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MacGregor AJ, Zouris JM, Dougherty AL, Dye JL. The Psychological Consequences of Combat Injury Among U.S. Navy Health Care Personnel. Mil Med 2024; 189:742-747. [PMID: 36255104 DOI: 10.1093/milmed/usac298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/08/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Military health care personnel face numerous risks to mental health, including those associated with combat injury, although no study has described combat injuries within this subgroup or assessed their impact on mental health outcomes. MATERIALS AND METHODS Male U.S. Navy-enlisted health care personnel, or corpsmen, with combat injury were identified from clinical records. Noninjured corpsmen were matched to injured corpsmen with a 4:1 ratio on year of deployment end or injury and location (Iraq or Afghanistan). The final study population included 2,025 corpsmen (405 injured and 1,620 noninjured). Mental health disorders assessed included posttraumatic stress disorder (PTSD), anxiety, adjustment, mood, and substance abuse disorders. Stratified Cox models were used for analysis while controlling for additional covariates, and injury severity was evaluated as a predictor. RESULTS Injuries primarily involved the head/neck (73.8%) and extremities (45.7%), and overall injury severity was mostly mild-to-moderate (85.9%). Injured relative to noninjured corpsmen had greater risk of PTSD (risk ratio [RR] 2.45, 95% confidence interval [CI] 2.05 to 2.94), anxiety disorder (RR 1.61, 95% CI 1.32 to 1.96), adjustment disorder (RR 1.88, 95% CI 1.55 to 2.27), mood disorder (RR 1.44, 95% CI 1.16 to 1.79), and substance abuse (RR 1.48, 95% CI 1.14 to 1.91). More severe injuries yielded stronger associations with PTSD (RR 3.57, 95% CI 2.48 to 5.14), anxiety disorder (RR 2.53, 95% CI 1.74 to 3.69), and adjustment disorder (RR 2.17, 95% CI 1.44 to 3.27). CONCLUSIONS U.S. Navy corpsmen are at risk of combat injury and associated mental health disorders. Injured corpsmen should be screened for mental health problems in the acute phase postinjury, during their remaining time in theater, and after returning home. Future research should address how combat injury compares with other stressors that health care personnel experience and whether the psychological consequences of these injuries (e.g., PTSD) negatively impact work performance and increase risk of burnout.
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Affiliation(s)
- Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA 92106, USA
- Axiom Resource Management, Inc., San Diego, CA 92106, USA
| | - James M Zouris
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA 92106, USA
- Leidos, Inc., San Diego, CA 92106, USA
| | - Judy L Dye
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA 92106, USA
- Leidos, Inc., San Diego, CA 92106, USA
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Evans AJ, Russo CM, Tovar MA, Liu A, Conley SP. Physiologic Fidelity as a Domain in Assessing Mixed Reality Trauma Simulation. Mil Med 2023; 188:3322-3329. [PMID: 35994047 DOI: 10.1093/milmed/usac244] [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: 04/07/2022] [Revised: 07/11/2022] [Accepted: 08/02/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Mixed reality has been used in trauma and emergency medicine simulation for more than a decade. As mixed reality potential in trauma simulation continues to expand, so too does the need to validate it as a surrogate for real-life emergency scenarios. Validation of these simulations can occur by measuring fidelity, or the degree to which a computing system can reproduce real-world experiences. After performing a literature review, we determined that most fidelity assessments of trauma and emergency simulations focus on how the user subjectively experiences the simulation. Although subjective user assessment is an important component of determining fidelity, we pose an introductory three-part framework that may assess mixed reality trauma simulation more adequately. MATERIALS AND METHODS A literature review was conducted using Google Scholar, PubMed, and the Uniformed Services University PowerER search database. Relevant articles were assessed to identify how studies measured fidelity in trauma simulation. We then designed the three-part framework to aid researchers in assessing the fidelity of mixed reality trauma simulations. RESULTS The domains we determined to best assess mixed reality emergency simulation are as follows:1. Continue assessing