Military Medicine最新文献

Background: Occupational burnout in healthcare workers, especially in military medical settings, poses risks in retention, patient safety, productivity, well-being, and military readiness. Prior research suggests that sex differences exist with burnout, yet limited data exist on how drivers of burnout interact within military contexts, especially during periods of high stress such as a global pandemic. The objective of this study is to examine sex-specific differences in burnout among military healthcare workers, including the influence of demographic factors, pandemic-related stressors, and leadership characteristics.

Materials and methods: A cross-sectional survey was administered to 424 healthcare workers employed at military medical treatment facilities between January and May 2023. Participants completed the Maslach Burnout Inventory (MBI) Health Services Survey, Adaptive Leadership with Authority Scale (ALAS), and Pandemic Experiences and Perceptions Survey (PEPS). Descriptive statistics, t-tests, chi-square analysis, Pearson correlations, and ANOVAs were conducted to assess burnout dimensions-emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA)-in relation to leadership, demographics variables, and pandemic stressors.

Results: Among 424 respondents (308 females, 116 males), overall burnout rates did not differ significantly by sex (25% males, 20% females, P = .28). However, females reported significantly higher EE than males (91.8% vs. 81.6%, P = .015, Cramer's V = 0.15). There were no differences in the levels of high DP (71.8% males, 64.6% females, P = .86) or low PA (10.5% males, 7.9% females, P = .67). Adaptive and supervisory leadership were protective against EE and DP for both sexes, but these effects were stronger and more consistent for females. Leadership was a protective factor against EE and low PA for females (r = -.34, P < .001; r = -.23, P < .001) and against EE for males (r = -.22, P = .027), though to a lesser extent. For males, tenure at the current position was inversely correlated with depersonalization (r = -.25, P = .01). Pandemic-related stress was more strongly associated with depersonalization in females. Role- and ethnicity-based interactions also revealed sex-specific patterns, with female physicians reporting higher EE and male depersonalization varying by healthcare role and ethnicity.

Conclusions: This study highlights important sex-based differences in burnout profiles and associated risk and protective factors among military healthcare workers. Findings underscore the critical role of leadership, particularly for female personnel related to EE, although tenure buffered depersonalization in males. These findings highlight the need for tailored burnout prevention strategies, particularly focused on adaptive leadership development and demographic-specific interventions.

Background: Military medical readiness plays a significant role in global military operations. While the severity of combat-related trauma is evident, musculoskeletal injuries (MSK's), are the largest medical threat to deployment readiness, and accounted for more than 60% of limited duty days in 2019. Across MSK's, the spine (lumbosacral: 30%; cervical: 22%; thoracic: 10%) accounts for 62% of MSKs. In the military population, there is a tremendous economic impact in training, retaining, and deploying a service member. Return-to-duty (RTD) rates and length of time for the treatment protocols for spine surgery vary significantly in published research. Research suggests RTD rates between 3-17 months following elective traditional open lumbar and cervical spine surgery, with a RTD rate of 64% within 1 year. When examining minimally invasive lumbar spine surgery (MIS), 100% of military personal had a RTD within 3 months. Research has yet to examine the impact of MIS of the cervical spine on the RTD rates of active-duty military.

Methods: The current study retrospectively examined surgical outcomes, return to duty, and patient-centric outcomes among 156 active duty or reserve military patients who underwent an outpatient minimally invasive (n = 79) cervical spine surgery or an open (n = 77) (Laminotomy/Foraminotomy/Decompression) for the treatment of cervical spinal stenosis.

Results: Significant reductions in visual analog scale of 3.31 and neck disability index of 16.01 were observed from preoperative to postoperative time points. 77% of service members RTD in less than 1 month, 19% RTD in 1-2 months and 4% RTD between 2-3 months. There were insignificant differences reported in the open surgery group.

Discussions: MIS has been shown to reduce tissue trauma and patient complications. MIS procedures have resulted in reducing postoperative stress responses and improving the recovery process following surgery. In the active-duty military population this plays an important role in return to duty quickness. Our findings suggest that MIS procedures in an ambulatory surgery center on the cervical spine result in improved patient outcomes and reduced RTD time in active-duty military personnel.

Background: In response to the February 2022 Russian invasion of Ukraine's, international aid and foreign investment from the U.S. Government and regional allies flowed into the country. As part of this support, the Department of War (DoW) has supported multiple research initiatives aimed at strengthening Ukrainian healthcare, further advancing the objectives of the U.S.-Ukraine partnership. Given the scope of U.S. involvement, a thorough investigation into the outcomes of this critical research was essential to ensure accountability and improve resource allocation.

