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Comment on "Self-Perception of Risk for HIV Acquisition and Calculated Risk for HIV Acquisition Among Active Duty Air Force Members With Newly Diagnosed HIV Infection". 对 "新确诊感染艾滋病毒的现役空军成员对艾滋病毒感染风险的自我感知和艾滋病毒感染风险的计算 "的评论。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae255
Hinpetch Daungsupawong, Viroj Wiwanitkit
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引用次数: 0
Force Health Surveillance in NATO Does Not Meet the Needs of Its Users: A Structured Evaluation of EpiNATO-2. 北约部队健康监测不能满足其用户的需求:对EpiNATO-2的结构化评估。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usad438
Adam Rowh, Robert Lindfield, Joanna Gaines

Introduction: Disease and non-battle injuries (DNBIs) cause substantial losses among military personnel. NATO has monitored DNBIs among its personnel since 1996 using multiple versions of a tool now called EpiNATO-2, but the surveillance system has never been systematically evaluated. Following a request from NATO to the CDC, the objective of this study was to assess surveillance system attributes of EpiNATO-2 using CDC's updated guidelines for evaluating public health surveillance systems.

Materials and methods: Between June and October 2022, a literature review and key informant interviews were conducted to assess the following attributes: usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, positive predictive value, representativeness, timeliness, stability, informatics system quality, informatics service quality, and informatics interoperability. Key informant interviews were conducted in Kosovo, Germany, and remotely with EpiNATO-2 users spanning three levels: clinical and data entry personnel (tactical level); regional medical and public health officers (operational level); and senior commanders and other governmental entities (strategic level).

Results: Fourteen EpiNATO-2 users participated in interviews, representing 3 of the 5 major NATO missions, 3 partner entities, and 7 nationalities. All users (100%) reported that the system did not meet their needs, with most users noting the following challenges: lack of clearly defined system objectives; poor data quality due to ambiguous case definitions and frequently unsubmitted reports (37% missing during January to June 2022); long delay between the occurrence of health events and the availability of corresponding data (≥2 weeks); and an antiquated and inflexible data management system. Overall, performance was deemed unsatisfactory on 11 of the 13 attributes.

Conclusions: This multinational sample of EpiNATO-2 users at all military levels reported that the system is currently not useful with respect to its stated objectives. Opportunities exist to improve the performance and usefulness of EpiNATO-2: improve case definitions, modernize data infrastructure, and regularly evaluate the surveillance system.

疾病和非战斗伤害(DNBIs)造成了军事人员的重大损失。自1996年以来,北约一直使用多种版本的EpiNATO-2工具监控其人员中的dnbi,但监控系统从未进行过系统评估。应北约向美国疾病控制与预防中心的要求,本研究的目的是利用美国疾病控制与预防中心更新的公共卫生监测系统评估指南,评估EpiNATO-2的监测系统属性。材料和方法:在2022年6月至10月期间,通过文献综述和关键信息提供者访谈来评估以下属性:有用性、简单性、灵活性、数据质量、可接受性、敏感性、正预测值、代表性、及时性、稳定性、信息学系统质量、信息学服务质量和信息学互操作性。在科索沃、德国和远程与EpiNATO-2用户进行了关键的信息者访谈,涉及三个级别:临床和数据输入人员(战术级别);区域医疗和公共卫生干事(业务级);以及高级指挥官和其他政府实体(战略层面)。结果:14名EpiNATO-2用户参与了访谈,代表了北约5个主要任务中的3个,3个伙伴实体和7个国家。所有用户(100%)报告系统没有满足他们的需求,大多数用户注意到以下挑战:缺乏明确定义的系统目标;由于病例定义不明确和经常未提交报告,数据质量较差(2022年1月至6月期间丢失37%);健康事件的发生与获得相应数据的时间间隔较长(≥2周);数据管理系统陈旧且不灵活。总体而言,在13个属性中,有11个被认为不令人满意。结论:EpiNATO-2所有军事级别用户的跨国样本报告说,该系统目前在其既定目标方面没有用处。存在改进EpiNATO-2的性能和有用性的机会:改进病例定义,使数据基础设施现代化,并定期评估监测系统。
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引用次数: 0
Strengthening Abortion Training: A Dilation and Evacuation Checklist in Military Resident Education. 加强人工流产培训:军事住院医师教育中的 "扩宫和排气检查表"。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usad491
Kiley Hunkler, Carissa Pekny, David Boedeker, Amanda Owens, Donald Wiersma, Sara Drayer

Introduction: A dilation and evacuation (D&E) is a safe and effective option for patients undergoing a second trimester abortion. Recent legislation and geographic restrictions threaten patients' access to this surgical procedure, prompting a call to action to strengthen abortion training. This quality improvement project aimed to assess if a standardized lecture and checklist would improve military trainee knowledge and comfort with performing D&Es.

