首页 > 最新文献

Military Medicine最新文献

英文 中文
Correction To: Ebola Virus Disease Outbreaks: Lessons Learned From Past and Facing Future Challenges. 更正为埃博拉病毒疾病爆发:从过去汲取的教训和面对未来的挑战。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae328
{"title":"Correction To: Ebola Virus Disease Outbreaks: Lessons Learned From Past and Facing Future Challenges.","authors":"","doi":"10.1093/milmed/usae328","DOIUrl":"10.1093/milmed/usae328","url":null,"abstract":"","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":"141443071","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
Comorbid Chronic Pain and Post-traumatic Stress Disorder: Current Rates and Psychiatric Comorbidities Among U.S. Military Veterans. 慢性疼痛与创伤后应激障碍并发症:美国退伍军人中慢性疼痛和创伤后应激障碍的当前发病率和精神病并发症。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae313
Katherine Hadlandsmyth, Caywin Zhuang, Mary A Driscoll, Brian C Lund

Introduction: This study reports rates of comorbid chronic pain and post-traumatic stress disorder (PTSD) among U.S. military veterans and rates of psychiatric comorbidities among those with both chronic pain and PTSD.

Materials and methods: This study utilized National Veterans Affairs (VA) administrative data to identify all veterans treated for chronic pain or PTSD in 2023. Multivariable logistic regression models determined the likelihood of each psychiatric comorbidity for those with chronic pain and PTSD relative to those with chronic pain only and separately to those with PTSD only, after adjusting for demographic variables and all other psychiatric comorbidities.

Results: Of the 5,846,453 service users of the VA in 2023, a total of 2,091,391 (35.8%) met the criteria for chronic pain and 850,191 (14.5%) met the criteria for PTSD. Furthermore, 21.6% of those with chronic pain also had PTSD and over half (53.2%) of those with PTSD also met the criteria for chronic pain (n = 452,113). Veterans with chronic pain and PTSD were significantly more likely to be women, Black or African American, Hispanic or Latina, and urban dwelling. Veterans with chronic pain and PTSD had significantly higher rates of all selected comorbidities relative to veterans with chronic pain only.

Conclusions: Patients with comorbid chronic pain and PTSD may benefit from tailored treatments to address the additive impact of these conditions.

导言:本研究报告了美国退伍军人中合并慢性疼痛和创伤后应激障碍(PTSD)的比例,以及同时患有慢性疼痛和创伤后应激障碍的退伍军人中合并精神病的比例:本研究利用美国退伍军人事务管理局(VA)的行政数据,确定了 2023 年所有接受过慢性疼痛或创伤后应激障碍治疗的退伍军人。多变量逻辑回归模型确定了患有慢性疼痛和创伤后应激障碍的退伍军人与仅患有慢性疼痛的退伍军人以及仅患有创伤后应激障碍的退伍军人发生每种精神疾病合并症的可能性,并对人口统计学变量和所有其他精神疾病合并症进行了调整:在 2023 年退伍军人事务部的 5,846,453 名服务用户中,共有 2,091,391 人(35.8%)符合慢性疼痛的标准,850,191 人(14.5%)符合创伤后应激障碍的标准。此外,21.6% 的慢性疼痛患者同时患有创伤后应激障碍,超过一半(53.2%)的创伤后应激障碍患者同时符合慢性疼痛的标准(n = 452,113 人)。患有慢性疼痛和创伤后应激障碍的退伍军人中,女性、黑人或非裔美国人、西班牙裔或拉丁裔以及居住在城市的比例明显更高。与仅患有慢性疼痛的退伍军人相比,患有慢性疼痛和创伤后应激障碍的退伍军人在所有选定合并症中的比例明显更高:结论:合并慢性疼痛和创伤后应激障碍的患者可能会受益于定制的治疗方法,以解决这些疾病的叠加影响。
{"title":"Comorbid Chronic Pain and Post-traumatic Stress Disorder: Current Rates and Psychiatric Comorbidities Among U.S. Military Veterans.","authors":"Katherine Hadlandsmyth, Caywin Zhuang, Mary A Driscoll, Brian C Lund","doi":"10.1093/milmed/usae313","DOIUrl":"10.1093/milmed/usae313","url":null,"abstract":"<p><strong>Introduction: </strong>This study reports rates of comorbid chronic pain and post-traumatic stress disorder (PTSD) among U.S. military veterans and rates of psychiatric comorbidities among those with both chronic pain and PTSD.</p><p><strong>Materials and methods: </strong>This study utilized National Veterans Affairs (VA) administrative data to identify all veterans treated for chronic pain or PTSD in 2023. Multivariable logistic regression models determined the likelihood of each psychiatric comorbidity for those with chronic pain and PTSD relative to those with chronic pain only and separately to those with PTSD only, after adjusting for demographic variables and all other psychiatric comorbidities.