Perceived stress and personal growth following the transition to military service: The role of sense of coherence and perceived social support

Relying on personal growth and structuration theories, we aimed to examine the internal (sense of coherence/SOC and help-seeking/HS) and external (perceived social support) resources that contribute to soldiers' personal growth following the transition to military service. We also investigated the role that perceived social support plays in moderating the relationship between SOC and personal growth, and between HS and personal growth. Two-hundred-and-seventy-one compulsory service soldiers (of whom 135 were men and 136 were women) completed self-report questionnaires between 6 and 12 months post-recruitment. The results showed both linear and curvilinear associations between soldiers' perceived stress and personal growth; SOC, HS, and perceived social support were positively correlated with personal growth; and perceived social support moderated both SOC and HS correlations with personal growth. Empirical evidence of personal growth in the transition to military service has been scant. Transitioning from civilian life to military service can be stressful and even traumatic but it can also provide opportunities for personal development. Our findings shed light on contributors to personal growth in the transition to military service, with both internal and external resources found to help one gain personal growth. It is evident that in order for soldiers to thrive, both perceived social support and active help-seeking are key factors.

First unprovoked seizures among soldiers recruited to the Israeli Defense Forces during 10 consecutive years: A population-based study

OBJECTIVE

The management of patients after a first unprovoked seizure (FUS) can benefit from stratification of the average 50% risk for further seizures. We characterized subjects with FUSs, out of a large generally healthy homogenous population of soldiers recruited by law to the Israeli Defense Forces, to investigate the role of the type of service, as a trigger burden surrogate, in the risk for additional seizures.

METHODS

Soldiers recruited between 2005 and 2014, who experienced an FUS during their service, were identified from military records. Subjects with a history of epilepsy or lack of documentation of FUS characteristics were excluded from the study. Data on demographics and military service and medical details were extracted for the eligible soldiers.

RESULTS

Of 816 252 newly recruited soldiers, representing 2 138 000 person-years, 346 had an FUS, indicating an incidence rate of 16.2 per 100 000 person-years. The FUS incidence rate was higher in combat versus noncombat male and female soldiers (p < .0001). Most subjects (75.7%) were prescribed antiseizure medications (ASMs), and 29.2% had additional seizures after the FUS. Service in combat units, abnormal magnetic resonance imaging, and being prescribed ASMs were correlated with a lower risk of having multiple seizures (95% confidence interval [CI] = .48-.97, .09-.86, .15-.28, respectively). On multivariate analysis, service in combat units (odds ratio [OR] = .48 for seizure recurrence, 95% CI = .26-.88) and taking medications (OR = .46, 95% CI = .24-.9) independently predicted not having additional seizures.

SIGNIFICANCE

FUS incidence rate was higher in combat soldiers, but they had a twofold lower risk of additional seizures than noncombat soldiers, emphasizing the value of strenuous triggers as negative predictors for developing epilepsy. This suggests a shift in the perception of epilepsy from a "yes or no" condition to a continuous trend of predisposition to seizures, warranting changes in the ways etiologies of epilepsy are weighted and treatments are delivered.

Enlisting in the army in the Jewish Ultraorthodox community and the consequences for wellbeing

Israeli law requires citizens to enlist in the army at 18 years old. However, the Jewish Ultraorthodox community has a longstanding agreement with the state that members of this community will not have to enlist in the army, given its spiritual leaders' strong opposition. Still, there are young men who go against the communal norms and enlist. In the current study we investigated these young men and the contribution of their self-esteem (a personal resource), their sense of community (a communal resource), and the community members' attitudes toward them (societal conditional regard, both positive and negative, and stigma) to their wellbeing. The current study consisted of 153 participants between the ages of 20 and 55 (M = 29.64, SD = 6.89). A path analysis model indicated the protective role played by self-esteem and sense of community in participants' wellbeing, and the risk factor posed by societal conditional negative regard and stigma. Moreover, self-esteem was found to mediate between income and wellbeing, whereas sense of community was found to mediate between societal conditional negative regard and wellbeing, and between stigma and wellbeing. The discussion highlights the complexity of the protective role played by sense of community against the risk of experiencing societal conditional negative regard and stigma. It also addresses the importance of promoting intervention programs during the army service of these young men, with a focus on promoting their self-esteem and on the presence of a spiritual leadership that legitimizes working, serving in the army, and yet still being part of the community.

