World War I. At least four of the 14 Australian female doctors that undertook overseas war service during World War I were engaged as surgeons and treated Australian, British and Allied casualties. These women operated in London, in Egypt and on the frontlines of the Macedonian campaign. While none of these other women became Fellows of the Royal Australasian College of Surgeons, their war efforts deserve recognition.
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Affiliation(s)
- Susan J Neuhaus
- University of Adelaide Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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1438
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Porter CK, Fitamaurice G, Tribble DR, Armstrong AW, Mostafa M, Riddle MS. Willingness to receive a hypothetical avian influenza vaccine among US military personnel in mid-deployment. Hum Vaccin Immunother 2013; 9:2613-7. [PMID: 23917256 DOI: 10.4161/hv.25910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Though no avian influenza vaccine currently exists, development efforts have increased. Given recent reports of suboptimal vaccination rates among US military personnel, we sought to assess factors associated with a willingness to receive a hypothetical avian influenza vaccine. A self-administered questionnaire was completed by US military personnel during mid-deployment to Iraq, Afghanistan, and surrounding regions. Respondents were predominately male (86.2%), Army (72.1%), and enlisted (86.3%) with a mean age of 29.6 y. The majority (77.1%) agreed to receive an avian influenza vaccine if available. Exploratory factor analysis (EFA) identified two factors, vaccine importance and disease risk, that best described the individual perceptions and both were associated with an increased willingness to receive the hypothetical vaccine (OR: 8.2 and 1.6, respectively). Importantly, after controlling for these factors differences in the willingness to receive this hypothetical vaccine were observed across gender and branch of service. These results indicated that targeted education on vaccine safety and efficacy as well as disease risk may modify vaccination patterns in this population.
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Affiliation(s)
- Chad K Porter
- Naval Medical Research Center; Enteric Diseases Department; Silver Spring, MD USA
| | - Gina Fitamaurice
- George Washington University; School of Public Health and Health Services; Washington, DC USA
| | - David R Tribble
- Infectious Diseases Clinical Research Program; Uniformed Services University; Bethesda, MD USA
| | | | - Manal Mostafa
- United States Naval Medical Research Unit No. 3; Cairo, Egypt
| | - Mark S Riddle
- Naval Medical Research Center; Enteric Diseases Department; Silver Spring, MD USA
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1439
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Amick MM, Clark A, Fortier CB, Esterman M, Rasmusson AM, Kenna A, Milberg WP, McGlinchey R. PTSD modifies performance on a task of affective executive control among deployed OEF/OIF veterans with mild traumatic brain injury. J Int Neuropsychol Soc 2013; 19:792-801. [PMID: 23823533 DOI: 10.1017/S1355617713000544] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Individuals with post-traumatic stress disorder (PTSD) show a cognitive bias for threatening information, reflecting dysregulated executive control for affective stimuli. This study examined whether comorbid mild Traumatic Brain Injury (mTBI) with PTSD exacerbates this bias. A computer-administered Affective Go/No-Go task measured reaction times (RTs) and errors of omission and commission to words with a non-combat-related positive or negative valence in 72 deployed United States service members from the wars in Iraq and Afghanistan. Incidents of military-related mTBI were measured with the Boston Assessment of Traumatic Brain Injury-Lifetime. PTSD symptoms were measured with the Clinician-Administered PTSD Scale. Participants were divided into those with (mTBI+, n = 34) and without a history of military-related mTBI (mTBI-, n = 38). Valence of the target stimuli differentially impacted errors of commission and decision bias (criterion) in the mTBI+ and mTBI- groups. Specifically, within the mTBI+ group, increasing severity of PTSD symptoms was associated with an increasingly liberal response pattern (defined as more commission errors to negative distractors and greater hit rate for positive stimuli) in the positive compared to the negative blocks. This association was not observed in the mTBI- group. This study underscores the importance of considering the impact of a military-related mTBI and PTSD severity upon affective executive control.