</p><p><strong>Results: </strong>Of the 5,846,453 service users of the VA in 2023, a total of 2,091,391 (35.8%) met the criteria for chronic pain and 850,191 (14.5%) met the criteria for PTSD. Furthermore, 21.6% of those with chronic pain also had PTSD and over half (53.2%) of those with PTSD also met the criteria for chronic pain (n = 452,113). Veterans with chronic pain and PTSD were significantly more likely to be women, Black or African American, Hispanic or Latina, and urban dwelling. Veterans with chronic pain and PTSD had significantly higher rates of all selected comorbidities relative to veterans with chronic pain only.</p><p><strong>Conclusions: </strong>Patients with comorbid chronic pain and PTSD may benefit from tailored treatments to address the additive impact of these conditions.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Hidden Enemy: Mal de Débarquement Syndrome and Its Impact on Military Operations. 隐藏的敌人:人格障碍综合症及其对军事行动的影响。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usad449
Charlotte K Hughes, Michael J Eliason, Akihiro J Matsuoka

Mal de Débarquement Syndrome (MdDS) is a poorly understood vestibular disorder that frequently affects military personnel exposed to motion during transportation and deployment. It is characterized by a persistent sensation of motion often experienced after disembarking from a ship or other mode of transportation. It can significantly affect a service member's balance, coordination, attention, and focus, which can then substantially impact their quality of life, ability to perform their military duties, and overall mission readiness. Despite its potential impact, comprehensive studies on MdDS are scarce, especially within the military. The unique conditions of military service, including frequent travel, long flights, maritime deployments, and high-stress environments, make the military well suited to study MdDS. Increased awareness and understanding of MdDS is crucial for everyone in the military-from medical personnel responsible for the diagnosis and treatment of MdDS to commanders who must consider the operational impact of impaired personnel.

伤残伤残综合症(MdDS)是一种鲜为人知的前庭障碍,经常影响在运输和部署过程中暴露于运动的军事人员。它的特点是经常在从船上或其他交通工具下船后出现持续的运动感。它会严重影响军人的平衡、协调、注意力和专注力,从而严重影响他们的生活质量、履行军事职责的能力和整体任务准备程度。尽管有潜在的影响,但对MdDS的全面研究很少,特别是在军队中。军事服务的独特条件,包括频繁的旅行、长途飞行、海上部署和高压力环境,使军队非常适合研究MdDS。提高对伤残人员的认识和了解对军队中的每一个人都至关重要,从负责诊断和治疗伤残人员的医务人员到必须考虑伤残人员的行动影响的指挥官。
{"title":"The Hidden Enemy: Mal de Débarquement Syndrome and Its Impact on Military Operations.","authors":"Charlotte K Hughes, Michael J Eliason, Akihiro J Matsuoka","doi":"10.1093/milmed/usad449","DOIUrl":"10.1093/milmed/usad449","url":null,"abstract":"<p><p>Mal de Débarquement Syndrome (MdDS) is a poorly understood vestibular disorder that frequently affects military personnel exposed to motion during transportation and deployment. It is characterized by a persistent sensation of motion often experienced after disembarking from a ship or other mode of transportation. It can significantly affect a service member's balance, coordination, attention, and focus, which can then substantially impact their quality of life, ability to perform their military duties, and overall mission readiness. Despite its potential impact, comprehensive studies on MdDS are scarce, especially within the military. The unique conditions of military service, including frequent travel, long flights, maritime deployments, and high-stress environments, make the military well suited to study MdDS. Increased awareness and understanding of MdDS is crucial for everyone in the military-from medical personnel responsible for the diagnosis and treatment of MdDS to commanders who must consider the operational impact of impaired personnel.</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":"138176736","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