Associations among meaning in life, coping, and distress in trauma-exposed U.S. military veterans

Experiencing meaning in life may be particularly relevant following traumatic experiences as individuals who report meaning post trauma report less psychological distress. Engaging in avoidant coping, however, may be a sign of underlying psychological distress in the aftermath of traumatic experiences. We sought to examine associations among meaning in life, avoidant coping, and psychological distress in a sample of trauma-exposed veterans. Secondary cross-sectional analyses were conducted on data from veterans exposed to a traumatic event(s) who experienced clinically meaningful guilt (N = 145). Questionnaires on meaning in life, avoidant coping, and psychological distress were administered, and structural equation modeling was used to test direct effects. Path analysis revealed that greater meaning was associated with lower depression, anxiety, and posttraumatic stress symptomatology, while higher avoidant coping was associated with greater depression, anxiety, posttraumatic stress, and somatization symptomatology. Participants who report more meaning in life and report lower avoidant coping post trauma may experience less psychological distress. If replicated longitudinally, results could suggest cultivating meaning in life and reducing avoidant coping may decrease psychological distress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Israeli soldiers' intentions and actions toward seeking mental health help: Barriers and facilitators

BACKGROUND

While military settings may increase psychological distress, soldiers frequently avoid seeking professional help. This study aimed to examine barriers and facilitators associated with intentions to seek help and actually seeking help from a mental health officer (MHO) and how these differ among soldiers who had sought help in the past and those who had not.

METHOD

This cross-sectional study included 263 combat and noncombat soldiers. The Health Belief Model and the Help-Seeking Model were the theoretical framework used to map the potential variables associated with soldiers' decision to seek help.

RESULTS

Stigma and administrative barriers were found to be significant barriers to both the intention to seek help and actually consulting an MHO. These findings were more definitive among combat soldiers. The belief in the effectiveness of mental health treatment was positively associated with the intention to seek help. Positive associations were found between well-being, perceived seriousness of one's condition, and belief in the effectiveness of mental health care and intention to seek MHO help. Distress and self-concealment were positively associated with actual consultation with an MHO. Public stigma about seeking help was associated with both the intention to seek mental health assistance and actually consulting an MHO.

CONCLUSION

Military commanders should make an effort to make soldiers feel safe to seek mental health assistance by creating a supportive organizational atmosphere to reduce the stigma associated with mental health care.

Acceptability and Feasibility of Delivering Decision Aids to Veterans for Management of Knee Osteoarthritis - A Pilot Study

Introduction

Decision aids are effective tools in facilitating patient-centered care and patient involvement in the decision-making process. Given unique barriers to providing patient-centered care for Veterans, implementation of decision aids may improve overall quality of care. We aimed to assess the acceptability and feasibility of video-based and pamphlet-based decision aid use in Veterans with knee osteoarthritis.

Materials and Methods

Veterans considering treatment for knee osteoarthritis received either an online video-based aid, pamphlet-based aid, or both before their surgical consult. At their visit, patients completed written pre-visit and post-visit questionnaires. The pre-visit questionnaire included questions about the patient's demographics, decision-making preferences, experiences using the assigned decision aids, and the Hip-Knee Decision Quality Instrument. The post-visit questionnaire assessed the patient's overall experience with the decision-making process and how use of the decision aid influenced their discussion with the physician.

Results

All 16 patients who received the pamphlet-based aid reviewed the decision aid before their visit, compared to only five of the 12 patients who received the video-based aid. Thirteen of 20 patients indicated that they preferred to share treatment decision-making with their physician. Seventeen of 20 patients believed they would feel comfortable questioning the treatment recommendation of their surgeon after decision aid use. Most patients reported a positive experience using their decision aid, regardless of modality, and found it easily comprehensible and useful in visit preparation. A preference for a pamphlet-based aid was expressed by the majority of patients.

Conclusion

Veterans considering treatment for knee osteoarthritis are well prepared to engage in a patient-centered care experience. Most patients preferred sharing the decision-making process with their physician and felt comfortable questioning them about treatment recommendations. Decision aids helped Veterans feel more informed about their treatment options and improved engagement and discussion with their physician. Pamphlet-based aids were utilized more reliably than video-based aids.

Military performance of men with attention-deficit/hyperactivity disorder: findings from a follow-up study in the Northern Finland birth cohort 1986

PURPOSE

The aim of this study was to assess the military performance of men with adolescent attention-deficit/hyperactivity disorder (ADHD) and men with childhood ADHD (in remission during adolescence) as compared with controls without ADHD.

METHODS

The study employs the general population-based Northern Finland Birth Cohort 1986 (NFBC1986) together with data received from the Finnish Defence Forces (FDF). A total of 38 men with childhood ADHD and 67 with adolescent ADHD were compared with 160 controls.

RESULTS

The men with adolescent ADHD were more often deemed unfit for military service, had more military health care visits, more often committed at least one offence during service, received poorer evaluations for team leadership skills and indulged in more alcohol consumption and smoking than the controls, while those with childhood ADHD did not differ from the controls in their military fitness, but received poorer evaluations for team leadership skills and smoked more than did the controls.

CONCLUSION

The conscripts with adolescent ADHD performed worse on many military parameters, but the men with ADHD in remission did not seem to suffer from such negative effects on military performance. The childhood ADHD group in particular was nevertheless somewhat limited in size, which might have led to a Type II error.