fidelity via subjective user assessments. This allows the researcher to know how real the simulation looked and felt to the user based on their individual report.2. Determine whether the trauma simulation changes the medical decision-making capacity of the user. If the user's decision-making capacity changes with a stress-inducing trauma simulation versus a non-stress-inducing simulation, then the stress-inducing trauma environment would be approaching greater fidelity.3. Study the domain of our newly proposed concept: physiologic fidelity. We define physiologic fidelity as the degree to which the simulation elicits a measurable, autonomic response independent of observed emotion or perceived affect. Recreating objective autonomic arousal may be the best way to ensure a trauma simulation reaches fidelity. CONCLUSION We propose a methodology to assess mixed reality trauma simulation fidelity. Once fidelity is more fully known to the researcher and the simulation user, adjustments can be made to approach reality more closely. Improved simulators may enrich the preparedness of both junior and senior learners for real-life emergencies. We believe assessing the three domains using the Wide Area Virtual Experience at the Val G. Hemming simulation center in Bethesda, MD, will validate mixed reality-trauma simulators as invaluable surrogates for real-life emergency scenarios and ultimately contribute to improved clinical outcomes for clinicians and their patients.
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Affiliation(s)
- Andrew J Evans
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Christopher M Russo
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Matthew A Tovar
- School of Medicine and Health Sciences, George Washington University, Washington, DC 20052, USA
| | - Alan Liu
- Virtual Medical Environments Laboratory, Val G. Hemming Simulation Center, Silver Spring, MD 20910, USA
| | - Sean P Conley
- Department of Military & Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Teixeira IG, Verzola MR, Filipini RE, Speretta GF. The effects of a firefighting simulation on the vascular and autonomic functions and cognitive performance: a randomized crossover study. Front Physiol 2023; 14:1215006. [PMID: 37811491 PMCID: PMC10551144 DOI: 10.3389/fphys.2023.1215006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction: During firefighting, physical and cognitive demands increase. However, the stress inherent to these events can decrease cognitive performance and increase the risk of cardiovascular events in firefighters. Thus, this crossover study aimed to evaluate the effects of a firefighting Simulation on cognitive performance and vascular and autonomic functions in military firefighters. Methods: Sixteen firefighters (37.8 ± 5.6 years) underwent anthropometry, mental health status, and sleep quality assessments. They randomly performed two interventions, Simulation (Firefighting tasks; 10.0 ± 1.1 min) and Control (rest for 10 min), on different days. After both interventions, cognitive performance was assessed using the Stroop Test, Paced Auditory Serial Addition Test, and Trail Making Test. Then, the vascular function was assessed using ultrasonography through the carotid artery reactivity to the cold pressor test. The arterial pressure, heart rate, and cardiac intervals were recorded before interventions. The cardiac intervals were also measured during the cold pressor test. Student's t-test and Wilcoxon were used for comparisons between Control and Simulation and the analysis of variance for repeated measures was used for comparison over time during the cold pressor test. A significance level of p < 0.05 was adopted. Results: Although the mean and maximum heart rate were higher before the Simulation (p < 0.0001), all the heart rate variability parameters (p > 0.05) and mean arterial pressure (p > 0.3795) were similar before the interventions. After Simulation, the cognitive performance was similar to Control (p > 0.05), except for the improvement in Stroop Test part B (p < 0.0001). After Simulation, carotid artery reactivity was attenuated (p < 0.0010). During the cold pressor test, the high-frequency band of the heart rate variability was lower after the Simulation (p < 0.0104). Discussion: Although firefighting Simulation did not substantially change cognitive performance, the lower carotid artery reactivity and parasympathetic modulation to the heart during the cold pressor test may contribute to greater vulnerability to cardiovascular events in firefighters on duty.