Optimization and Validation of an FTIR-based, All-in-one System for Viable MDR Bacteria Detection in Combat-related Wound Infection. 优化和验证基于傅立叶变换红外技术的一体化系统,用于检测与战斗有关的伤口感染中可存活的 MDR 细菌。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae068
Ying Chen, Andrew Leung, Yulia Wang, Nathan K Archer
<p><strong>Introduction: </strong>The U.S. Military members experiencing combat-related injuries have a higher chance of developing infections by multidrug-resistant (MDR) bacteria at admission to military hospitals. MDR wound infections result in higher amputation rates and greater risks for subsequent or chronic infections that require readmission or extended stay in the hospital. Currently, there is no FDA-clear, deployable early diagnostic system for suitable field use.We are reporting our efforts to improve a previously developed Rapid Label-free Pathogen Identification (RAPID) system to detect viable MDR bacteria in wound infections and perform antibiotic susceptibility testing (AST). Specifically, we added multiplex and automation capability and significantly simplified the sample preparation process. A functional prototype of the improved system was built, and its performance was validated using a variety of lab-prepared spiked samples and real-world samples.</p><p><strong>Materials and methods: </strong>To access the baseline performance of the improved RAPID system in detecting bacteria presence, we selected 17 isolates, most of them from blood or wound infections, and prepared mono-strain spiked samples at 104 to 106 cfu/mL concentration. These samples were processed and analyzed by the RAPID system. To demonstrate the AST capability of the system, we selected 6 strains against 6 different antibiotics and compared the results from the system with the ones from the gold standard method.To validate the system's performance with real-world samples, we first investigated its performance on 3 swab samples from epicutaneous methicillin-resistant Staphylococcus aureus-exposed mouse model. The AST results from our system were compared with the ones from the gold standard method. All animal experiments were approved by the Johns Hopkins University Animal Care and Use Committee (Protocol No. MO21M378). Then, we obtained swab samples from 7 atopic dermatitis (AD) patients and compared our AST results with the ones from the gold standard method. The human subject protocol was approved by the Johns Hopkins Medicines Institutional Review Boards (Study No. CR00043438/IRB00307926) and by USAMRDC (Proposal Log Number/Study Number 20000251).</p><p><strong>Results: </strong>High-quality data were obtained from the spiked samples of all 17 strains. A quantitative analysis model built using these data achieved 94% accuracy in predicting the species ID in 8 unknown samples. The AST results on the spiked samples had shown 100% matching with the gold standard method. Our system successfully detects the presence/absence of viable bacteria in all 3 mouse and 7 AD patient swab samples. Our system shows 100% and 85.7% (6 out of 7) accuracy when compared to the oxacillin susceptibility testing results for the mouse and the AD patient swabs, respectively.</p><p><strong>Conclusions: </strong>Our system has achieved excellent performance in detecting viable bacteria