Materials and methods: Using society recommendations and incorporating available level I to III evidence, a standardized checklist for D&Es was created to include necessary equipment, procedural steps, perioperative considerations, and potential complications. The checklist and associated lecture were presented to gynecology residents from seven of the nine military training programs. Residents completed a six-question assessment regarding comfort and knowledge in performing D&Es prior to and following the intervention. Responses were ranked on a five-point Likert scale and analyzed with the Wilcoxon sign-rank test. This project was deemed exempt by the Institutional Review Board. The standard Plan, Do, Study, Act (PDSA) methodology was used for ongoing assessment of the efficacy of this quality improvement project.

Results: There were 67 trainees that completed the pre-intervention assessment and 44 who completed it post-intervention, with 27 responses paired for statistical analysis. All trainees self-reported improved comfort and knowledge in all procedural aspects of D&Es, with the largest improvement observed in equipment knowledge (mean difference 1.44, P <0.001), performing procedural steps (mean difference 1.26, P <0.001), and managing complications (mean difference 1.33, P <0.001).

Conclusions: Use of an evidence-based checklist significantly improves resident knowledge and comfort with performing second trimester D&Es. In a post Dobbs environment, the military is an appropriate proxy for larger society and training programs need to develop alternatives and adjuncts to clinical training.

简介扩张和排空术(D&E)是第二孕期人工流产患者的一种安全有效的选择。最近的立法和地域限制威胁到了患者接受这种手术的机会,因此呼吁采取行动加强人工流产培训。本质量改进项目旨在评估标准化讲座和核对表是否能提高军事受训人员对实施 D&E 的了解和舒适度:采用学会的建议并结合现有的 I 至 III 级证据,创建了一份 D&E(人工流产)标准化核对表,其中包括必要的设备、手术步骤、围手术期注意事项和潜在的并发症。九个军事培训项目中的七个项目向妇科住院医师介绍了该核对表和相关讲座。住院医师在干预前和干预后完成了一份由六个问题组成的评估,内容涉及进行 D&E 的舒适度和知识。评估结果采用李克特五点量表进行排序,并通过 Wilcoxon 符号秩检验进行分析。该项目被机构审查委员会视为豁免项目。标准的 "计划、实施、研究、行动(PDSA)"方法用于持续评估该质量改进项目的效果:共有 67 名学员完成了干预前的评估,44 名学员完成了干预后的评估,其中有 27 份答卷配对进行了统计分析。所有受训人员都自我报告说,他们在所有 D&E 程序方面的舒适度和知识水平都有所提高,其中设备知识方面的提高最大(平均差异为 1.44,P 结论:使用循证核对表能显著提高受训人员的舒适度和知识水平:使用循证核对表可显著提高住院医师对第二孕期产前检查的知识水平和操作舒适度。在后多布斯环境中,军队是大社会的适当代表,培训计划需要开发临床培训的替代品和辅助工具。
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引用次数: 0
The Military-Civilian Partnership Quality Improvement Program Concept: A Process to Improve Data Collection and Outcomes Assessment. 军民合作质量改进计划概念:改进数据收集和成果评估的程序。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae117
Justin P Fox, Ryan E Earnest, Valerie Sams

Introduction: Military-Civilian Partnerships (MCPs) are vital for maintaining the deployment readiness of military health care physicians. However, tracking their clinical activity has proven to be challenging. In this study, we introduce a locally driven process aimed at the passive collection of external clinical workload data. This process is designed to facilitate an assessment of MCP physicians' deployment readiness and the effectiveness of individual MCPs.

Materials and methods: From March 2020 to February 2023, we conducted a series of quality improvement projects at the Wright Patterson Medical Center (WPMC) to enhance our data collection efforts for MCP physicians. Our methodology encompassed several steps. First, we assessed our existing data collection processes and their outcomes to identify improvement areas. Next, we tested various data collection methods, including self-reporting, a web-based smart phone application, and an automated process based on billing or electronic health record data. Following this, we refined our data collection process, incorporating the identified improvements and systematically tracking outcomes. Finally, we evaluated the refined process in 2 different MCPs, with our primary outcome measure being the collection of monthly health care data.