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Affiliation(s)
- Iara G. Teixeira
- Post-Graduate Program in Neurosciences, Federal University of Santa Catarina, Florianópolis, Brazil
- Department of Physiological Sciences, Biological Sciences Centre, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Marcio R. Verzola
- Military Firefighters Corps of Santa Catarina, Florianópolis, Brazil
| | - Richard E. Filipini
- Department of Physiological Sciences, Biological Sciences Centre, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Guilherme F. Speretta
- Post-Graduate Program in Neurosciences, Federal University of Santa Catarina, Florianópolis, Brazil
- Department of Physiological Sciences, Biological Sciences Centre, Federal University of Santa Catarina, Florianópolis, Brazil
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Qian YF, Liu Y, Wang L, Li Q, Sun RQ. Current status of post-traumatic stress disorder among emergency nurses and the influencing factors. Front Psychiatry 2023; 14:1203782. [PMID: 37732073 PMCID: PMC10507613 DOI: 10.3389/fpsyt.2023.1203782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/03/2023] [Indexed: 09/22/2023] Open
Abstract
Objective To gain a better understanding of the current state of traumatic stress experienced by emergency nurses of Grade III Level A hospitals in Jiangsu Province, as well as their coping styles after experiencing such traumatic events. Additionally, this study aims to identify the primary factors that influence the responses of these nurses to traumatic events. Methods Using a cluster random sampling method, we enrolled 265 nurses working in the emergency departments of five Grade III Level A hospitals in Jiangsu Province. These nurses participated in a questionnaire survey that included inquiries regarding general information, previous traumatic experiences, and a post-traumatic stress disorder self-assessment scale (PCL-C) for emergency department nurses. Results A total of 290 questionnaires were distributed, resulting in 265 valid questionnaires and an effective rate of 91.38%. These findings indicated that emergency nurses who participated in public health emergencies such as the COVID-19 pandemic (45.66%) and sudden health deterioration and death of patients (43.77%) encountered the most traumatic events. The top two traumatic events that had a moderate or greater impact on emergency nurses were verbal abuse from patients or their family members (39.24%) and verbal or physical threats by patients or their family members (35.09%). The mean PCL-C score of nurses who experienced traumatic events was 33.62 ± 11.37, with a positive rate of 26.04%. Results from the one-way analysis of variance and multiple linear regression analysis demonstrated that the working years, monthly income, and personal health status of emergency nurses were the main factors contributing to post-traumatic stress disorder. Conclusion Emergency nurses are susceptible to severe traumatic stress following traumatic events, and effective interventions are necessary to address the diverse factors that contribute to their psychological well-being.
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Affiliation(s)
- Yu-Fei Qian
- Department of Emergency, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Ying Liu
- Department of Nursing, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Li Wang
- Department of Emergency, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Qing Li
- Department of Emergency, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Rong-Qian Sun
- Department of Emergency, The Second Affiliated Hospital of Nantong University, Nantong, China
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Lawrence-Wolff KM, Higgs JB, Young-McCaughan S, Mintz J, Foa EB, Resick PA, Kelly KM, Maurer DM, Borah AM, Yarvis JS, Litz BT, Hildebrand BA, Williamson DE, Peterson AL. Prevalence of Fibromyalgia Syndrome in Active-Duty Military Personnel. Arthritis Care Res (Hoboken) 2023; 75:667-673. [PMID: 34606694 DOI: 10.1002/acr.24801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/19/2021] [Accepted: 09/30/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Previous research with civilian populations has found strong associations between fibromyalgia (FM) and posttraumatic stress disorder (PTSD). We undertook this study to investigate the prevalence of FM in military service members with and without PTSD. METHODS Participants were active duty military personnel recruited into either an epidemiologic cohort study of service members before a military deployment or 1 of 3 PTSD treatment trials. Instruments used to document FM and PTSD included the PTSD Checklist-Stressor-Specific Version, the PTSD Symptom Scale-Interview, and the 2012 American College of Rheumatology FM questionnaire. RESULTS Across the 4 studies, 4,376 subjects completed surveys. The prevalence of FM was 2.9% in the predeployment cohort, and the prevalence was significantly higher in individuals with PTSD (10.8%) compared with those without PTSD (0.8%). In the treatment trials, all of the participants met criteria for PTSD before starting treatment, and the prevalence of FM was 39.7%. CONCLUSION The prevalence of FM in active duty service members preparing to deploy is similar to that reported for the general population of the US but is higher than expected for a predominantly male cohort. Furthermore, the prevalence of FM was significantly higher in service members with comorbid PTSD and was highest among those seeking treatment for PTSD. Further investigation is needed to determine the factors linking PTSD and FM.