导言:经历过与战斗有关的伤害的美国军人在进入军队医院时,有更高的机会受到耐多药(MDR)细菌的感染。MDR 伤口感染会导致更高的截肢率和更大的后续或慢性感染风险,从而需要再次入院或延长住院时间。目前,还没有适合野外使用的、经 FDA 批准的、可部署的早期诊断系统。我们报告了我们为改进先前开发的快速无标签病原体识别 (RAPID) 系统所做的努力,该系统可检测伤口感染中存活的 MDR 细菌,并执行抗生素药敏试验 (AST)。具体来说,我们增加了多重和自动化功能,并大大简化了样品制备过程。我们建立了改进系统的功能原型,并使用各种实验室制备的加标样本和实际样本验证了其性能:为了了解改进型 RAPID 系统在检测细菌存在方面的基准性能,我们选择了 17 种分离菌株(其中大部分来自血液或伤口感染),并制备了 104 至 106 cfu/mL 浓度的单菌株加标样本。RAPID 系统对这些样本进行了处理和分析。为了证明该系统的 AST 能力,我们选择了 6 种菌株针对 6 种不同的抗生素,并将该系统得出的结果与金标准方法得出的结果进行了比较。我们将系统得出的 AST 结果与金标准方法得出的结果进行了比较。所有动物实验均获得了约翰霍普金斯大学动物护理和使用委员会(Protocol No.MO21M378)的批准。然后,我们采集了 7 名特应性皮炎(AD)患者的拭子样本,并将我们的 AST 结果与金标准方法的结果进行了比较。该人体试验方案获得了约翰霍普金斯大学医学机构审查委员会(研究编号:CR00043438/IRB00307926)和美国医学研究与发展中心(提案编号/研究编号:20000251)的批准:结果:从所有 17 个菌株的加标样品中获得了高质量的数据。利用这些数据建立的定量分析模型在预测 8 个未知样本的物种 ID 方面达到了 94% 的准确率。加标样品的 AST 结果显示与金标准方法的匹配率为 100%。我们的系统能成功检测出所有 3 个小鼠样本和 7 个 AD 患者拭子样本中是否存在存活细菌。与小鼠和 AD 患者拭子中的奥沙西林药敏试验结果相比,我们的系统分别显示出 100% 和 85.7% 的准确率(7 个样本中的 6 个):我们的系统在检测存活细菌的存在以及以多重、自动和易于操作的方式对实验室制备的样本和真实样本进行 AST 检测方面表现出色。我们的研究结果为开发一种快速(从样本到答案的时间不超过 3 小时)、准确、灵敏、物种特异性强的便携式系统指明了道路,该系统可用于检测野外环境中是否存在 MDR 战斗相关伤口感染。我们未来的工作包括加固 RAPID 系统并评估其在相关环境条件下的性能。
{"title":"Optimization and Validation of an FTIR-based, All-in-one System for Viable MDR Bacteria Detection in Combat-related Wound Infection.","authors":"Ying Chen, Andrew Leung, Yulia Wang, Nathan K Archer","doi":"10.1093/milmed/usae068","DOIUrl":"10.1093/milmed/usae068","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The U.S. Military members experiencing combat-related injuries have a higher chance of developing infections by multidrug-resistant (MDR) bacteria at admission to military hospitals. MDR wound infections result in higher amputation rates and greater risks for subsequent or chronic infections that require readmission or extended stay in the hospital. Currently, there is no FDA-clear, deployable early diagnostic system for suitable field use.We are reporting our efforts to improve a previously developed Rapid Label-free Pathogen Identification (RAPID) system to detect viable MDR bacteria in wound infections and perform antibiotic susceptibility testing (AST). Specifically, we added multiplex and automation capability and significantly simplified the sample preparation process. A functional prototype of the improved system was built, and its performance was validated using a variety of lab-prepared spiked samples and real-world samples.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;To access the baseline performance of the improved RAPID system in detecting bacteria presence, we selected 17 isolates, most of them from blood or wound infections, and prepared mono-strain spiked samples at 104 to 106 cfu/mL concentration. These samples were processed and analyzed by the RAPID system. To demonstrate the AST capability of the system, we selected 6 strains against 6 different antibiotics and compared the results from the system with the ones from the gold standard method.To validate the system's performance with real-world samples, we first investigated its performance on 3 swab samples from epicutaneous methicillin-resistant Staphylococcus aureus-exposed mouse model. The AST results from our system were compared with the ones from the gold standard method. All animal experiments were approved by the Johns Hopkins University Animal Care and Use Committee (Protocol No. MO21M378). Then, we obtained swab samples from 7 atopic dermatitis (AD) patients and compared our AST results with the ones from the gold standard method. The human subject protocol was approved by the Johns Hopkins Medicines Institutional Review Boards (Study No. CR00043438/IRB00307926) and by USAMRDC (Proposal Log Number/Study Number 20000251).