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1440
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Tran BR, Thomas AG, Ditsela M, Vaida F, Phetogo R, Kelapile D, Chambers C, Haubrich R, Shaffer R. Condom use behaviours and correlates of use in the Botswana Defence Force. Int J STD AIDS 2013; 24:883-92. [PMID: 23970609 DOI: 10.1177/0956462413486889] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preventing HIV infection is a priority for militaries. HIV prevention research is needed to monitor existing programme, identify areas for modification, and develop new interventions. Correct and consistent condom use is highly effective against HIV. However, use among soldiers is lower than ideal. This study describes condom use behaviours and examines correlates of use in the Botswana Defence Force (BDF). Analyses were based on 211 male BDF personnel, aged 18-30, who completed a cross-sectional survey that collected baseline data for an intervention study. Results showed that 51% of participants reported always using condoms, 35% used condoms most times, and 14% used condoms occasionally/never. Condom use varied by partner type and was typically higher with casual partners in comparison to regular partners. After adjustment for age and marital status, factors associated with lower condom use included excessive alcohol use, perception that using condoms reduce sexual pleasure, and having a trusted partner. However, higher levels of HIV knowledge and reports of being circumcised were protective against lower condom use. HIV interventions aimed at increasing condom use in the BDF should address condom perceptions, alcohol abuse, and issues of trust. Innovative ways to increase condom use in this population should also be explored.
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Affiliation(s)
- Bonnie Robin Tran
- Naval Health Research Center, Department of Defense HIV/AIDS Prevention Program, San Diego, USA
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1441
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Vest KG, Clark LL. Serosurvey and observational study of US Army Veterinary Corps officers for Q fever antibodies from 1989 to 2008. Zoonoses Public Health 2013; 61:271-82. [PMID: 23859558 PMCID: PMC4171783 DOI: 10.1111/zph.12067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Indexed: 11/30/2022]
Abstract
Since World War II, the military has experienced outbreaks of Q fever among deploying units including recent case reports of Q fever in US military personnel returning from serving in the Middle East during Operation Iraqi Freedom and Operation Enduring Freedom. Occupational exposure and prevalence of Q fever among US Army Veterinary Corps officers have not been examined. A retrospective serosurvey and observational study of 500 military veterinarians were conducted using archived serum specimens from military veterinarians who entered and served between 1989 and 2008 and were tested for exposure to Coxiella burnetii. Corresponding longitudinal health-related, demographic, medical and deployment data were examined. A total of 69 (13.8%) individuals at military entry and 85 (17%) had late career positive titres. A total of 18 (3.6%) individuals showed seroconversion. Women were more likely to be seropositive after military service [prevalence ratio (PR) 1.96; 95% confidence interval (CI) 1.15–3.35] and were also more likely to seroconvert (incidence rate ratio 3.55; 95% CI 1.19–12.7). Women who deployed to Operation Iraqi Freedom were more likely to be seropositive (PR 3.17; 95% CI 1.03–9.71). Veterinarians with field service and pathology specialties had the highest incidence rates (7.0/1000 PY; 95% CI 4–12 and 3–19, respectively). This is the first report documenting US military veterinarians' exposure to C. burnetii. Military veterinarians are at risk prior to service, with moderate number of new cases developing during service and most maintaining titres for long periods of time. Women consistently demonstrated higher seroprevalence and incidence levels. As increasing numbers of women enter the veterinary profession and subsequently the US Army, this may warrant close monitoring. This study likely underestimates exposure and risk and does not address chronic health effects, which may be valuable to explore in future health studies.