Dietary Supplement and Prescription Medication Use among US Military Service Members with Clinically Diagnosed Medical Conditions: The US Military Dietary Supplement Use Study

BACKGROUND

Use of prescription medications (PM) with dietary supplements (DSs) can be hazardous because of potential adverse interactions, but patterns of dual use in military service members (SMs) has not been examined.

OBJECTIVE

Investigate dual use of filled PMs (FPMs) and DSs, factors associated with dual use, and dual use among SMs with clinically-diagnosed medical conditions (CDMCs).

DESIGN

Cross-sectional. Data on FPM and CDMCs were obtained from medical surveillance records. Between December 2018 and August 2019, participants completed a questionnaire on DS use in the previous 6 months.

PARTICIPANTS

A stratified random sample of 26,880 service members (SMs) from all military services.

MAIN OUTCOME MEASURES

Prevalence of dual use of FPM with DSs within a 6-month period, demographic/lifestyle factors associated with dual use, and prevalence of dual use among SMs with CDMCs.

STATISTICAL ANALYSIS

Prevalences were calculated as percents; Chi-square statistics examined differences across various strata of demographic and lifestyle characteristics; univariable and multivariable logistic regression determined the odds of using FPM with DSs use for various CDMCs.

RESULTS

About one-half (49%) of SMs had use dual of FPM with DSs in the 6-month period. Dual use was higher among women; increased with older age, more formal education, higher body mass index, and more physical activity; was highest among American Indian SMs and lowest among Asian SMs; was higher among former tobacco users; and was highest among Army personnel, lowest among Marine Corps personnel. The overall prevalence of dual use in the 6-month period was higher among those with a CDMC than those without (62% vs. 19%) and this relationship was maintained for 20 International Classification of Diseases, Revision 10, code groupings covering virtually all CDMCs.

CONCLUSION

This is the first study to document a high prevalence of dual FPMs and DSs in SMs, especially among those with CDMCs.

Guidelines for Diagnosing and Quantifying Noise-Induced Hearing Loss

This paper makes recommendations for the diagnosis and quantification of noise-induced hearing loss (NIHL) in a medico-legal context. A distinction is made between NIHL produced by: steady broadband noise, as occurs in some factories; more impulsive factory sounds, such as hammering; noise exposure during military service, which can involve very high peak sound levels; and exposure to very intense tones. It is argued that existing diagnostic methods, which were primarily developed to deal with NIHL produced by steady broadband noise, are not adequate for the diagnosis of NIHL produced by different types of exposures. Furthermore, some existing diagnostic methods are based on now-obsolete standards, and make unrealistic assumptions. Diagnostic methods are proposed for each of the types of noise exposure considered. It is recommended that quantification of NIHL for all types of exposures is based on comparison of the measured hearing threshold levels with the age-associated hearing levels (AAHLs) for a non-noise exposed population, as specified in ISO 7029 (2017), usually using the 50^th percentile, but using another percentile if there are good reasons for doing so. When audiograms are available both soon after the end of military service and some time afterwards, the most recent audiogram should be used for diagnosis and quantification, since this reflects any effect of the noise exposure on the subsequent progression of hearing loss. It is recommended that the overall NIHL for each ear be quantified as the average NIHL across the frequencies 1, 2, and 4 kHz.

Modification of a Method for Diagnosing Noise-Induced Hearing Loss Sustained During Military Service

Moore (2020) proposed a method for diagnosing noise-induced hearing loss (NIHL) sustained during military service, based on an analysis of the shapes of the audiograms of military personnel. The method, denoted M-NIHL, was estimated to have high sensitivity but low-to-moderate specificity. Here, a revised version of the method, denoted rM-NIHL, was developed that gave a better balance between sensitivity and specificity. A database of 285 audiograms of military noise-exposed men was created by merging two previously used databases with a new database, randomly shuffling, and then splitting into two, one for development of the revised method and one for evaluation. Two comparable databases of audiograms of 185 non-exposed men were also created, again one for development and one for evaluation. Based on the evaluation databases, the rM-NIHL method has slightly lower sensitivity than the M-NIHL method, but the specificity is markedly higher. The two methods have similar overall diagnostic performance. If an individual is classified as having NIHL based on a positive diagnosis for either ear, the rM-NIHL method has a sensitivity of 0.98 and a specificity of 0.63. Based on a positive diagnosis for both ears, the rM-NIHL method has a sensitivity of 0.76 and a specificity of 0.95.

Subjective well-being among male veterans in later life: the enduring effects of early life adversity

OBJECTIVES

This study investigated the association between childhood and young adult adversities and later-life subjective well-being among older male veterans. We also explored whether early-life parent-child relationships and later-life social engagement served as moderators and mediators, respectively.

METHODS

Data were from the 2008 to 2012 waves of the Health and Retirement Study for male veterans (N = 2026). Subjective well-being measures included depressive symptoms, self-rated health, and life satisfaction. Linear regression with the Process macro was employed to estimate the relationships.

