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Kopelman ZA, Baker TM, Aden JK, Ramirez CI. Postoperative Venous Thromboembolism Following Hysterectomy in the Department of Defense. Mil Med 2024; 189:1106-1113. [PMID: 36892149 DOI: 10.1093/milmed/usad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/04/2022] [Accepted: 02/23/2023] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Hysterectomy is the most common major gynecologic procedure performed in the USA. Surgical complications, such as venous thromboembolism (VTE), are known risks that can be mitigated by preoperative risk stratification and perioperative prophylaxis. Based on recent data, the current post-hysterectomy VTE rate is found to be 0.5%. Postoperative VTE significantly impacts health care costs and patients' quality of life. Additionally, for active duty personnel, it can negatively impact military readiness. We hypothesize that the incidence of post-hysterectomy VTE rates will be lower within the military beneficiary population because of the benefits of universal health care coverage. MATERIALS AND METHODS The Military Health System (MHS) Data Repository and Management Analysis and Reporting Tool was used to conduct a retrospective cohort study of postoperative VTE rates within 60 days of surgery among women who underwent a hysterectomy at a military treatment facility between October 1, 2013, and July 7, 2020. Patient demographics, Caprini risk assessment, preoperative VTE prophylaxis, and surgical details were obtained by chart review. Statistical analysis was performed using the chi-squared test and Student t-test. RESULTS Among the 23,391 women who underwent a hysterectomy at a military treatment facility from October 2013 to July 2020, 79 (0.34%) women were diagnosed with VTE within 60 days of their surgery. This post-hysterectomy VTE incidence rate (0.34%) is significantly lower than the current national rate (0.5%, P < .0015). There were no significant differences in postoperative VTE rates with regard to race/ethnicity, active duty status, branch of service, or military rank. Most women with post-hysterectomy VTE had a moderate-to-high (4.29 ± 1.5) preoperative Caprini risk score; however, only 25% received preoperative VTE chemoprophylaxis. CONCLUSION MHS beneficiaries (active duty personnel, dependents, and retirees) have full medical coverage with little to no personal financial burden for their health care. We hypothesized a lower VTE rate in the Department of Defense because of universal access to care and a presumed younger and healthier population. The postoperative VTE incidence was significantly lower in the military beneficiary population (0.34%) compared to the reported national incidence (0.5%). Additionally, despite all VTE cases having moderate-to-high preoperative Caprini risk scores, the majority (75%) received only sequential compression devices for preoperative VTE prophylaxis. Although post-hysterectomy VTE rates are low within the Department of Defense, additional prospective studies are needed to determine if stricter adherence to preoperative chemoprophylaxis can further reduce post-hysterectomy VTE rates within the MHS.
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Affiliation(s)
- Zachary A Kopelman
- Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Tieneka M Baker
- Department of Obstetrics and Gynecology, New Mexico Veterans Affairs Health Care System, Albuquerque, NM 87131, USA
| | - James K Aden
- Department of Graduate Medical Education, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Christina I Ramirez
- Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
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Sharifian N, Kolaja CA, LeardMann CA, Castañeda SF, Carey FR, Seay JS, Carlton KN, Rull RP, Cohort Study Team FTM. Racial, Ethnic, and Sex Disparities in Mental Health Among US Service Members and Veterans: Findings From the Millennium Cohort Study. Am J Epidemiol 2024; 193:500-515. [PMID: 37968361 DOI: 10.1093/aje/kwad221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 11/17/2023] Open
Abstract
Although disparities in mental health occur within racially, ethnically, and sex-diverse civilian populations, it is unclear whether these disparities persist within US military populations. Using cross-sectional data from the Millennium Cohort Study (2014-2016; n = 103,184; 70.3% male; 75.7% non-Hispanic White), a series of logistic regression analyses were conducted to examine whether racial, ethnic, and/or sex disparities were found in mental health outcomes (posttraumatic stress disorder (PTSD), depression, anxiety, and problematic anger), hierarchically adjusting for sociodemographic, military, health-related, and social support factors. Compared with non-Hispanic White individuals, those who identified as American Indian/Alaska Native, non-Hispanic Black, Hispanic/Latino, or multiracial showed greater risk of PTSD, depression, anxiety, and problematic anger in unadjusted models. Racial and ethnic disparities in mental health were partially explained by health-related and social support factors. Women showed greater risk of depression and anxiety and lower risk of PTSD than men. Evidence of intersectionality emerged for problematic anger among Hispanic/Latino and Asian or Pacific Islander women. Overall, racial, ethnic, and sex disparities in mental health persisted among service members and veterans. Future research and interventions are recommended to reduce these disparities and improve the health and well-being of diverse service members and veterans.