Results: Our examination at the WPMC initially identified several weaknesses in our established data collection efforts. These included unclear responsibility for data collection within the Medical Group, an inadequate roster of participating MCP physicians, and underutilization of military and community resources for data collection. To address these issues, we implemented revisions to our data collection process. These revisions included establishing clear responsibility for data collection through the Office of Military-Civilian Partnerships, introducing a regular "roll call" to match physicians to MCP agreements, passively collecting data each month through civilian partner billing or information technology offices, and integrating Office of Military-Civilian Partnership efforts into regular executive committee meetings. As a result, we observed a 4-fold increase in monthly data capture at WPMC, with similar gains when the refined process was implemented at an Air Force Center for the Sustainment of Trauma and Readiness Skills site.

Conclusions: The Military-Civilian Partnership Quality Improvement Program concept is an effective, locally driven process for enhancing the capture of external clinical workload data for military providers engaged in MCPs. Further examination of the Military-Civilian Partnership Quality Improvement Program process is needed at other institutions to validate its effectiveness and build a community of MCP champions.

导言:军民合作(MCP)对于保持军队医疗保健医生的部署准备状态至关重要。然而,跟踪他们的临床活动已被证明具有挑战性。在本研究中,我们介绍了一种由地方驱动的流程,旨在被动收集外部临床工作量数据。该流程旨在促进对 MCP 医生的部署准备情况和单个 MCP 的有效性进行评估:从 2020 年 3 月到 2023 年 2 月,我们在莱特帕特森医疗中心(WPMC)开展了一系列质量改进项目,以加强对 MCP 医生的数据收集工作。我们的方法包括几个步骤。首先,我们评估了现有的数据收集流程及其结果,以确定需要改进的地方。接下来,我们测试了各种数据收集方法,包括自我报告、基于网络的智能手机应用程序以及基于账单或电子健康记录数据的自动化流程。随后,我们改进了数据收集流程,纳入了已确定的改进措施,并对结果进行了系统跟踪。最后,我们在两家不同的医疗保健中心对改进后的流程进行了评估,主要结果指标是每月医疗保健数据的收集情况:在对 WPMC 的检查中,我们初步发现了在数据收集工作中存在的几个薄弱环节。其中包括医疗小组内部数据收集责任不明确、参与 MCP 的医生名册不足以及未充分利用军队和社区资源进行数据收集。为解决这些问题,我们对数据收集流程进行了修订。这些修订包括通过军民合作办公室明确数据收集的责任,采用定期 "点名 "的方式将医生与 MCP 协议相匹配,每月通过民事合作伙伴的账单或信息技术办公室被动收集数据,以及将军民合作办公室的工作纳入执行委员会的定期会议。结果,我们发现 WPMC 的每月数据采集量增加了 4 倍,在空军创伤和战备技能维持中心实施改进后的流程时也取得了类似的成果:军民合作质量改进计划概念是一种有效的、由地方推动的流程,可加强参与军民合作计划的军队医疗服务提供者的外部临床工作量数据采集。需要在其他机构对军民合作质量改进计划流程进行进一步检查,以验证其有效性并建立一个军民合作质量改进计划倡导者社区。
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引用次数: 0
The Link Between Somatization and Dissociation and PTSD Severity in Veterans Who Sought Help From the IDF Combat Stress Reaction Unit. 向以色列国防军战斗应激反应小组寻求帮助的退伍军人的躯体化和分离与创伤后应激障碍严重程度之间的联系。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae118
Nizan Shabat, Uzi Bechor, Nirit Yavnai, Lucian Tatsa-Laur, Leah Shelef

Introduction: This study aimed to examine the relationships between dissociative and somatic symptoms and how they might contribute to PTSD severity among ex-soldiers who sought help from the IDF Combat Stress Reaction Unit (CSRU).

Materials and methods: This cross-sectional study included 1,305 former compulsory, career, and reserve soldiers, who filled out self-report questionnaires on admission for evaluation at the CSRU. The study's dependent variables included two posttraumatic stress disorder measures (CAPS and PCL-5). The independent variables were the Dissociative Experience Scale and Brief Symptom Inventory. Background and service-related variables were also examined.