RESULTS

Adverse childhood experiences (ACEs) were positively associated with number of depressive symptoms and negatively related to life satisfaction. Combat exposure, a young adulthood adversity experience, was positively associated with depressive symptoms, but not with self-rated health or life satisfaction. Later-life social engagement mediated the relationship between ACEs and subjective well-being indices. Parent-child relationship quality did not moderate the association between the measures of adversity and any measure of subjective well-being.

DISCUSSION

Childhood adversity and combat exposure were related to worse later life subjective well-being. Also, later-life social engagement mediated the association of two early life adversity measures and subjective well-being. Future research should examine subjective well-being and early life adversity for female veterans and should employ more detailed information about combat exposure.

The model of psychological safety of a soldier's personality

BACKGROUND

From 2014 to the present, Ukrainian military personnel have been fighting in Eastern Ukraine against illegal armed formations of separatists. The resulting combat stress negatively affects servicemen's mental health status. This study aimed to examine the factor structure of a scale to assess the psychological safety of a soldier's personality (PSSP), taking into account changes in the conditions of military service to improve the professional and psychological training of military personnel.

PARTICIPANTS AND PROCEDURE

The study involved 118 officers of the National Guard of Ukraine. The semantic differential method, expert judgment, and exploratory factor analysis were used to determine the factor structure of the PSSP.

RESULTS

The PSSP model to maintain combat readiness in daily activities includes four components: "Moral and communicative", "Motivational and volitional", "Value and meaning of life" and "Inner comfort". For activities in extreme conditions (during combat deployment), the personality potential of four structural components is used: "Moral and volitional regulation", "Coping strategies", "Value and meaning of life" and "Post-traumatic growth/regression".

CONCLUSIONS

The PSSP model consists of four components that have different content depending on the conditions for performance of professional tasks by military personnel. It is advisable to use the obtained results of the content of the PSSP model in the development of professional and psychological training programs for the purposeful formation of the resilience of military personnel, taking into account the conditions of their activities.

Understanding processes that advance suicidal behavior among Israeli active duty soldiers: A mediation model

OBJECTIVES

The current study was aimed to identify the factors and mechanisms that promote nonsuicidal self-injury and suicidal ideation (SI) as precursors of suicidal behaviors in a sample of 553 Israeli active-duty soldiers.

METHODS

A mediation model was used to examine the contribution of posttraumatic stress disorder (PTSD) symptoms, emotion-regulation difficulties, habituation, and risk-taking behaviors to soldiers' self-injury and SI.

RESULTS

Results indicated direct effects between PTSD symptoms and self-injury and SI, as well as between emotion regulation difficulties and self-injury. Indirect effects were found between PTSD symptoms and nonsuicidal self-injury (NSSI) through the mechanisms of habituation and risk-taking behavior and between difficulties in emotion regulation and NSSI through the mechanism of risk-taking behaviors.

CONCLUSION

To tackle soldiers' suicidal behaviors, clinicians might assess soldiers' PTSD symptoms and difficulties in emotion regulation and intervene by lessening their access to thrill-seeking situations and situations that increase habituation to pain and death.

War across the life course: examining the impact of exposure to conflict on a comprehensive inventory of health measures in an aging Vietnamese population

BACKGROUND

The majority of evidence indicates that exposure to war and other traumatic events continue to have negative impacts on health across the life course. However, existing research on health effects of war exposure primarily concentrates on short-term impacts among veterans in high-income countries sent elsewhere to battle. Yet, most wars situate in lower- and middle-income countries, where many are now or will soon be entering old age. Consequently, the current burden of exposure to war has ignored an important global population.

METHODS

The Vietnam Health and Aging Study (VHAS) is a longitudinal study designed to examine historical exposure to highly stressful events during the American War. Two modes of data collection, involving a sample of 2447 individuals aged 60+ years in northern Vietnam, took place between May and August 2018. Using this first wave of data, we generate indexed measures of war exposure and analyze their associations with a set of 12 health outcomes, accounting for confounding variables.

RESULTS

Results indicate that greater exposure to three types of war exposure (death and injury, stressful living conditions, and fearing death and/or injury) in earlier life is associated with worse health in later-life across a large number of health outcomes, such as number of diagnosed health conditions, mental distress, somatic symptoms, physical functioning, post-traumatic stress symptoms and chronic pain.

CONCLUSIONS

Findings support a life course theory of health and point to long-term effects of war on health that require detailed attention.

[The analysis of achievement of prognostic indices of the Concept of the Federal system of training of citizen to military service]

The article analyzes the achievement of the prognostic indices of the Concept of the federal system of training citizens for military service for the period up to 2020 (to reduce the number of citizens who do not meet the requirements of military service due to health and physical conditions; to increase the rate of fitness for military service of citizens who have arrived at draft commissions; to ensure the availability of the first sports category or sports rank for citizens who are subject to military service draft). The causes and factors preventing the achievement of the target values of the Concept are considered. The set of measures targeting to improve medical support of the youth of military draft age is proposed.