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Jones MU, Banaag A, Nafea SS, Koehlmoos TP. Evaluation of Racial Disparities in Suspected Child Abuse among Insured Children with Head Injury. CHILD MALTREATMENT 2023; 28:713-722. [PMID: 36571822 DOI: 10.1177/10775595221148424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Previous studies demonstrate racial disparities in child abuse evaluations even after controlling for health insurance coverage. We conducted a cross-sectional study using the Military Health System Data Repository (MDR) of Military Health System (MHS) beneficiaries born between fiscal years 2016 and 2018 to evaluate racial disparities and other factors in the suspicion of child abuse. We observed beneficiaries for 2.5 years after birth and assessed the incidence of head injury using diagnostic codes. Among children with head injury codes, we performed a multivariable logistic regression analysis to measure the association between race and the concurrent use of the diagnostic code for suspected child abuse (SCA) or for the performance of a skeletal survey. There were 195,893 infants included and 45,269 (23.1%) underwent evaluations for head injury. Less than one percent (n = 424) concurrently had the diagnostic code for SCA or a skeletal survey performed within 2 weeks of the head injury evaluation. When controlling for other factors, race was not associated with SCA. Higher military rank was independently associated with decreased odds of SCA. Racial disparities in SCA may be mitigated in the MHS, and further evaluation is needed. Military rank could be a factor in SCA disparities and warrants further study.
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Affiliation(s)
- Milissa U Jones
- Department of Pediatrics, Uniformed Services University, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Amanda Banaag
- Department of Pediatrics, Tripler Army Medical Center, Tripler Army Medical Center, HI, USA
| | - Shamim S Nafea
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA
| | - Tracey Perez Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA
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Lundeberg K, Tindal R, Grob PC, Hamilton J, Gonzalez-Brown VM, Keyser E. Military healthcare system mitigates racial disparities for severe maternal morbidity from preeclampsia. AJOG GLOBAL REPORTS 2023; 3:100215. [PMID: 37362057 PMCID: PMC10285530 DOI: 10.1016/j.xagr.2023.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND In the United States, Black women die at 2.5 times the rate of White women and 3.5 times the rate of Hispanic women. These racial health care disparities have been largely attributed to access to health care and other social determinants of health. OBJECTIVE We hypothesize that the Military healthcare system models universal health care access seen in other developed countries and should equalize these rates. STUDY DESIGN Delivery data from 41 Military treatment facilities across the Department of Defense (Army, Air Force, and Navy) including over 36,000 deliveries from 2019 to 2020 were compiled in a convenience dataset through the National Perinatal Information Center. After aggregation, the parameters of percent of deliveries complicated by Severe Maternal Morbidity and percent of severe maternal morbidity secondary to pre-eclampsia with and without transfusion were calculated. Risk ratios were calculated by race for the resulting summary data. American Indian/Alaska Native were excluded because of limited total number deliveries preventing statistical analyses. RESULTS Overall, the risk of severe maternal morbidity was increased among Black women compared to White women. The risk of severe maternal morbidity related to pre-eclampsia showed no significant difference among races with or without transfusion. When other races were set as reference group, there was a significant difference for White women, suggesting a protective effect. CONCLUSION Although women of color still experience overall severe maternal morbidity at higher rates than their White counterparts, TRICARE may have equalized the risk of severe maternal morbidity for deliveries complicated by pre-eclampsia.