Results: Spearman correlation revealed that the higher the level of somatization is, the higher the level of PTSD via PCL and CAPS. A significant positive association was found between somatization and dissociation (r = 0.544; P < 0.001). The higher the somatization level, the more severe the dissociation. A multivariate logistic regression analysis to predict severe PTSD revealed that the longer the time elapsed from the traumatic event (OR = 1.019, P = 0.015), the higher the risk for severe PTSD. The most prominent variables were dissociation (OR = 6.420, P < 0.001) and somatization (OR = 4.792, P < 0.001). The entire model reached 40.8% of the shared variance in the regression.

Conclusions: While there is direct reference to dissociation in the clinical assessment by PCL or CAPS, there is no such reference to somatization. Highly functioning combatants sometimes express their distress somatically. Our findings suggest regarding severe somatic symptoms as diagnostic criteria for PTSD.

简介:本研究旨在研究向以色列国防军战斗应激反应股(CSRU)寻求帮助的退伍士兵的分离症状和躯体症状之间的关系,以及它们如何可能导致创伤后应激障碍的严重程度:这项横断面研究包括 1305 名退役义务兵、职业军人和预备役军人,他们在入院接受 CSRU 评估时填写了自我报告问卷。研究的因变量包括两个创伤后应激障碍测量指标(CAPS 和 PCL-5)。自变量是分离体验量表和症状简明量表。此外,还对背景和服务相关变量进行了研究:斯皮尔曼相关性表明,躯体化程度越高,PCL 和 CAPS 中的创伤后应激障碍程度就越高。躯体化与解离之间存在明显的正相关(r = 0.544;P 结论:虽然解离与躯体化有直接关系,但躯体化与创伤后应激障碍之间也存在明显的正相关:虽然 PCL 或 CAPS 的临床评估中直接提到了解离,但却没有提到躯体化。高功能战斗人员有时会通过躯体表达他们的痛苦。我们的研究结果建议将严重的躯体症状作为创伤后应激障碍的诊断标准。
{"title":"The Link Between Somatization and Dissociation and PTSD Severity in Veterans Who Sought Help From the IDF Combat Stress Reaction Unit.","authors":"Nizan Shabat, Uzi Bechor, Nirit Yavnai, Lucian Tatsa-Laur, Leah Shelef","doi":"10.1093/milmed/usae118","DOIUrl":"10.1093/milmed/usae118","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to examine the relationships between dissociative and somatic symptoms and how they might contribute to PTSD severity among ex-soldiers who sought help from the IDF Combat Stress Reaction Unit (CSRU).</p><p><strong>Materials and methods: </strong>This cross-sectional study included 1,305 former compulsory, career, and reserve soldiers, who filled out self-report questionnaires on admission for evaluation at the CSRU. The study's dependent variables included two posttraumatic stress disorder measures (CAPS and PCL-5). The independent variables were the Dissociative Experience Scale and Brief Symptom Inventory. Background and service-related variables were also examined.</p><p><strong>Results: </strong>Spearman correlation revealed that the higher the level of somatization is, the higher the level of PTSD via PCL and CAPS. A significant positive association was found between somatization and dissociation (r = 0.544; P < 0.001). The higher the somatization level, the more severe the dissociation. A multivariate logistic regression analysis to predict severe PTSD revealed that the longer the time elapsed from the traumatic event (OR = 1.019, P = 0.015), the higher the risk for severe PTSD. The most prominent variables were dissociation (OR = 6.420, P < 0.001) and somatization (OR = 4.792, P < 0.001). The entire model reached 40.8% of the shared variance in the regression.</p><p><strong>Conclusions: </strong>While there is direct reference to dissociation in the clinical assessment by PCL or CAPS, there is no such reference to somatization. Highly functioning combatants sometimes express their distress somatically. Our findings suggest regarding severe somatic symptoms as diagnostic criteria for PTSD.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140330016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clothing and Equipment Fit Among Male and Female Canadian Armed Forces Members. 加拿大武装部队男女成员的服装和装备适合度。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae179
Kristina M Gruevski, Adrienne Sy, Linda Bossi, Emma Moon, Junhan Bae, Allan Keefe

Introduction: The fit of military clothing and equipment is essential for the health and safety of military operators. Given the aim of increasing the proportion of women and the known biological and morphological differences between male and female soldiers, an understanding of fit across different items of kit is needed. The aim of this study was to quantify subjective fit ratings of 8 items of military clothing and equipment, including combat shirt, combat pants, rucksack, small pack, tactical vest, fragmentation vest, helmet, and ballistic eyewear as a function of relative stature and occupational group among male and female Canadian Armed Forces members.