The Effect of Exposure to Noise during Military Service on the Subsequent Progression of Hearing Loss

This paper reviews and re-analyses data from published studies on the effects of noise exposure on the progression of hearing loss once noise exposure has ceased, focusing particularly on noise exposure during military service. The data are consistent with the idea that such exposure accelerates the progression of hearing loss at frequencies where the hearing loss is absent or mild at the end of military service (hearing threshold levels (HTLs) up to approximately 50 dB HL), but has no effect on or slows the progression of hearing loss at frequencies where the hearing loss exceeds approximately 50 dB. Acceleration appears to occur over a wide frequency range, including 1 kHz. However, each of the studies reviewed has limitations. There is a need for further longitudinal studies of changes in HTLs over a wide range of frequencies and including individuals with a range of HTLs and ages at the end of military service. Longitudinal studies are also needed to establish whether the progression of hearing loss following the end of exposure to high-level sounds depends on the type of noise exposure (steady broadband factory noises versus impulsive sounds).

Leon L. Wiltse, MD (1913-2005)

This biographical sketch draws on articles written by and about one of the most influential orthopedic spine surgeons of our time, Dr. Leon L. Wiltse. Our aim is to commemorate his life and contributions to the fields of orthopedic and spine surgery, while also highlighting his early connections to the Dallas area.

The Role of Past Suicidal Behavior on Current Suicidality: A Retrospective Study in the Israeli Military

Past suicide attempts are a significant risk factor for future suicidality. Therefore, the present military-based study examined the past suicidal behavior of soldiers who recently made a severe suicide attempt. Our sample consisted of 65 active-duty soldiers (61.5% males), between the ages of 18 and 28 years old (M = 20.4, SD ± 1.3). The inclusion criterion was a recent severe suicide attempt, requiring at least a 24 h hospitalization. This sample was divided into two groups, according to previous suicidal behavior, namely whether their first suicide attempt was before or after enlistment (n = 25; 38.5% and n = 40; 61.5%, respectively). We then examined the lethality and intent of the recent event in regard to this division. Four measures were used to assess the subjects' suicidal characteristics: the Columbia Suicide Severity Rating Scale, the Self-Harm Behavior Questionnaire, the Suicidal Behaviors Questionnaire-Revised, and the Beck Scale for Suicide Ideation. No significant difference in the severity of the suicide attempts (either actual or potential severity) were found between those who had suicide attempts before enlistment and those who had their first attempt in the service. As a matter of fact, most of the suicide attempts that occurred for the first time during military service had used a violent method (58.3%, n = 21). Finally, using multivariate analyses, we found that current thoughts and behavior, rather than past suicidality, was the strongest predictor for the lethality of suicide attempts.

Military service and related risk factors for amyotrophic lateral sclerosis

BACKGROUND

The cause of amyotrophic lateral sclerosis (ALS) is unknown, but occupations have been explored as a potential proxy measure of risk. There is a substantial body of literature connecting military service to ALS. We aimed to summarize and assess the quality of this evidence.

METHODS

Systematic review of the literature, including observational studies which explored one of the following exposures: general military service (army, air force, marines, or navy); or specific exposures associated with military service measured among military personnel. The outcome of interest was ALS incidence, which could include onset, diagnosis, or death from ALS.

RESULTS

A total of 2642 articles were screened. Following exclusion, 19 articles remained for inclusion in the systematic review, including 1 meta-analysis and 18 original observational studies. Most studies were of moderate quality. In general, the relationship between military service was suggestive of an increased risk, particularly among Gulf War and WWII veterans. Exposure to pesticides (including Agent Orange) certain chemicals (exhaust, burning agents), heavy metals, and head trauma appeared to increase the risk of ALS among military personnel.

CONCLUSIONS

There is a possible association between military service and the subsequent development of ALS; however, the evidence was limited. Studies were generally hindered by small sample sizes and inadequate follow-up time. Future studies should endeavor to objectively measure specific exposures, or combinations thereof, associated with military service, as this will be of vital importance in implementing preventative strategies into military organizations.

Military-related experiences and late-life depressive symptomatology among Japanese-American world war II veterans

Objectives: To examine military service-related variables and late-life depressive symptomatology among older Japanese-American males.Method: This study is a secondary data analysis of a longitudinal, community-based study. A sample of 2669 participants (771 World War II veterans, 1898 civilians) was drawn from the Honolulu-Asia Aging Study. Depressive symptoms were assessed twice across a 9-year period with the Center for Epidemiologic Studies-Depression scale. Covariates included sociodemographic, physical health, health behavior, and psychosocial variables. Combat exposure and symptomatology were examined among a subset of 426 veterans. Cross-sectional and longitudinal designs were analyzed with linear regression.Results: Veterans and civilians did not differ in depression scores. Baseline depression scores significantly predicted follow-up depression scores. For the full sample, lower ratings of quality of life satisfaction, daily activity control and general health were associated with higher depression scores both cross-sectionally and longitudinally. Among veterans, light combat exposure was marginally associated with lower depression scores and longitudinally, previous depression scores and poorer health ratings were significant predictors of depression scores.Conclusion: Results suggest that military service does not affect late-life depressive symptomatology. However, combat exposure may play a marginal role in increased symptoms. Reasons for results include the possibility that other factors are more relevant to late-life depression, symptomatology naturally decreasing over time, or type of combat exposure measurement. Results expand literature by examination of an ethnoracial group not studied often and longitudinal examination of late-life depressive symptoms within a military-related context. Stakeholders should be knowledgeable of the distinct issues presented when serving aging veterans.