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Affiliation(s)
- Kathleen Lundeberg
- Department of Obstetrics and Gynecology, Wright-Patterson Medical Center, Wright-Patterson Air Force Base, OH (Dr Lundeberg)
| | - Rachel Tindal
- Obstetrics and Gynecology associated with each medical center, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, Fort Sam Houston, TX (Drs Tindal, Gonzalez-Brown, and Keyser)
| | - Patrizia C. Grob
- Department of Obstetrics and Gynecology, Womack Army Medical Center, Fort Bragg, NC (Dr Grob)
| | - Jameaka Hamilton
- Obstetrics and Gynecology associated with each medical center, Mike O'Callaghan Military Medical Center, Nellis Air Force Base, Las Vegas, NV (Dr Hamilton)
| | - Veronica M. Gonzalez-Brown
- Obstetrics and Gynecology associated with each medical center, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, Fort Sam Houston, TX (Drs Tindal, Gonzalez-Brown, and Keyser)
| | - Erin Keyser
- Obstetrics and Gynecology associated with each medical center, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, Fort Sam Houston, TX (Drs Tindal, Gonzalez-Brown, and Keyser)
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Black men in white coats - Barriers black men face in medicine, implications to decreased representation, and potential interventions at the uniformed services university of the health sciences. J Natl Med Assoc 2023; 115:147-156. [PMID: 36717351 DOI: 10.1016/j.jnma.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/27/2022] [Accepted: 01/09/2023] [Indexed: 01/29/2023]
Abstract
The number of black male applicants to US medical schools has remained stagnant over the last 30 years. The etiology behind the lack of applicants is multifaceted and involves greater systemic barriers, specifically, educational and social barriers. The lack of representation of black males in medicine also has downstream implications for the health of the African American/black community. African Americans exhibit some of the lowest levels of trust in the healthcare system, have less access to care than their non-minority peers, and have, comparatively, poorer healthcare outcomes than other populations in the US. Research has demonstrated that patient-provider race concordance improves communication, outcomes, culturally competent care, and satisfaction with care. The greater the gap between these two populations, the harder it becomes to improve healthcare outcomes, maintain a medically ready fighting force in the US military, and improve trust in the healthcare system. This article provides an analysis of the multifactorial barriers black male applicants face applying, matriculating, and graduating medical school and how decreased representation may affect healthcare delivery. Furthermore, this review explores next steps and potential implementations at the Uniformed Services University of the Health Sciences to address the above deficiencies.
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Oliver JD, Nee R, Grunwald LR, Banaag A, Pavkov ME, Burrows NR, Koehlmoos TP, Marks ES. Prevalence and Characteristics of CKD in the US Military Health System: A Retrospective Cohort Study. Kidney Med 2022; 4:100487. [PMID: 35812527 PMCID: PMC9257409 DOI: 10.1016/j.xkme.2022.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Rationale & Objective The US Military Health System (MHS) is a global health care network with a diverse population that is more representative of the US population than other study cohorts and with fewer disparities in health care access. We aimed to examine the prevalence of chronic kidney disease (CKD) in the MHS and within demographic subpopulations. Study Design Multiple cross-sectional analyses of demographic and claims-based data extracted from the MHS Data Repository, 1 for each fiscal year from 2006-2015. Setting & Population Multicenter health care network including active-duty military, retirees, and dependents. The average yearly sample size was 3,285,348 individuals. Exposures Age, sex, race, active-duty status, and active-duty rank (a surrogate for socioeconomic status). Outcome CKD, defined as the presence of matching International Classification of Diseases, Ninth Revision, codes on either 1 or more inpatient or 2 or more outpatient encounters. Analytical Approach t test for continuous variables and χ2 test for categorical variables; multivariable logistic regression for odds ratios. Results For 2015, the mean (standard deviation) age was 38 (16). Crude CKD prevalence was 2.9%. Age-adjusted prevalence was 4.9% overall—1.9% active-duty and 5.4% non–active-duty individuals. ORs for CKD were calculated with multiple imputations to account for missing data on race. After adjustment, the ORs for CKD (all P < 0.001) were 1.63 (95% CI, 1.62-1.64) for an age greater than 40 years, 1.16 (95% CI, 1.15-1.17) for Black race, 1.15 (95% CI, 1.14-1.16) for senior enlisted rank, 0.94 (95% CI, 0.93-0.95) for women, and 0.50 (95% CI, 0.49-0.51) for active-duty status. Limitations Retrospective study based on International Classification of Diseases, Ninth Revision, coding. Conclusions Within the MHS, older age, Black race, and senior enlisted rank were associated with a higher risk of CKD, whereas female sex and active-duty status were associated with a lower risk.