Materials and methods: An online survey was distributed to male and female Canadian Armed Forces members, where fit was reported by participants according to a 7-point Likert acceptability scale. Participants were binned into 1 of 6 (3 males, 3 females) standing stature categories based on percentiles in a male and female distribution that included (1) under 35th percentile stature, (2) 35th to 80th percentile stature, and (3) over 80th percentile stature. Additionally, participants were separated according to occupational group: Group A: Infantry, Combat Engineer, Artillery, Armored; group B: Signals, Medical Technician, Intelligence, Signals Intelligence/Cyber Ops; group C: Supply Technician, Weapons Technician, Vehicle Technician, Electronic-Optronic Technician, Ammunition Technician; other: Not in other groups, examples include: Financial Services Administrator, Cook. This study was approved by the Defence Research and Development Canada Human Research Ethics Committee under protocol 2019-048, Amendment 2.

Results: There were significant effects attributable to stature category and occupational group on the fit of equipment. Specifically, fit acceptability of the rucksack helmet, small pack, and tactical vest was significantly affected by occupational group. Differences between stature categories were detected in all items with the exception of the small pack.

Conclusions: Military equipment fit has previously been shown to have implications for protection, performance, and mobility. The results of the investigation demonstrate different patterns of fit acceptability in male and female soldiers across items of clothing and equipment and may require different solutions.

简介:军用服装和装备的合身性对军事人员的健康和安全至关重要。鉴于增加女兵比例的目标,以及男女士兵之间已知的生理和形态差异,需要了解不同装备的合身性。本研究的目的是量化加拿大武装部队男性和女性成员对 8 种军用服装和装备(包括作战衬衫、作战裤子、背包、小背包、战术背心、防弹背心、头盔和防弹眼镜)的主观合身性评分,并将其与相对身材和职业类别挂钩:我们向加拿大武装部队的男女成员发放了一份在线调查问卷,参与者根据 7 点李克特可接受性量表来报告是否适合自己。根据男性和女性分布中的百分位数,将参与者分为 6 个站立身材类别(3 男 3 女)中的 1 个,这些类别包括:(1)低于第 35 百分位数的身材;(2)第 35 至 80 百分位数的身材;以及(3)超过第 80 百分位数的身材。此外,还根据职业组别对参与者进行了分类:A 组:步兵、战斗工兵、炮兵、装甲兵;B 组:信号兵、医疗技术员、情报员、信号情报员/网络行动员;C 组:供应技术员、武器技术员:供应技术员、武器技术员、车辆技术员、电子-光电技术员、弹药技术员;其他:不属于其他组别,例如财务管理员、厨师。本研究获得了加拿大国防研究与发展部人类研究伦理委员会(Defence Research and Development Canada Human Research Ethics Committee)2019-048号协议第2修正案的批准:结果:身材类别和职业组别对装备的合身性有明显影响。具体来说,职业类别对背包头盔、小背包和战术背心的合身性有显著影响。除小背包外,所有装备在身材类别上都存在差异:军事装备的适配性先前已被证明对防护、性能和机动性有影响。调查结果表明,男性和女性士兵对不同服装和装备的合身性有不同的接受模式,可能需要不同的解决方案。
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引用次数: 0
Evaluation of a Military Global Health Engagement Mission for Critical Wartime Surgical Specialty Readiness. 对战时关键外科专科准备工作的全球军事卫生参与任务进行评估。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae242
Joseph Aryankalayil, Margaret Shields, Michael Baird, Rathnayaka M K D Gunasingha, W Michael Pullen, Mark Johnson, Jamie Fitch, Ian Uber, Tamara Worlton

Introduction: Surgical volume at Military Treatment Facilities (MTFs) has been gradually decreasing for roughly the past 2 decades. The Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program linked surgical volume and readiness using a tool known as the KSA metric. However, the extent to which military medical missions contribute to the readiness of critical wartime specialties has not been evaluated using this metric.

Methods: In this study, a retrospective analysis was conducted using the surgical case logs from the US Naval Ship (USNS) Comfort missions in 2018 and 2019. The comprehensive case log data were categorized by year, surgeon, procedure, and location. The analysis focused on providing detailed descriptive statistics, including percentages pertaining to the types of procedures performed during these missions. The 2018 mission was 11 weeks in duration, and supported activities in Ecuador, Peru, Colombia, and Honduras. The USNS Comfort mission in 2019 lasted 6 months (June-November 2019), and visited 12 countries in Central America, South America, and the Caribbean.