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Affiliation(s)
- K G Vest
- Armed Forces Health Surveillance Center, Silver Spring, MD, USA
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1442
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DeRuiter SL, Southall BL, Calambokidis J, Zimmer WMX, Sadykova D, Falcone EA, Friedlaender AS, Joseph JE, Moretti D, Schorr GS, Thomas L, Tyack PL. First direct measurements of behavioural responses by Cuvier's beaked whales to mid-frequency active sonar. Biol Lett 2013; 9:20130223. [PMID: 23825085 PMCID: PMC3730631 DOI: 10.1098/rsbl.2013.0223] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Most marine mammal strandings coincident with naval sonar exercises have involved Cuvier's beaked whales (Ziphius cavirostris). We recorded animal movement and acoustic data on two tagged Ziphius and obtained the first direct measurements of behavioural responses of this species to mid-frequency active (MFA) sonar signals. Each recording included a 30-min playback (one 1.6-s simulated MFA sonar signal repeated every 25 s); one whale was also incidentally exposed to MFA sonar from distant naval exercises. Whales responded strongly to playbacks at low received levels (RLs; 89–127 dB re 1 µPa): after ceasing normal fluking and echolocation, they swam rapidly, silently away, extending both dive duration and subsequent non-foraging interval. Distant sonar exercises (78–106 dB re 1 µPa) did not elicit such responses, suggesting that context may moderate reactions. The observed responses to playback occurred at RLs well below current regulatory thresholds; equivalent responses to operational sonars could elevate stranding risk and reduce foraging efficiency.
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Affiliation(s)
- Stacy L DeRuiter
- Centre for Research into Ecological and Environmental Modelling, Scottish Oceans Institute, University of St Andrews, , St Andrews, UK
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1443
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Walton TO, Walker DD, Kaysen DL, Roffman RA, Mbilinyi L, Neighbors C. Reaching soldiers with untreated substance use disorder: lessons learned in the development of a marketing campaign for the Warrior Check-Up study. Subst Use Misuse 2013; 48:908-21. [PMID: 23869462 PMCID: PMC4942844 DOI: 10.3109/10826084.2013.797996] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Warrior Check-Up, a confidential telephone-delivered intervention, is designed to reach active-duty soldiers with untreated substance-use disorder at a large U.S. military base. This paper describes the development and successful implementation of the study's marketing strategies at the recruitment period's midpoint (2010-2012). Qualitative analyses of focus groups (n = 26) and survey responses (n = 278) describe the process of campaign design. Measures of demographics, media exposure, post-traumatic stress, anxiety and depression gathered from callers (n = 172) are used in quantitative analysis assessing the campaign's success in reaching this population. Implications, limitations, and suggestions for future research are discussed. Department of Defense provided study funding.
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Affiliation(s)
- Thomas O Walton
- University of Washington, School of Social Work, 909 NE 43rd St., Suite 304, Seattle, WA 98105, USA.
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1444
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Kim YM, Banda J, Hiner C, Tholandi M, Bazant E, Sarkar S, Andrade ASA, Makwala C. Assessing the quality of HIV/AIDS services at military health facilities in Zambia. Int J STD AIDS 2013; 24:365-70. [PMID: 23970703 DOI: 10.1177/0956462412472811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
After rapidly scaling up HIV/AIDS-related health services, the Zambian Defence Force (ZDF) has become concerned with assuring their quality. This evaluation assesses provider performance at eight ZDF facilities based on direct observations of 191 antenatal care (ANC) consultations and 175 follow-up consultations for antiretroviral therapy (ART). In addition, 43 ZDF health providers were interviewed about the work environment and service quality. On-the-job performance varied widely: providers completed as few as 0% and as many as 100% of tasks associated with each performance standard. Overall scores averaged 66% (range: 47-93%) for ANC consultations and 60% (range: 37-100%) for ART consultations. Perceptions of the work environment were generally positive, but 57% of providers lack confidence in their clinical skills and 42% think staffing is insufficient. These findings, which point to the unique opportunities and challenges in the military setting, will be used to guide a quality improvement initiative.
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Affiliation(s)
- Y M Kim
- Jhpiego/USA, an affiliate of Johns Hopkins University, 1615 Thames Street, Baltimore MD 21231, USA.