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Smith HJ. Ethical Responsibilities of a Military to the Social Determinants of Health of its Service Members. Mil Med 2022; 187:252-256. [PMID: 35389484 DOI: 10.1093/milmed/usab554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/19/2021] [Accepted: 12/24/2021] [Indexed: 11/15/2022] Open
Abstract
A military exists in a unique position. It is an organization in which active duty members knowingly join or are conscripted into service with the understanding that there is an increased risk of mental and/or bodily harm as compared to many other occupations. However, while the nature of the profession can inherently be dangerous, it does not follow that its members be placed at undue excess risk if that risk can be reasonably avoided or reduced. Social determinants of health are one example of influences under a military's purview that impact health outcomes and well-being. Although the U.S. Military performs well across many health equity measures, disparities persist and require attention and redress. Military policies and practices deeply impact members' lives during and after service, and the durability and profundity of these effects establish the ethical grounds upon which any military policy should be structured. The ethical obligation is fortified by the extent of control a military exercises over its personnel. Taken together, these factors necessitate a concerted effort by militaries to remain cognizant of the ethical impacts of their policies and practices and to ensure focus remains on the well-being and readiness of its personnel. As such, militaries have ethical responsibilities to promote healthy social determinants of health among their service members via policies and public health measures.
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Affiliation(s)
- Hunter Jackson Smith
- Department of Emerging Infectious Diseases, U.S. Army Medical Research Directorate-Africa, Kisumu 40103, Kenya.,Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD 20814, USA
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Martin R, Banaag A, Riggs DS, Koehlmoos TP. Minority Adolescent Mental Health Diagnosis Differences in a National Sample. Mil Med 2021; 187:e969-e977. [PMID: 34387672 DOI: 10.1093/milmed/usab326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/16/2021] [Accepted: 07/28/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Mental health disparities and differences have been identified amongst all age groups, including adolescents. However, there is a lack of research regarding adolescents within the Military Health System (MHS). The MHS is a universal health care system for military personnel and their dependents. Research has indicated that the MHS removes many of the barriers that contribute to health disparities. Additional investigations with this population would greatly contribute to our understanding of disparities and health services delivery without the barrier of access to care. MATERIALS AND METHODS This study analyzed the diagnostic trends of anxiety, depression, and impulse control disorders and differences within a national sample of adolescents of active-duty military parents. The study utilized 2006 to 2014 data in the MHS Data Repository for adolescents ages 13-18. The study identified 183,409 adolescents with at least one diagnosis. Multivariable logistic regressions were conducted to assess the differences and risks for anxiety, depression, and impulse control disorders in the identified sample. RESULTS When compared to White Americans, minority patients had a higher likelihood of being diagnosed with an impulse control disorder (odds ratio [OR] = 1.43; confidence interval [CI] 1.39-1.48) and a decreased likelihood of being diagnosed with a depressive disorder (OR = 0.98; CI 0.95-1.00) or anxiety disorder (OR = 0.80; CI 0.78-0.83). Further analyses examining the subgroups of minorities revealed that, when compared to White Americans, African American adolescents have a much higher likelihood of receiving a diagnosis of an impulse control disorder (OR = 1.66; CI 1.61-1.72) and a lower likelihood of receiving a diagnosis of a depressive disorder (OR = 0.93; CI 0.90-0.96) and an anxiety disorder (OR = 0.75; CI 0.72-0.77). CONCLUSION This study provides strong support for the existence of race-based differences in adolescent mental health diagnoses. Adolescents of military families are a special population with unique experiences and stressors and would benefit from future research focusing on qualitative investigations into additional factors mental health clinicians consider when making diagnoses, as well as further exploration into understanding how best to address this special population's mental health needs.