Three cusps are better than two: bicuspid aortic valve and implications for military service

Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation. It is an aortopathy and is associated with other congenital heart disease. Although there is no mortality increase with BAV, the natural history increases the risk of aortic valve disease, aortic dilatation and infective endocarditis over the time frame of a full military career. Military service theoretically increases the risk of aortic dilatation and endocarditis in BAV. Conversely, there are some who have BAV who would not suffer any complications during their military career. Currently, potential UK Army recruits undergo personal/family history and physical examination plus an ECG and, although this goes beyond American Heart Association guidelines, it does not screen specifically for BAV. This would necessitate a transthoracic echo for each potential recruit but would be a considerable increase in resources-both time and financial. In addition to the recruitment medical, military personnel undergo frequent medicals, which could identify those who develop significant valvular disease. Those with mild valve disease are at lowest risk of complication. Those with aortic dilatation only remain a concern.

Disability Rating and 1-Year Mortality Among Veterans With Service-Connected Health Conditions

OBJECTIVES

Military service is associated with an increased risk of disability and death after discharge. This study determined the relationships among characteristics, disability ratings, and 1-year mortality risks of veterans receiving compensation for service-connected health conditions (ie, conditions related to illnesses or injuries incurred or aggravated during military service).

METHODS

This study included 4 010 720 living veterans who had ≥1 service-connected health condition and were receiving disability compensation on October 1, 2016. We obtained data on veteran demographic, military service, and disability characteristics from the Veterans Benefits Administration VETSNET file and on 1-year mortality from the Veterans Administration vital status file. We compared veteran characteristics and 1-year mortality rates within and between the following combined service-connected disability rating categories: low, 10% to 40% disability; medium, 50% to 90% disability; high, 100% disability. We used logistic regression analysis to determine the relationships between disability ratings and 1-year mortality rates.

RESULTS

Of 4 010 720 veterans, 515 095 (12.8%) had high disability ratings, 1 600 786 (39.9%) had medium disability ratings, and 1 894 839 (47.2%) had low disability ratings. The 1-year mortality rates were 4.5% for those with high disability, 1.9% for those with medium disability, and 1.9% for those with low disability ratings. Compared with veterans with low disability ratings, veterans with high disability ratings had more than twice the odds of 1-year mortality (odds ratio = 2.45; 95% confidence interval, 2.40-2.50).

CONCLUSIONS

The combined disability rating is an important determinant of short-term survival among veterans with service-connected health conditions. Veterans with a 100% disability rating comprise a highly select group with increased short-term risk of death due at least in part to their military service. Future studies assessing the relationships among combat exposure, age, duration of disability, disability ratings, and survival would be valuable.

The Effect of Vietnam-Era Conscription and Genetic Potential for Educational Attainment on Schooling Outcomes

This study examines whether draft lottery estimates of the causal effects of Vietnam-era military service on schooling vary by an individual's genetic propensity toward educational attainment. To capture the complex genetic architecture that underlies the bio-developmental pathways, behavioral traits and evoked environments associated with educational attainment, we construct polygenic scores (PGS) for respondents in the Health and Retirement Study (HRS) that aggregate thousands of individual loci across the human genome and weight them by effect sizes derived from a recent genome-wide association study (GWAS) of years of education. Our findings suggest veterans with below average PGSs for educational attainment may have completed fewer years of schooling than comparable non-veterans. On the other hand, we do not find any difference in the educational attainment of veterans and non-veterans with above average PGSs. Results indicate that public policies and exogenous environments may induce heterogeneous treatment effects by genetic disposition.

Resilience Mediates Impact of Some Childhood Maltreatment on Post-Traumatic Stress Symptoms in Conscripted Marines in the Republic of Korea

Although it is known that post-traumatic stress symptoms (PTSS) can result from military service, the variance in PTSS unexplained by military service warrants further investigation, and no researchers have investigated South Korean Marines' vulnerability during their 2-year conscripted service as the first line of national defense against threats from North Korea. This study was designed to examine whether resilience mediated the relationship between childhood maltreatment and PTSS in 169 Korean conscripts into the Marine Corps. In a cross-sectional study design, the Childhood Trauma Questionnaire-Short Form was used to measure childhood maltreatment, including abuse and neglect. The Impact of Event Scale-Revised and the Connor-Davidson Resilience Scale were used to measure PTSS and resilience. Structural equation modeling was used for data analysis. Half the conscripts reported at least one type of childhood maltreatment, and 22.3% had high PTSS, even in a short period of service. Childhood abuse was significantly associated with PTSS during military service, a relationship that was not mediated by resilience. However, resilience mediated the relationship between childhood neglect and PTSS during military service. Assessment of childhood maltreatment and resilience prior to military service is crucial for identifying conscripts at increased risk for PTSS during even brief military service. In addition to direct interventions for abuse effects among all Marines, interventions enhancing resilience may benefit conscripts who experienced childhood neglect. © 2016 Wiley Periodicals, Inc.