Materials and methods: To gauge the impact of these investments, the Center for Health Services Research at the Uniformed Services University of the Health Sciences conducted a Buxton-Hanney Payback Framework assessment, which systematically identifies the outcomes generated by these projects. From January 2025 to April 2025, the research team employed snowball sampling and grey literature review to identify principal investigators involved in DoW-funded Ukrainian health research. The team conducted virtual consultations to collect outcome data pertaining to the framework's domains, which were catalogued into a structured data collection instrument.

Results: The team identified 7 DoW-funded projects dedicated to Ukraine's health and trauma system. These projects yielded a total of 80 outcomes across the Buxton-Hanney framework domains, revealing a broad spectrum of impacts. These included academic knowledge outputs through publications and workforce training; policy-level contributions for healthcare; direct health benefits; and economic returns driven by workforce resilience and expansion of business operations.

Conclusions: Identified outcomes underscore the strategic value of sustained investment in military healthcare research. Investments not only support allies but also provide crucial lessons that can strengthen healthcare delivery for the U.S. Military, particularly in dynamic and conflict-affected environments. Even in their early stages, projects demonstrated immediate value by providing real-time insights that advance the partnership's objectives. Furthermore, this assessment advocates for the utilization of the Buxton-Hanney Framework as a standardized tool for assessing the outcomes and impacts for programs within the DoW.

Introduction: In 2023, the prevalence of overweight and obesity in the Czech Army was 56% out of 19% in men and 38% out of 5% in women according to the body mass index (BMI). This study monitors changes in body composition following a targeted intervention in the Czech military population with the aim of reducing body weight in overweight or obese individuals.

Materials and methods: A prospective clinical study was conducted between 2023 and 2025 in six military units. Anthropometric measurements (weight, height, BMI) and body composition analysis (body fat, muscle mass, visceral fat) were performed using the bioimpedance method. Subsequently, participants received a targeted education on the results of the analysis and dietary and exercise measures were recommended. Follow-up body composition examinations were performed at 6 and 12 months.

Results: In a sample of 200 individuals (139 men, 61 women), 56% of subjects had a normal body fat percentage (PBF), (men up to 20%, women up to 28% inclusive). There was no significant change in monitored parameters in individuals with a normal PBF, but individuals with an above-normal PBF experienced weight loss (-0.8 kg in men, -3.6 kg in women) without any reduction in muscle mass. A statistically significant decrease in PBF (0.8% in men, 2% in women) and visceral fat was found in the entire sample during the follow-up measurement after 6 months.

Conclusion: This study demonstrates that a structured, physician-led, individualized intervention effectively reduces body fat and visceral adiposity while preserving muscle mass and improving key health parameters in overweight and obese soldiers. The feasible model highlights the importance of personalized, education-based prevention and has potential for broader application beyond the military.

Clinical trial registration:

Introduction: Millions of United States (U.S.) veterans report exposures to a wide range of chemical, physical, radiological, and biological agents during their military service (i.e., military exposures). Given the negative implications of military exposures for veterans health, high quality research is needed to inform disability policy and healthcare strategies. Existing repositories may help streamline research efforts but have not been comparatively evaluated. We conducted a rapid review to identify repositories for streamlining primary and secondary research on long-term health effects of military exposures.

Materials and methods: Repositories were included for analysis if they contained data or biospecimens that were collected from current or former U.S. service members. Six criteria concerning inventory (i.e., measures of exposures, biospecimens, personally identifiable information) and research permissions (i.e., future use, future contact, and sharing) were used to make a collective assessment of utility for military exposures research. Repositories were also descriptively coded for specific types of exposure-related data (i.e., air pollutants, chemicals, metals, radiation, warfare agents) and the exposure assessment method (i.e., direct or indirect).

Results: Of 52 identified resources, 29 repositories were eligible for further analysis. The most frequently represented exposure-related data type was air pollutants (n = 13), followed by chemicals (n = 11), warfare agents (n = 8), radiation (n = 6), and metals (n = 5). Most repositories used indirect (n = 24) versus direct (n = 5) exposure assessment methods. Eight repositories met al. 6 assessment criteria.

Conclusions: We identified 8 repositories that are useful for streamlining research on the long-term health outcomes of military exposures. Future efforts that focus on evaluating their data and biospecimen quality will further distinguish these resources regarding readiness to produce high-quality research that informs disability policy and healthcare strategies.

Introduction: All prospective blood donors who report behaviors or conditions that may increase risk of transfusion-transmitted infection (TTI) are temporarily deferred from donating. In this study, we evaluate how deferrals for TTI risk impact future donation attempts, ultimately informing how deferral policy changes may affect the military population.