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;High-quality data were obtained from the spiked samples of all 17 strains. A quantitative analysis model built using these data achieved 94% accuracy in predicting the species ID in 8 unknown samples. The AST results on the spiked samples had shown 100% matching with the gold standard method. Our system successfully detects the presence/absence of viable bacteria in all 3 mouse and 7 AD patient swab samples. Our system shows 100% and 85.7% (6 out of 7) accuracy when compared to the oxacillin susceptibility testing results for the mouse and the AD patient swabs, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our system has achieved excellent performance in detecting viable bacteria ","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":"140184882","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
Comparison of Vestibular/Ocular Motor Screening (VOMS) and Computerized Eye-tracking to Identify Exposure to Repetitive Head Impacts. 比较前庭/眼球运动筛查 (VOMS) 和计算机化眼球跟踪技术,以确定头部是否受到重复性撞击。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae065
Anthony P Kontos, Aaron J Zynda, Amir Minerbi
<p><strong>Introduction: </strong>Military service members (SMs) are exposed to repetitive head impacts (RHIs) in combat and training that are purported to adversely affect brain health, including cognition, behavior, and function. Researchers have reported that RHI from blast-related exposure may affect both vestibular and ocular function, which in turn may be related to symptomology. As such, an examination of the effects of RHI on exposed military SMs should incorporate these domains. To date, researchers have not compared groups of exposed special operations forces (SOF) operators on combined clinical vestibular/ocular and eye-tracker-based outcomes. Therefore, the primary purpose of this study was to compare participant-reported symptoms and performance on the Vestibular/Ocular Motor Screening (VOMS) tool with performance on the computerized RightEye tracking system between SOF operators exposed to blast-related RHI and healthy controls without blast-related exposure. In addition, the study aimed to compare subgroups of snipers and breachers exposed to RHI to controls on the preceding metrics, as well as identify a subset of individual (demographic) factors, participant-reported symptoms, and performance metrics on VOMS and RightEye that best identify SOF operators exposed to RHI from unexposed controls.</p><p><strong>Materials and methods: </strong>The study involved a cross-sectional design including 25 Canadian SOF SMs comprised of breachers (n = 9), snipers (n = 9), and healthy, unexposed controls (n = 7). The former 2 groups were combined into an RHI group (n = 18) and compared to controls (n = 7). Participants provided demographics and completed a self-reported concussion-related symptom report via the Military Acute Concussion Evaluation 2, the VOMS, and RightEye computerized eye-tracking assessments. Independent samples t-tests and ANOVAs were used to compare the groups on the outcomes, with receiver operating characteristic curve and area under the curve (AUC) analyses to identify predictors of blast exposure. This study was approved by the Defence Research Development Canada Human Research Ethics Committee and the Canadian Forces Surgeon General/Special Forces Command.</p><p><strong>Results: </strong>The results from t-tests supported group differences for age (P = .012), participant-reported symptoms (P = .006), and all VOMS items (P range = <.001-.02), with the RHI group being higher than healthy controls on all variables. ANOVA results supported group differences among snipers, breachers, and controls for age (P = .01), RightEye saccades (P = .04), participant-reported total symptom severity (P = .03), and VOMS total scores (P = .003). The results of the receiver operating characteristic curve analyses supported age (AUC = 0.81), Military Acute Concussion Evaluation 2 participant-reported total symptom severity (AUC = 0.87), and VOMS total scores (AUC = 0.92) as significant predictors of prior blast exposure.</p><p><strong>Concl