The Influence of Men's Military Service on Smoking Across the Life Course

The military is described as a social context that contributes to the (re-)initiation or intensification of cigarette smoking. We draw on data from the 1985-2014 National Survey of Drug Use and Health (NSDUH) and the Wisconsin Longitudinal Study (WLS) to conduct complementary sub-studies of the influence of military service on men's smoking outcomes across the life course. Descriptive findings from an age-period-cohort analysis of NSDUH data document higher probabilities of current smoking and heavy smoking among veteran men across a broad range of cohorts and at all observed ages. Findings from sibling fixed-effects Poisson models estimated on the WLS data document longer durations of smoking among men who served in the military and no evidence that selection explains the observed relationship. Together, these results provide novel and potentially generalizable evidence that participation in the military in early adulthood exerts a causal influence on smoking across the life course.

Pastoral Care and Counseling with Military Families

The complex human experience of military service and the stress suffered by millions of military families each time a loved one deploys present unique challenges and opportunities in providing pastoral care and counseling. War and military service impact many facets of our society, as well as generational and interpersonal relationships. This article speaks to both academic and practitioner communities, and provides a vision for effective pastoral care and counseling with military families drawing on resources from family systems theory.

Acute Kidney Injury in Critically Injured Combat Veterans: A Retrospective Cohort Study

BACKGROUND

Acute kidney injury (AKI) has been associated with mortality after traumatic injury. However, there is a paucity of data for military service members with injuries received in combat. We sought to identify risk factors for AKI after combat trauma and evaluate whether AKI is a predictor of mortality.

STUDY DESIGN

Retrospective observational study.

SETTINGS & PARTICIPANTS

US service members who were critically wounded in Iraq or Afghanistan from February 1, 2002, to February 1, 2011, and survived until evacuation to Landstuhl Regional Medical Center, Germany.

PREDICTORS

Demographic variables, vital signs, injury severity score, presence of burn injury, and mechanism of injury as defined at the time of initial injury, as well as the presence of AKI ascertained within the first 7 days using KDIGO (Kidney Disease: Improving Global Outcomes) serum creatinine criteria.

OUTCOMES

Logistic regression models were used to identify risk factors for both AKI and death.

RESULTS

Of 6,011 records, 3,807 were included for analysis after excluding patients with missing data. AKI occurred in 474 (12.5%) patients and 112 (2.9%) died. More patients with versus without AKI died (n=62 [13.1%] vs n=50 [1.5%]; P<0.001). After adjustment, AKI was a predictor of mortality (OR, 5.14; 95% CI, 3.33-7.93; P<0.001). Predictors of AKI were age, African American race, injury severity score, amputations, burns, and presenting vital signs.

LIMITATIONS

AKI diagnoses limited to creatinine-based definitions.

CONCLUSIONS

AKI predicted mortality in combat veterans injured in the wars in Iraq and Afghanistan.

Serving the army as secretaries: intersectionality, multi-level contract and subjective experience of citizenship

With the growing elusiveness of the state apparatus in late modernity, military service is one of the last institutions to be clearly identified with the state, its ideologies and its policies. Therefore, negotiations between the military and its recruits produce acting subjects of citizenship with long-lasting consequences. Arguing that these negotiations are regulated by multi-level (civic, group, and individual) contracts, we explore the various meanings that these contracts obtain at the intersectionality of gender, class, and ethnicity; and examine how they shape the subjective experience of soldierhood and citizenship. More particularly, we analyse the meaning of military service in the retrospective life stories of Israeli Jewish women from various ethno-class backgrounds who served as army secretaries - a low-status, feminine gender-typed occupation within a hyper-masculine organization. Findings reveal that for women of the lower class, the organizing cultural schema of the multi-level contract is that of achieving respectability through military service, which means being included in the national collective. Conversely, for middle-class women, it is the sense of entitlement that shapes their contract with the military, which they expect to signify and maintain their privileged status. Thus, while for the lower class, the multi-level contract is about inclusion within the boundaries of the national collective, for the dominant groups, this contract is about reproducing social class hierarchies within national boundaries.