Materials and methods: This retrospective chart review evaluated all blood donors with pre-donation deferrals at a single site between October 2019 and December 2022. Among the 14 deferral categories, 7 were classified as behaviors or conditions that increase risk of TTI. The rate of donation reattempts within the study period was assessed in donors deferred for TTI risk and compared to that of donors deferred for low hemoglobin matched by sex, age, and military training status.

Results: Six thousand three hundred and fifty two (12.8%) of the 49,613 blood donors identified during the study had a pre-donation deferral. The most common reason for pre-donation deferral was anemia (54.2%), but TTI-risk accounted for a significant fraction of deferrals (10.7%). We found that donors who were deferred for TTI risk were significantly less likely to attempt redonation during the study period compared to those deferred for anemia (P < .001). On multivariate analysis, donors deferred for men who have sex with men and travel or residence in a malaria-endemic area were independently associated with a decreased redonation attempt rate and increased time to reattempt.

Conclusion: Pre-donation deferrals for TTI risk were associated with a decreased rate of redonation and increased time to reattempt compared to donors deferred for anemia.

This case report details the lifelong sequelae and complex management of a shrapnel injury sustained by a 4-year-old male during a 1943 World War II bombing. The initial trauma caused a severe right elbow fracture and complete ulnar nerve transection, resulting in ankylosis and chronic joint dysfunction. Decades later, the patient developed recurrent ulcerations and scar instability over the olecranon. A suspected chronic osteomyelitis was initially managed conservatively with antibiotics and scar revision with lipofilling. However, ulceration recurred, ultimately necessitating aggressive surgical intervention, initially postponed for the patient's heart conditions. This involved fistulectomy, extensive bone debridement, and definitive coverage with a reverse-flow perforator flap based on the posterior interosseous and radial recurrent arteries. The procedure achieved successful healing with no recurrence at five-year follow-up. This case underscores that chronic complications from wartime trauma can manifest over a lifetime. It highlights the necessity of a definitive surgical approach, combining radical debridement with robust soft tissue reconstruction, even after long periods of quiescence. For elderly patients with complex comorbidities, this pedicled flap provides a reliable, single-stage reconstructive option in the challenging elbow region.

Introduction: Endometrial cancer incidence is rising in the United States, including among women younger than 50 years, raising concern for women serving on active duty, retirees, and their dependents. Age-related differences in clinicopathologic features and treatment have been documented in the general U.S. population and the differences may be influenced by access to care. We aimed to study clinicopathologic and treatment features of women within the Department of War (DoW) Military Health System (MHS) to better understand age-related differences in tumor characteristics, surgical management, and adjuvant therapy by age in this universal access setting.

Materials and methods: We conducted a retrospective cohort study using the Military Cancer Epidemiology (MilCanEpi) database, which links the DoW cancer registry and medical claims data. Women diagnosed with endometrial cancer from 2001 to 2014 who underwent hysterectomy within 6 months of diagnosis were included. Modified Poisson regression was used to estimate adjusted risk ratios (ARRs) for advanced tumor stage (II-IV vs. I), aggressive histological subtypes (high-grade endometrioid endometrial carcinoma [EEC] or non-EEC vs. low-grade EEC), surgical approach, and adjuvant therapy (chemotherapy or radiation) by age group: 18-49, 50-64, and ≥65 years.

Results: Among 1,223 patients, 16% were aged 18-49, 61% aged 50-64, and 23% aged ≥65. Compared with women aged 50-64, those aged 18-49 were less likely to have aggressive histologic subtypes (ARR = 0.65; 95% CI = 0.44-0.96), while those aged ≥65 were at higher risk for more aggressive histologic subtypes (ARR = 1.54; 95% CI = 1.25-1.90). No significant age-related differences were observed in tumor stage, time to surgery, surgical approach, or lymphadenectomy. Among patients with aggressive histologic subtypes (n = 287), receipt of adjuvant therapy did not differ significantly by age (18-49 years: ARR = 0.84, 95% CI = 0.58-1.21; ≥65 years: ARR = 0.92, 95% CI = 0.78-1.08) relative to women aged 50-64 years at diagnosis.

Conclusions: Within the MHS, age-related differences in endometrial cancer were confined to tumor histology, with younger women less likely and older women more likely to present with aggressive subtypes. This is consistent with that reported in the general U.S. population. Importantly, no age-related differences were observed in surgical management or receipt of adjuvant therapy when adjusted for tumor features. This may suggest the role of healthcare access in mitigating age-related treatment gaps observed in the general population.