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Affiliation(s)
| | - Jay B Higgs
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas
| | - Stacey Young-McCaughan
- University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, Texas
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, Texas
| | - Edna B Foa
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | | | - Kevin M Kelly
- Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | | | - Adam M Borah
- Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | | | - Brett T Litz
- VA Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts
| | - Bernard A Hildebrand
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, and University of the Incarnate Word School of Osteopathic Medicine, San Antonio, Texas
| | | | - Alan L Peterson
- University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, Texas
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Moore BA, Judkins JL, Dyal MA, Schlenk M, Meyer E, Straud CL, Mysliwiec V, Peterson AL, Baker MT. Behavioral and Occupational Health in Military Firefighters: An Understudied Population. Behav Modif 2021; 46:453-478. [PMID: 34291696 DOI: 10.1177/01454455211033515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To our knowledge, no studies on health conditions in U.S. military firefighters exist. Data and demographics from the Defense Medical Epidemiology Database were analyzed on several shared medical issues among military personnel and civilian firefighters. Descriptive statistics and Chi-Square goodness of fit tests were conducted to support study aims. Between 2001 and 2015, substantial incidence rate increases (per 10,000) of tinnitus, PTSD, insomnia, and OSA (2005-2015) were observed. Modest to large increases in depressive disorders, adjustment reaction, generalized anxiety disorder, and panic disorder were observed. Decreasing rates were observed for alcohol dependence, hypertension, and tobacco use disorder. While efforts have examined the impact of sustained operations on military members, first responder military subgroups like firefighters are deficient. Cognitive Behavior Therapy interventions are efficacious for preventing and reducing behavioral health problems; therefore, tailoring them specifically for U.S. military firefighters could significantly improve quality of life and long-term health.
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Affiliation(s)
| | - Jason L Judkins
- US Army Institute of Environmental Medicine, Natick, MA, USA
| | | | | | | | - Casey L Straud
- University of Texas Health Science Center at San Antonio, USA.,University of Texas at San Antonio, USA.,South Texas Veterans Health Care System, San Antonio, USA
| | | | - Alan L Peterson
- University of Texas Health Science Center at San Antonio, USA.,University of Texas at San Antonio, USA.,South Texas Veterans Health Care System, San Antonio, USA
| | - Monty T Baker
- Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
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Chambers JA, Davidson C, Fanning NS, Genualdi JM. Leveraging Virtual Reality to Enhance Expeditionary Medical Team Performance in Three Key Areas. Mil Med 2020; 185:e1357-e1359. [PMID: 32426826 DOI: 10.1093/milmed/usaa072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/12/2020] [Accepted: 04/02/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- James A Chambers
- Department of Plastic Surgery, Malcolm Grow Medical Clinics, 1060 W Perimeter Road, Joint Base Andrews, MD 20762
| | - Colin Davidson
- Department of Obstetrics and Gynecology, Malcolm Grow Medical Clinics, 1060 W Perimeter Road, Joint Base Andrews, MD 20762
| | - Nicole Suzanne Fanning
- Department of Obstetrics and Gynecology, Malcolm Grow Medical Clinics, 1060 W Perimeter Road, Joint Base Andrews, MD 20762
| | - Joseph M Genualdi
- Department of Podiatry, Malcolm Grow Medical Clinics, 1060 W Perimeter Road, Joint Base Andrews, MD 20762
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