导言:军人(SMs)在作战和训练中会受到重复性头部撞击(RHIs),据称会对大脑健康(包括认知、行为和功能)产生不利影响。研究人员报告称,与爆炸相关的 RHI 可能会影响前庭和眼部功能,进而可能与症状有关。因此,研究 RHI 对暴露在爆炸环境中的军方工作人员的影响应包括这些方面。迄今为止,研究人员还没有比较过暴露于环境中的特种作战部队(SOF)操作人员组别在临床前庭/眼部和眼动追踪器基础上的综合结果。因此,本研究的主要目的是比较暴露于爆炸相关 RHI 的特种作战部队操作人员与未暴露于爆炸相关风险的健康对照组之间的参与者报告症状、前庭/眼球运动筛查 (VOMS) 工具的表现以及计算机化 RightEye 跟踪系统的表现。此外,该研究还旨在比较暴露于 RHI 的狙击手和突破者亚组与对照组在前述指标上的表现,并确定个人(人口统计学)因素、参与者报告的症状以及 VOMS 和 RightEye 性能指标的子集,这些子集最能将暴露于 RHI 的 SOF 操作员与未暴露于 RHI 的对照组区分开来:研究采用横断面设计,包括 25 名加拿大特种作战部队 SM,其中包括突破者(9 人)、狙击手(9 人)和健康的未暴露对照组(7 人)。前两组被合并为 RHI 组(n = 18),并与对照组(n = 7)进行比较。参与者提供人口统计数据,并通过军事急性脑震荡评估 2(Military Acute Concussion Evaluation 2)、VOMS 和 RightEye 计算机化眼动追踪评估完成脑震荡相关症状的自我报告。独立样本 t 检验和方差分析用于比较各组的结果,接收者工作特征曲线和曲线下面积 (AUC) 分析用于确定爆炸暴露的预测因素。这项研究获得了加拿大国防研究发展部人类研究伦理委员会和加拿大军队外科医生/特种部队司令部的批准:t检验结果支持年龄(P = .012)、参与者报告的症状(P = .006)和所有VOMS项目(P范围 = 结论)的组间差异:参与者报告的脑震荡症状、VOMS 分数和年龄有助于从对照组中识别暴露于 RHI 的 SOF 操作员。RightEye 指标在区分 RHI 组别与对照组方面没有作用。狙击手和突破者之间的差异值得进一步研究。总之,研究结果表明,VOMS 可能是筛查暴露于 RHI 对 SOF 操作员影响的有用工具。未来的调查应在更大的军事特战队员样本中进行,考虑更多因素(如 RHI 暴露水平、病史和性别),并包括更多的评估领域(如平衡、认知和心理)。
{"title":"Comparison of Vestibular/Ocular Motor Screening (VOMS) and Computerized Eye-tracking to Identify Exposure to Repetitive Head Impacts.","authors":"Anthony P Kontos, Aaron J Zynda, Amir Minerbi","doi":"10.1093/milmed/usae065","DOIUrl":"10.1093/milmed/usae065","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Military service members (SMs) are exposed to repetitive head impacts (RHIs) in combat and training that are purported to adversely affect brain health, including cognition, behavior, and function. Researchers have reported that RHI from blast-related exposure may affect both vestibular and ocular function, which in turn may be related to symptomology. As such, an examination of the effects of RHI on exposed military SMs should incorporate these domains. To date, researchers have not compared groups of exposed special operations forces (SOF) operators on combined clinical vestibular/ocular and eye-tracker-based outcomes. Therefore, the primary purpose of this study was to compare participant-reported symptoms and performance on the Vestibular/Ocular Motor Screening (VOMS) tool with performance on the computerized RightEye tracking system between SOF operators exposed to blast-related RHI and healthy controls without blast-related exposure. In addition, the study aimed to compare subgroups of snipers and breachers exposed to RHI to controls on the preceding metrics, as well as identify a subset of individual (demographic) factors, participant-reported symptoms, and performance metrics on VOMS and RightEye that best identify SOF operators exposed to RHI from unexposed controls.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;The study involved a cross-sectional design including 25 Canadian SOF SMs comprised of breachers (n = 9), snipers (n = 9), and healthy, unexposed controls (n = 7). The former 2 groups were combined into an RHI group (n = 18) and compared to controls (n = 7). Participants provided demographics and completed a self-reported concussion-related symptom report via the Military Acute Concussion Evaluation 2, the VOMS, and RightEye computerized eye-tracking assessments. Independent samples t-tests and ANOVAs were used to compare the groups on the outcomes, with receiver operating characteristic curve and area under the curve (AUC) analyses to identify predictors of blast exposure. This study was approved by the Defence Research Development Canada Human Research Ethics Committee and the Canadian Forces Surgeon General/Special Forces Command.