Results: The 2019 mission case log, spanning 6 months, was evaluated using the KSA score in order to assess readiness and compare against 6 months of MTF KSA values within the same calendar year. In 2019, the orthopedic surgeon aboard the USNS Comfort had a total KSA score of 44,006, but the 6-month USNS Comfort mission only contributed 5,364 points (12% of the annual score). The general surgery practice aboard the USNS Comfort produced lower KSA scores compared to each surgeon's respective MTF practice (Table III). Analyzing the cases logged by general surgeons also highlights minimal surgical diversity during these missions, with more than 90% of cases being hernia repairs or laparoscopic cholecystectomies (Table I). In addition, 35% of total procedures performed in 2018 and 2019 were performed laparoscopically.

Conclusions: The analysis of operative data from the 2019 USNS Comfort mission, in comparison with the surgeons' work at their respective MTFs, reveals limited benefit in the ability of hospital-ship missions to bolster surgical readiness as measured by the KSA score. However, this is not a reflection on the value of Global Health Engagement (GHE) itself but a review of the way in which it is leveraged to support surgical readiness. Military surgeons participate in GHE as part of a larger strategy to strengthen relationships with partner nations, improve military medical force interoperability, and bolster partner nation medical capacity and capabilities. The KSA score offers an excellent tool to compare readiness metrics across significantly different GHE missions, and facilitates the opportunity for future prospective studies to improve case volume, diversity, and ultimately readiness.

导言:大约在过去 20 年中,军事治疗设施(MTF)的手术量一直在逐渐减少。知识、技能和能力(KSA)临床准备计划使用一种称为 KSA 指标的工具将手术量和准备状态联系起来。然而,军事医疗任务在多大程度上促进了关键战时专科的战备状态还没有使用该指标进行过评估:在本研究中,我们使用 2018 年和 2019 年美国海军舰艇(USNS)"舒适 "号任务的手术病例日志进行了回顾性分析。综合病例日志数据按年份、外科医生、手术和地点进行了分类。分析的重点是提供详细的描述性统计数字,包括与这些任务期间实施的手术类型有关的百分比。2018 年的任务为期 11 周,支持在厄瓜多尔、秘鲁、哥伦比亚和洪都拉斯开展的活动。美国海军 "舒适 "号2019年的任务为期6个月(2019年6月至11月),访问了中美洲、南美洲和加勒比海地区的12个国家:使用 KSA 分数对跨度为 6 个月的 2019 年任务病例日志进行了评估,以评估准备情况,并与同一日历年内 6 个月的 MTF KSA 值进行比较。2019 年,美国海军 "舒适 "号上的骨科医生的 KSA 总分为 44006 分,但美国海军 "舒适 "号 6 个月的任务只贡献了 5364 分(占年度总分的 12%)。与每位外科医生各自的 MTF 实践相比,"舒适 "号上的普通外科实践产生的 KSA 分数较低(表 III)。对普外科医生记录的病例进行分析后还发现,在这些任务中,外科手术的多样性极少,90% 以上的病例都是疝修补术或腹腔镜胆囊切除术(表 I)。此外,2018 年和 2019 年进行的手术总数中有 35% 是通过腹腔镜进行的:通过对 2019 年美国海军 "舒适 "号任务的手术数据进行分析,并与外科医生在各自 MTF 的工作情况进行比较,发现医院船任务在加强手术准备能力(以 KSA 分数衡量)方面的益处有限。然而,这并不是对全球卫生参与(GHE)本身价值的反思,而是对利用全球卫生参与支持外科手术准备的方式的回顾。军事外科医生参与全球卫生参与是加强与伙伴国关系、提高军事医疗部队互操作性、增强伙伴国医疗能力的更大战略的一部分。KSA 评分提供了一个很好的工具,可用于比较明显不同的 GHE 任务的准备度量,并为未来的前瞻性研究提供机会,以提高病例量、多样性并最终改善准备度。
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引用次数: 0
Obesity and Overweight: First Comprehensive Overview in the French Armed Forces. 肥胖与超重:法国武装部队首次全面概述。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae217
Livia Mannaioni, Thierry Jay, Yvain Goudard, Olivier Aoun, Ghislain Pauleau, Anne Montois, Bruno de La Villéon

Introduction: The global rise in obesity is well-established, with significant health implications. This study aims to comprehensively assess overweight and obesity prevalence within the French Armed Forces.