Long-term community reintegration: concepts, outcomes and dilemmas in the case of a military service member with a spinal cord injury

PURPOSE

Despite growing knowledge about medical and functional recovery in clinical settings, the long-term issue of community reintegration with a spinal cord injury (SCI) in the military context remains virtually unexamined. Thus, the U.S. Department of Defense created the SCI Qualitative Research Program to advance knowledge about service members' reintegration into civilian life. The purpose of this paper is to better characterize the long-term outcomes related to the community participation experienced and desired vis-à-vis a case study of a military veteran who suffered a service-related traumatic SCI.

METHODS

An in-depth anthropological interview was used with Jake, a 28-year old marine with a service-related C5/C6 SCI. Data were analyzed using content analysis.

FINDINGS

Three significant themes were identified: opportunities for better engaging socially meaningful others may not be adequately included in so-called "client-centered" interventions; how management of the social self in inter-personal interactions and public spaces is critical to gaining broader societal acceptance; and how meaningful age normative relationships and activities are essential to establish lasting inclusive social connections.

CONCLUSIONS

Jake's case challenges existing models of rehabilitation predominantly focused on physical capacity building. Study findings point to the need for rehabilitation to invest more resources in efforts to address the existential and social elements of long-term social reintegration. Implications for Rehabilitation Both the veteran with SCI and their meaningful support network face challenges socially reintegrating after injury and rehabilitation. Empowering clients to envision future possibilities in terms of family, intimate relationships, and meaningful work are important to successful long-term social reintegration. Addressing the existential desires and social capacities of the individual may be as important as addressing physical functioning skills after SCI.

HIV risk behavior and access to services: what predicts HIV testing among heterosexually active homeless men?

HIV is a serious epidemic among homeless persons, where rates of infection are estimated to be three times higher than in the general population. HIV testing is an effective tool for reducing HIV transmission and for combating poor HIV/AIDS health outcomes that disproportionately affect homeless persons, however, little is known about the HIV testing behavior of homeless men. This study examined the association between individual (HIV risk) and structural (service access) factors and past year HIV testing. Participants were a representative sample of 305 heterosexually active homeless men interviewed from meal programs in the Skid Row region of Los Angeles. Logistic regression examined the association between past year HIV testing and demographic characteristics, HIV risk behavior, and access to other services in the Skid Row area in the past 30 days. Despite high rates of past year HIV testing, study participants also reported high rates of HIV risk behavior, suggesting there is still significant unmet need for HIV prevention among homeless men. Having recently used medical/dental services in the Skid Row area (OR: 1.91; CI: 1.09, 3.35), and being a military veteran (OR: 2.10; CI: 1.01-4.37) were significantly associated with HIV testing service utilization. HIV testing was not associated with HIV risk behavior, but rather with access to services and veteran status, the latter of which prior research has linked to increased service access. We suggest that programs encouraging general medical service access may be important for disseminating HIV testing services to this high-risk, vulnerable population.

The Pervasive Role of Rank in the Health of U.S. Veterans

The following article tests the hypothesis that veterans have better health if they were officers when they were in the U.S. military than if they served in the enlisted ranks. It examines this hypothesis by presenting results from logistic regressions that are based on four surveys: the National Survey of Veterans, the Survey of Retired Military, the Panel Study of Income Dynamics, and the Wisconsin Longitudinal Study. In all four of these surveys, the evidence is consistent with the hypothesis that military rank is associated with health, particularly among veterans who served longer. It also suggests that the health gradient by rank is independent of similar gradients by education and income as well as health differences by race. These findings indicate that health may be influenced not just by differences in civilian society but also by those in the military.

The Privileges of Rank: The Peacetime Draft and Later-life Attainment

This article examines the effects of peacetime cold war military service on the life course according to four potentially overlapping theories that state that military service (1) was a disruption, (2) was a positive turning point, (3) allowed veterans to accumulate advantage, and (4) was an agent of social reproduction. The article argues that the extent to which the effect of military service on veterans' lives corresponds with one or another of the preceding theories depends on historical shifts in three dimensions: conscription, conflict, and benefits. Military service during the peacetime draft era of the late 1950s had a neutral effect on the socioeconomic attainment of enlisted veterans. However, it had a positive effect on veterans who served as officers, which partly stemmed from status reproduction and selection. Yet net of pre-service and educational differences by rank, officers in this peacetime draft era were still able to accumulate advantage.

Military positions and post-service occupational mobility of Union Army veterans, 1861-1880

Although the Civil War has attracted a great deal of scholarly attention, little is known about how different wartime experiences of soldiers influenced their civilian lives after the war. This paper examines how military rank and duty of Union Army soldiers while in service affected their post-service occupational mobility. Higher ranks and non-infantry duties appear to have provided more opportunities for developing skills, especially those required for white-collar jobs. Among the recruits who were unskilled workers at the time of enlistment, commissioned and non-commissioned officers were much more likely to move up to a white-collar job by 1880. Similarly, unskilled recruits assigned to white-collar military duties were more likely to enter a white-collar occupation by 1880. The higher occupational mobility of higher-ranking soldiers is likely to have resulted from disparate human capital accumulations offered by their military positions rather than from their superior abilities.