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The results from t-tests supported group differences for age (P = .012), participant-reported symptoms (P = .006), and all VOMS items (P range = &lt;.001-.02), with the RHI group being higher than healthy controls on all variables. ANOVA results supported group differences among snipers, breachers, and controls for age (P = .01), RightEye saccades (P = .04), participant-reported total symptom severity (P = .03), and VOMS total scores (P = .003). The results of the receiver operating characteristic curve analyses supported age (AUC = 0.81), Military Acute Concussion Evaluation 2 participant-reported total symptom severity (AUC = 0.87), and VOMS total scores (AUC = 0.92) as significant predictors of prior blast exposure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Concl","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":"140294043","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
Military Family Perspectives on Enrollment and Engagement in the WIC Program. 军人家庭对加入和参与 WIC 计划的看法。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae192
Binny Chokshi, Sidney Zven, Rachel Burris, Meaghan Wido, Elizabeth Hisle-Gorman

Introduction: One in four U.S. service members endorses food insecurity. The Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an invaluable, underutilized resource that can increase access to nutritious food for families with children under 5 years of age. Our research sought to evaluate military family perceptions and engagement with the WIC program.

Materials and methods: We conducted a mixed-method study, recruiting from a convenience sample of military families who applied for financial assistance for child care. An 18-question survey and follow-up focus groups assessed participant demographics and experiences with WIC. We utilized descriptive statistics ordinal logistic regression analyses for quantitative data analysis. For qualitative data, descriptive content analysis with constant comparison and inductive and deductive coding of interviews identified emerging themes. This study was approved by the Uniformed Services University of the Health Sciences Institutional Review Board.

Results: Among the 399 survey respondents, 25% were currently enrolled in WIC and 39% had been previously enrolled. Service members and their partners learned about WIC from a variety of sources, and there was no significant association between the branch of service or rank and WIC enrollment. There were 40 total participants in 10 completed focus groups. Six themes emerged: (1) Military-specific factors create unique circumstances related to WIC engagement; (2) the WIC program facilitates access to formula supplementation and nutritious foods for military families; (3) lack of program awareness and misinformation are top barriers to WIC engagement in military families; (4) stigma impacts WIC program enrollment and engagement; (5) logistics of enrollment can impact WIC engagement among military families; and (6) the military can support WIC enrollment and engagement through standardization, education, and leadership commitment.

Conclusions: Our findings suggest that unique circumstances related to military family life create a profound need for programs addressing food support, such as WIC. Interventions to improve WIC enrollment among military families need to be rooted in broad outreach efforts, not targeted at specific ranks, branches, or ages. Specific recommendations include increasing information dissemination, universally screening military families for WIC, decreasing logistical burdens, and involving military leadership.