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Affiliation(s)
- Raquel Martin
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Amanda Banaag
- Department of Preventive Medicine and Biostatistics, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD 20817, USA
| | - David S Riggs
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Tracey P Koehlmoos
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Pope J, Banaag A, Madsen C, Hanson T, Khan M, Koehlmoos TP. The Mitigation of Racial Disparities in Cervical Cancer Screening Among U.S. Active Duty Service Women. Mil Med 2021; 186:e373-e378. [PMID: 33175967 DOI: 10.1093/milmed/usaa427] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/02/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The U.S. Preventive Services Task Force recommends regular cervical cancer screening for women aged 21-65 years. Such screening is key to reducing mortality and morbidity. Despite improvement in the screening rate, cervical cancer still disproportionately affects women of minority groups because of access to quality health care. The Military Health System (MHS) mitigates this barrier through universal healthcare coverage for all active duty service members and their families. However, such racial/ethnic disparities, seen in civilian population, have not been studied in the MHS. MATERIALS AND METHODS This is a retrospective cross-sectional study utilizing fiscal years 2011-2016 claims data obtained from the MHS Data Repository for 112,572 active duty service women aged 21-64 years. Study analyses included descriptive statistics on patient demographics, calculations of the proportion of patients who received cervical cancer screenings as well as the proportion of patients in compliance with USPSTF guidelines, and unadjusted odds ratios for the likelihood of compliance by race and military service. RESULTS Of the study population, 50.0% of active duty women were screened for cervical cancer. When compared to White women, Black (1.05 OR, 1.03-1.08 CI), Native American/Alaskan Native (1.26 OR, 1.15-1.39 CI), and Other (1.12 OR, 1.06-1.18 CI) women were significantly more likely to receive cervical cancer screenings. The proportions of 3-year compliance were relatively equal within each race category (ranging from 43% to 45%), with no significant findings for the odds of compliance in any race when compared to White active duty women; however, proportions of 3-year compliance by service ranged from 11.7% in the Marines to 84.4% in the Navy, and active duty women in the Navy were six times more likely to be in compliance with guidelines than women in the Army. When looking at 5-year compliance in active duty women aged 30-64 years, women in the Navy were more likely than women in the Army to meet compliance guidelines (1.24 OR, 1.14-1.36 CI), while women in the Air Force were slightly less likely (0.90 OR, 0.82-0.98 CI). CONCLUSIONS The women in our population demonstrated similar or lower compliance than other studies conducted in the U.S. general population, and racial disparities for cervical cancer screening were partially mitigated in active duty service women. While our research demonstrates that universal insurance can help provide equal access and care, investigation into the factors that encourage greater usage among members of different military branches may help to understand and develop policies to improve health care systems.
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Affiliation(s)
- Jessica Pope
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Amanda Banaag
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Cathaleen Madsen
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Tranessia Hanson
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Munziba Khan
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Tracey Perez Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
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Abstract
INTRODUCTION It is critical for the U.S. Army Medical Department to acknowledge the distinctive medical needs of soldiers and conceptualize soldier-centered care as a unique concept. In addition to the nationally recognized standards of patient-centered care, soldier-centered care includes provisions for the priorities of soldier health and wellness, injury prevention, illness and injury management, and the preservation of physical performance and medical readiness. The development of soldier-centered care as a distinctive concept may strengthen the evidence base for interventions that support improvements to soldier care and thus, enhance health outcomes specific to soldiers. The purpose of this article is to analyze the concept of soldier-centered care, clarify the meaning of soldier-centered care, and propose a theoretical definition. METHODS Rodgers' evolutionary concept analysis method was used to search and analyze the literature for related terms, attributes, antecedents, and consequences and to create a theoretical definition for soldier-centered care. RESULTS The results of this concept analysis indicated that soldier-centered care is realized through the presence of nine attributes: operational alignment of care, provider and support staff therapeutic competence, management of transitions and care coordination, technology and accessibility, management of limited and lost work days, trust and expectation management, leadership support, continuity, and access to care. Soldier-centered care is focused on health and wellness promotion, disease and injury prevention, and early diagnosis and treatment of acute injuries in the primary care setting to facilitate timely injury recovery, reduce reinjury, and prevent long-term disabilities. The result of soldier-centered care is enhanced physical performance, medical readiness, and deployability for soldiers. Based on the literature analysis, the following theoretical definition of soldier-centered care is proposed: Soldier-centered care is individualized, comprehensive healthcare tailored to the soldier's unique medical needs delivered by a care team of competent primary care providers and support staff who prioritize trust and expectation management, operational alignment of care, leadership support, care coordination, and the management of limited and lost workdays through the use of evidence-based practice approaches that employ innovative information technology to balance access to care and continuity. CONCLUSIONS The concept of soldier-centered care often emerges in discussions about optimal physical performance and medical readiness for soldiers. Although soldier-centered care and patient-centered care have similar conceptual underpinning, it is important to clarify the unique physical and medical requirements for soldiers that differentiate soldier-centered care from patient-centered care. Implementing the defining attributes of soldier-centered care in the U.S. Army primary care setting may improve the quality of care and health outcomes for soldiers. When defining performance metrics for primary care models of care, the U.S. Army Medical Department must consider assessing outcomes specific to the soldier population. Developing empirical indicators for the attributes of soldier-centered care will support meaningful testing of the concept.
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Affiliation(s)
- Tanekkia M Taylor-Clark
- University of Alabama at Birmingham, School of Nursing, 1701 University Boulevard, Birmingham, AL, 35205
| | - Patricia A Patrician
- University of Alabama at Birmingham, School of Nursing, 1701 University Boulevard, Birmingham, AL, 35205
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Ansley SD, Howard JT. Dietary Intake and Elevated C-Reactive Protein Levels in US Military Veterans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E403. [PMID: 33419190 PMCID: PMC7825497 DOI: 10.3390/ijerph18020403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/22/2020] [Accepted: 12/30/2020] [Indexed: 02/08/2023]
Abstract
Elevated inflammatory markers, such as high sensitivity C-reactive protein (hs-CRP), have been associated with the pathogenesis of cardiovascular disease (CVD)-related diseases. However, limited studies have evaluated the potential association between dietary consumption and hs-CRP levels in a large, nationally representative sample, and fewer have investigated their role in ethnic and racial minority military populations. The goal of this study is to explore the relationship between dietary intake, health behaviors, and hs-CRP in individuals with prior military status and whether these associations differ by race/ethnicity. A complex, multistage, probability sample design was used from the National Health and Nutrition Examination (NHANES) 2015-2018 waves. Our results indicate that previously deployed military service members had a higher prevalence of clinically elevated hs-CRP levels than civilians. Differences in hs-CRP among deployed veterans and civilians remained even after multivariable adjustment. Individuals classified as overweight and obese demonstrated clinically elevated hs-CRP levels compared with those with a normal body mass index (BMI). Dietary factors did not attenuate the association between changes in hs-CRP levels and veteran status. These findings suggest the need for further investigation into how military-specific stressors contribute to unfavorable health outcomes for the military population.
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Affiliation(s)
- Stephanie D. Ansley
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX 78249, USA;
- Consequences of Trauma Working Group, the Center for Community-Based and Applied Health Research, University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Jeffrey T. Howard
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX 78249, USA;
- Consequences of Trauma Working Group, the Center for Community-Based and Applied Health Research, University of Texas at San Antonio, San Antonio, TX 78249, USA
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Ditch S, Roberts TA, Hansen S. The influence of health care utilization on the association between hormonal contraception initiation and subsequent depression diagnosis and antidepressant use. Contraception 2020; 101:237-243. [PMID: 31935385 DOI: 10.1016/j.contraception.2019.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Assess the influence of healthcare utilization on previously reported associations between contraception initiation, diagnosis of depression, and dispensing of antidepressant medications. STUDY DESIGN Retrospective cohort analysis of insurance records from 272,693 women ages 12-34 years old enrolled in the United States Military Healthcare System in September 2014 and followed for 12 months. We compared outcomes of women who initiated hormonal contraception with all women eligible for care and then with women who accessed care during the study month using Kaplan-Meier and Cox proportional hazards analyses. RESULTS Women age 12-34 who initiated hormonal contraception experienced a higher risk of depression diagnosis and antidepressant use when compared to all enrolled women but not when compared to women who accessed care. Among those who accessed care, some progestins (i.e., levonorgestrel, Hazard Ratio (HR) = 1.46, and norelgestromin, HR = 1.93) were associated with an increased rate of depression diagnosis but not antidepressant use; norethindrone (HR = 0.21) was associated with a decreased rate of depression diagnosis. CONCLUSION When compared to women utilizing their health insurance, associations between initiating hormonal contraception and depression diagnosis and antidepressant use decreased or disappeared. This suggests that healthcare utilization may have confounded previous reports of an association between hormonal contraception use and depression and antidepressant use.