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1445
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Vinsonneau U, Pinon B, Paleiron N, Rohel G, Piquemal M, Desideri-Vaillant C, Castellant P, Abaléa J, Valls-Bertaut V, Carré F, Mansourati J, Paule P. Prevalence of early repolarization patterns in a French military population at low cardiovascular risk: implications for preventive medicine. Ann Noninvasive Electrocardiol 2013; 18:436-40. [PMID: 24047487 DOI: 10.1111/anec.12057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Early repolarization pattern (ERP) associated with a risk of sudden death has recently been described. Very few studies have examined the prevalence of this pattern in a military population characterized by a predominance of young, active male subjects. Therefore, the main objective of this study was to evaluate the prevalence of ERP in a healthy military population free of heart disease but subjected to extreme and potentially arrhythmogenic physical activity. METHODS This prospective, multicenter study was carried out from November 2010 to November 2011 and included 746 individuals undergoing ECG screening; 466 were men (62.4%) and 280 were women (37.5%). Each ECG was interpreted twice by trained cardiologists. RESULTS The total prevalence of ERP was 13.8% (103/746); 16% (46/280) in women and 12% (57/466) in men (P > 0.05). It declined with age and the pattern of slurring in inferior location was the most common. Heart rate was significantly lower in military officers with ERP. CONCLUSIONS ERP was commonly found in this healthy military population. Preventing the risk of sudden death in this population requires systematic ECG screening, medical history analysis and clinical examination to identify symptomatic patients.
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Affiliation(s)
- Ulric Vinsonneau
- Department of Cardiology, Clermont Tonnerre Hospital of Military Training, 29240, Brest, France
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1446
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Abstract
The wars in Afghanistan and Iraq have been challenging for US uniformed service families and their children. Almost 60% of US service members have family responsibilities. Approximately 2.3 million active duty, National Guard, and Reserve service members have been deployed since the beginning of the wars in Afghanistan and Iraq (2001 and 2003, respectively), and almost half have deployed more than once, some for up to 18 months' duration. Up to 2 million US children have been exposed to a wartime deployment of a loved one in the past 10 years. Many service members have returned from combat deployments with symptoms of posttraumatic stress disorder, depression, anxiety, substance abuse, and traumatic brain injury. The mental health and well-being of spouses, significant others, children (and their friends), and extended family members of deployed service members continues to be significantly challenged by the experiences of wartime deployment as well as by combat mortality and morbidity. The medical system of the Department of Defense provides health and mental health services for active duty service members and their families as well as activated National Guard and Reserve service members and their families. In addition to military pediatricians and civilian pediatricians employed by military treatment facilities, nonmilitary general pediatricians care for >50% of children and family members before, during, and after wartime deployments. This clinical report is for all pediatricians, both active duty and civilian, to aid in caring for children whose loved ones have been, are, or will be deployed.
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1447
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Abstract
STUDY OBJECTIVES Considerable research indicates that sleep disturbances and insomnia are more common and severe among individuals following a traumatic brain injury (TBI). It remains unclear, however, how the experience of multiple TBIs affect sleep disturbances and insomnia. The current study investigated the incidence and severity of insomnia and sleep complaints among active-duty military personnel who have sustained multiple TBIs. DESIGN AND SETTING Upon intake at a military TBI clinic located in Iraq, 150 male military patients completed standardized self-report measures and clinical interviews. MEASUREMENTS AND RESULTS Patients were categorized into three groups according to history of TBI: zero TBIs (n = 18), single TBI (n = 54), multiple TBIs (n = 78). Rates of clinical insomnia significantly increased across TBI groups (P < 0.001):- 5.6% for no TBIs, 20.4% for single TBI, and 50.0% for multiple TBIs. Insomnia severity significantly increased across TBI groups even when controlling for depression, posttraumatic stress disorder, and concussion symptom severity (B = 1.134, standard error = 0.577, P = 0.049). CONCLUSIONS Multiple TBIs are associated with increased risk for and severity of sleep disturbance among male military personnel.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies, Salt Lake City, UT 84112, USA.