Materials and methods: Using data from the Unique Medical-Military Software (UMMS) in 2018, a cross-sectional study was conducted on active French Military personnel aged 18 and above, who underwent periodic medical examinations (PME) in 2017. Body Mass Index (BMI) served as the main criterion for overweight and obesity classification. A representative sample was obtained through random sampling.

Results: The sample included 17,082 individuals, revealing an average age of 33.5 years, with 36.1% classified as overweight and 9.6% as obese. The mean BMI of women was significantly lower than that of men (23.9 vs 25.3 kg/m2-P < .001). Results indicated that 22.4% of women vs 38.5% of men were overweight (P < .001). For obesity, the difference was not significant (8.8% of women vs 9.8% of men-P = .138). BMI increased with age, and non-commissioned officers (NCOs) showed the highest prevalence of obesity. Gendarmes exhibited the highest BMI and overweight rates (50.1%) among military branches.

Conclusion: While obesity is less prevalent in the French Armed Forces compared to the general population, the study emphasizes the equivalent prevalence of overweight. We confirm here that the global epidemic of obesity and overweight affects all armed forces. France seems less affected than other Western armies. Targeting specific groups, such as NCOs and the national gendarmerie, is crucial for prevention.

引言肥胖症在全球呈上升趋势,对健康产生了重大影响。本研究旨在全面评估法国武装部队中超重和肥胖的发生率:利用2018年唯一医疗军事软件(UMMS)的数据,对2017年接受定期体检(PME)的18岁及以上法国现役军人进行了横断面研究。体重指数(BMI)作为超重和肥胖分类的主要标准。通过随机抽样获得了具有代表性的样本:样本包括 17 082 人,平均年龄为 33.5 岁,36.1% 的人被归类为超重,9.6% 的人被归类为肥胖。女性的平均体重指数明显低于男性(23.9 vs 25.3 kg/m2-P 结论:虽然与普通人群相比,法国武装部队中肥胖症的发病率较低,但这项研究强调了超重的流行程度相当。我们在此证实,肥胖和超重在全球的流行影响着所有武装部队。与其他西方国家的军队相比,法国受到的影响似乎较小。针对军士和国家宪兵等特定群体进行预防至关重要。
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引用次数: 0
Differences in Perceived Stress During the COVID-19 Pandemic Among Military Dental Postgraduate Residents. 军队口腔医学研究生在 COVID-19 大流行期间感知到的压力差异。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae270
James M Ross, Nora L Watson, Nicholas J Hamlin, John E Schmidt

Introduction: In military training settings, stress can improve focus and motivation fostering effective learning. However, high perceived stress can be debilitating resulting in poor learning and clinical errors. Multiple studies have focused on medical residency stress; but there has been minimal focus on dental residents and even less on the impact of the unique stressors from the COVID-19 pandemic. The objectives of this study were to determine the impact of the COVID-19 pandemic on perceived stress of residents in a military dental residency training program and explore the association among perceived stress and anxiety, depression, sleep quality, and social support.

Materials and methods: Dental residents (N = 20) at the Naval Postgraduate Dental School participated in this study. Residents were assessed via self-report measures quarterly from March 2020 through June 2021. The assessment included measures of anxiety (GAD-7), depression (PHQ-9), perceived stress (PSS), fatigue (FSI), and social support (DUKE-SSQ).

Results: Before the pandemic shutdown, 60% of participants reported high perceived stress. These residents reported an initial decrease in symptoms of anxiety, depression, and fatigue compared to residents reporting low pre-pandemic perceived stress but returned to baseline levels post-shutdown. Additionally, the high stress participants reported lower social support.

Conclusions: Based on pre-pandemic perceived stress, participants responded differently to the impact of the pandemic shutdown. The low baseline stress participants may have a more robust sense of grit and resilience. These findings suggest that postgraduate dental training programs should integrate coping skills training opportunities, especially for residents reporting high perceived stress before residency.