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Affiliation(s)
- Sarah Ditch
- Adolescent Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr., Fort Sam Houston, TX 78234, United States.
| | - Timothy A Roberts
- Adolescent Medicine/Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City, School of Medicine, Kansas City, MO, United States.
| | - Shana Hansen
- Adolescent Medicine/Pediatrics, San Antonio Military Medical Center, 3100 Schofield Rd. Bldg. 1179, Fort Sam Houston, TX 78234, United States
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Schoenfeld AJ, Belmont PJ, Blucher JA, Jiang W, Chaudhary MA, Koehlmoos T, Kang JD, Haider AH. Sustained Preoperative Opioid Use Is a Predictor of Continued Use Following Spine Surgery. J Bone Joint Surg Am 2018; 100:914-921. [PMID: 29870441 DOI: 10.2106/jbjs.17.00862] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative opioid use is known to increase the likelihood of complications and inferior outcomes following spine surgery. We evaluated the association of preoperative opioid use and other risk factors with postoperative opioid use. METHODS We queried 2006-2014 TRICARE insurance claims to identify adults who underwent lumbar interbody arthrodesis, lumbar discectomy, lumbar decompression, or lumbar posterolateral arthrodesis. The duration of preoperative opioid use was categorized as acute exposure, exposed without sustained use, intermediate sustained use, and chronic sustained use. Cox proportional-hazard models that adjusted for demographic factors, preoperative diagnoses, comorbidities, postoperative complications, and the type of procedure performed were used to identify factors associated with a reduced likelihood of opioid discontinuation following the surgical procedure. RESULTS There were 27,031 patients included in this analysis. Following the surgical procedure, 67.1% of patients had discontinued opioid use by 30 days, and 86.4% had ceased use by 90 days. Overall, 2,379 patients (8.8%) continued to use opioid medications at 6 months. Duration of preoperative opioid use, among other demographic and clinical factors, was the most important predictor of continued use following a surgical procedure. CONCLUSIONS The majority of patients who were using prescription opioids prior to the surgical procedure discontinued these medications postoperatively. Duration of preoperative use appears to be the most important predictor of sustained use following a surgical procedure. CLINICAL RELEVANCE Our results indicate that the majority of patients who are using prescription opioids prior to spine surgery discontinue these medications following surgical intervention. Among those who continue opioid use ≥90 days after the surgical procedure, the duration of preoperative use appears to be the most important predictor.
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Affiliation(s)
- Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Philip J Belmont
- Departments of Surgery (P.J.B.) and Preventive Medicine and Biostatistics (T.K.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Justin A Blucher
- Department of Orthopaedic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Muhammad Ali Chaudhary
- Department of Orthopaedic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tracey Koehlmoos
- Departments of Surgery (P.J.B.) and Preventive Medicine and Biostatistics (T.K.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - James D Kang
- Department of Orthopaedic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adil H Haider
- Department of Orthopaedic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Universal insurance and an equal access healthcare system eliminate disparities for Black patients after traumatic injury. Surgery 2018; 163:651-656. [DOI: 10.1016/j.surg.2017.09.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/05/2017] [Accepted: 09/13/2017] [Indexed: 11/23/2022]
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