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1448
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Abstract
Ballistic protection for the neck has historically taken the form of collars attached to the ballistic vest (removable or fixed), but other approaches, including the development of prototypes incorporating ballistic material into the collar of an under body armour shirt, are now being investigated. Current neck collars incorporate the same ballistic protective fabrics as the soft armour of the remaining vest, reflecting how ballistic protective performance alone has historically been perceived as the most important property for neck protection. However, the neck has fundamental differences from the thorax in terms of anatomical vulnerability, flexibility and equipment integration, necessitating a separate solution from the thorax in terms of optimal materials selection. An integrated approach towards the selection of the most appropriate combination of materials to be used for each of the two potential designs of future neck protection has been developed. This approach requires evaluation of the properties of each potential material in addition to ballistic performance alone, including flexibility, mass, wear resistance and thermal burden. The aim of this article is to provide readers with an overview of this integrated approach towards ballistic materials selection and an update of its current progress in the development of future ballistic neck protection.
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Affiliation(s)
- John Breeze
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
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1449
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Goodwin RD, Prescott M, Tamburrino M, Calabrese JR, Liberzon I, Galea S. Smoking is a predictor of depression onset among National Guard soldiers. Psychiatry Res 2013; 206:321-3. [PMID: 23291043 PMCID: PMC3701300 DOI: 10.1016/j.psychres.2012.11.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 11/05/2012] [Accepted: 11/13/2012] [Indexed: 11/16/2022]
Abstract
This report examines the relationship between smoking and depression in a sample of American soldiers. Persistent, active smoking is associated with increased risk of incident depression at follow up. History of smoking in the absence of current smoking at baseline was not associated with depression at follow-up.
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Affiliation(s)
- Renee D Goodwin
- Columbia University, Mailman School of Public Health, 722 West 168th Street, NY 10032, USA.
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1450
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Insana SP, Hall M, Buysse DJ, Germain A. Validation of the Pittsburgh Sleep Quality Index Addendum for posttraumatic stress disorder (PSQI-A) in U.S. male military veterans. J Trauma Stress 2013; 26:192-200. [PMID: 23512653 PMCID: PMC3746481 DOI: 10.1002/jts.21793] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 10/31/2012] [Accepted: 11/27/2012] [Indexed: 11/05/2022]
Abstract
Sleep disturbances are core symptoms of posttraumatic-stress disorder (PTSD), yet they bear less stigma than other PTSD symptoms. Given the growing number of returning military veterans, brief, valid assessments that identify PTSD in a minimally stigmatizing way may be useful in research and clinical practice. The study purpose was to evaluate the psychometric properties of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A), and to examine its ability to identify PTSD cases among U.S. male military veterans. Male military veterans (N = 119) completed the PSQI-A, as well as measures of sleep quality, combat exposure, posttraumatic stress, depression, and anxiety. Veterans with PTSD had higher PSQI-A identified disruptive nocturnal behaviors than veterans without PTSD. The PSQI-A had good internal consistency and convergent validity with sleep quality, combat exposure, PTSD symptoms, depression, and anxiety. A cutoff score ≥ 4 provided an area under the curve = .81, with 71% sensitivity, 82% specificity, and 60% positive and 83% negative predictive value for a clinical diagnosis of PTSD; correct classification was 74%. The PSQI-A is a valid measure to possibly detect PTSD among male military veterans. Assessment of disruptive nocturnal behaviors may provide a cost-effective, nonstigmatizing approach to PTSD screening without directly probing for trauma exposure(s).
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Affiliation(s)
| | - Martica Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine,
,Department of Psychology, University of Pittsburgh Pittsburgh Pennsylvania, USA
| | - Daniel J. Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine,
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine,
,Department of Psychology, University of Pittsburgh Pittsburgh Pennsylvania, USA
,Corresponding author. Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O’Hara St., Pittsburgh, PA 15213, USA; .
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