介绍:在军事训练环境中,压力可以提高注意力和动力,促进有效学习。然而,高感知压力可能会导致学习效果不佳和临床错误。已有多项研究关注了医学住院医师的压力,但对牙科住院医师的关注却很少,而对 COVID-19 大流行病所带来的独特压力的影响的关注就更少了。本研究的目的是确定 COVID-19 大流行对军事牙科住院医师培训项目中住院医师感知压力的影响,并探讨感知压力与焦虑、抑郁、睡眠质量和社会支持之间的关联:海军牙科研究生院的牙科住院医师(N = 20)参与了这项研究。从 2020 年 3 月到 2021 年 6 月,住院医师每季度接受一次自我报告评估。评估内容包括焦虑(GAD-7)、抑郁(PHQ-9)、感知压力(PSS)、疲劳(FSI)和社会支持(DUKE-SSQ):在大流行关闭之前,60% 的参与者表示感受到了很大的压力。与大流行前感知压力较低的居民相比,这些居民最初的焦虑、抑郁和疲劳症状有所减轻,但在关机后又恢复到基线水平。此外,高压力参与者的社会支持也较低:结论:根据大流行前的压力感知,参与者对大流行关闭的影响做出了不同的反应。基线压力低的学员可能具有更强的勇气和适应力。这些研究结果表明,口腔医学研究生培训项目应整合应对技能培训机会,尤其是针对住院医师在实习前感知压力较大的情况。
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引用次数: 0
Emerging Trends in the Prevalence of Military Medicine Interest Groups and Specialty Tracks at U.S. Medical Schools. 美国医学院军事医学兴趣小组和专业方向的流行趋势。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae250
Donald P Keating Iii, Megan A Unrath, Rachel M Steffes, Timothy M Guenther, Bryan G Beutel

Introduction: A challenge confronting health care is the national physician shortage, notably impacting the DoD's recruitment of military physicians. To address this, the Health Professions Scholarship Program is annually awarded to medical students to facilitate their transition into the U.S. Armed Forces. There is a glaring absence of military medical education in civilian schools to accommodate the unique interests of these students. While medical schools have adapted with interest groups and specialty tracks, the current presence of military medicine interest groups (MMIGs) and military medicine specialty tracks (MMSTs) remains under-explored. This study aimed to (1) update the prevalence of MMIGs in U.S. medical institutions, (2) identify the presence of MMSTs, and (3) compare military medicine involvement between allopathic and osteopathic programs.

Methods: The study was approved for exempt status from the Kansas City University Institutional Review Board (study number 20,211,568-1). In a cross-sectional analysis, surveys were sent to 208 U.S. medical schools, with responses from student services or available public data from 200 institutions included in the final analysis. A secondary survey was sent to respondents who provided MMIG or MMST contacts.

Results: Results indicated that 62% (n = 124/200) of schools currently have an established MMIG, a modest growth from 56% (n = 70/125) in 2015 (p = .14). MMST prevalence, however, is minimal at 2.5% (5/200). Osteopathic institutions demonstrated a significantly greater engagement in military medicine education (88.7%) compared to allopathic schools (52.4%) (p < .001).

Conclusion: This research underscores the need for comprehensive military medical training in medical schools to meet the interests and career aspirations of their students. Future studies should also evaluate the efficacy of MMIGs and MMSTs in preparing students for military medical roles.

导言:医疗保健面临的一项挑战是全国性的医生短缺问题,这尤其影响了国防部招募军医的工作。为解决这一问题,美国每年都会向医科学生颁发 "卫生职业奖学金计划",以帮助他们向美国武装部队过渡。平民学校明显缺乏军事医学教育,无法满足这些学生的独特兴趣。虽然医学院已经通过兴趣小组和专业方向进行了调整,但目前军事医学兴趣小组(MMIGs)和军事医学专业方向(MMSTs)的存在仍未得到充分探索。本研究旨在:(1) 更新军事医学兴趣小组在美国医疗机构中的普遍程度;(2) 确定军事医学专业方向(MMST)的存在情况;(3) 比较全科医学和骨科医学项目在军事医学方面的参与情况:该研究获得了堪萨斯城大学机构审查委员会的豁免批准(研究编号 20,211,568-1)。在横断面分析中,我们向 208 所美国医学院校发送了调查问卷,最终分析包括了 200 所院校学生服务部门的回复或可获得的公共数据。对提供 MMIG 或 MMST 联系方式的受访者进行了二次调查:结果显示,62%(n = 124/200)的学校目前已建立了MMIG,与2015年的56%(n = 70/125)相比略有增长(p = .14)。然而,MMST 的流行率极低,仅为 2.5%(5/200)。与对抗疗法学校(52.4%)相比,整骨疗法机构在军事医学教育中的参与度明显更高(88.7%)(p 结论:这项研究强调,医学院需要开展全面的军事医学培训,以满足学生的兴趣和职业抱负。未来的研究还应评估 MMIGs 和 MMSTs 在培养学生适应军事医学角色方面的功效。
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引用次数: 0
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Military Medicine
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