导言:每四名美国军人中就有一人面临粮食不安全问题。妇女、婴儿和儿童补充营养计划(WIC)是一项宝贵但未得到充分利用的资源,它可以增加有 5 岁以下儿童的家庭获得营养食品的机会。我们的研究旨在评估军人家庭对 WIC 计划的看法和参与情况:我们开展了一项混合方法研究,从申请儿童保育经济援助的军人家庭中招募了方便抽样。一项包含 18 个问题的调查和后续焦点小组对参与者的人口统计学特征和使用 WIC 的经验进行了评估。在定量数据分析中,我们使用了描述性统计序数逻辑回归分析。对于定性数据,我们采用了描述性内容分析和不断比较的方法,并对访谈进行了归纳和演绎编码,从而确定了新出现的主题。本研究获得了统一服务卫生科学大学机构审查委员会的批准:在 399 名调查对象中,25% 目前已加入 WIC,39% 以前曾加入过。现役军人及其伴侣从各种渠道了解到 WIC,而服役部门或军衔与 WIC 注册之间没有显著关联。共有 40 人参加了 10 个焦点小组。我们发现了六个主题:(1)军队的特殊因素造成了与参与 WIC 相关的独特情况;(2)WIC 计划为军人家庭获得配方补充剂和营养食品提供了便利;(3)缺乏计划意识和错误信息是军人家庭参与 WIC 的最大障碍;(4)耻辱感影响了 WIC 计划的注册和参与;(5)注册的后勤工作会影响军人家庭参与 WIC;以及(6)军队可以通过标准化、教育和领导承诺来支持 WIC 的注册和参与:我们的研究结果表明,与军人家庭生活相关的特殊情况导致了对 WIC 等食品支持计划的巨大需求。提高军人家庭 WIC 注册率的干预措施需要植根于广泛的外联工作,而不是针对特定的军衔、军种或年龄。具体建议包括加强信息传播、为 WIC 对军人家庭进行普遍筛查、减轻后勤负担以及让军队领导层参与进来。
{"title":"Military Family Perspectives on Enrollment and Engagement in the WIC Program.","authors":"Binny Chokshi, Sidney Zven, Rachel Burris, Meaghan Wido, Elizabeth Hisle-Gorman","doi":"10.1093/milmed/usae192","DOIUrl":"10.1093/milmed/usae192","url":null,"abstract":"<p><strong>Introduction: </strong>One in four U.S. service members endorses food insecurity. The Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an invaluable, underutilized resource that can increase access to nutritious food for families with children under 5 years of age. Our research sought to evaluate military family perceptions and engagement with the WIC program.</p><p><strong>Materials and methods: </strong>We conducted a mixed-method study, recruiting from a convenience sample of military families who applied for financial assistance for child care. An 18-question survey and follow-up focus groups assessed participant demographics and experiences with WIC. We utilized descriptive statistics ordinal logistic regression analyses for quantitative data analysis. For qualitative data, descriptive content analysis with constant comparison and inductive and deductive coding of interviews identified emerging themes. This study was approved by the Uniformed Services University of the Health Sciences Institutional Review Board.</p><p><strong>Results: </strong>Among the 399 survey respondents, 25% were currently enrolled in WIC and 39% had been previously enrolled. Service members and their partners learned about WIC from a variety of sources, and there was no significant association between the branch of service or rank and WIC enrollment. There were 40 total participants in 10 completed focus groups. Six themes emerged: (1) Military-specific factors create unique circumstances related to WIC engagement; (2) the WIC program facilitates access to formula supplementation and nutritious foods for military families; (3) lack of program awareness and misinformation are top barriers to WIC engagement in military families; (4) stigma impacts WIC program enrollment and engagement; (5) logistics of enrollment can impact WIC engagement among military families; and (6) the military can support WIC enrollment and engagement through standardization, education, and leadership commitment.</p><p><strong>Conclusions: </strong>Our findings suggest that unique circumstances related to military family life create a profound need for programs addressing food support, such as WIC. Interventions to improve WIC enrollment among military families need to be rooted in broad outreach efforts, not targeted at specific ranks, branches, or ages. Specific recommendations include increasing information dissemination, universally screening military families for WIC, decreasing logistical burdens, and involving military leadership.</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":"140922655","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
Types of COVID-19 Disaster Work and Psychological Responses in National Guard Service Members. COVID-19 灾害工作类型与国民警卫队成员的心理反应。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae228
Holly B Herberman Mash, Carol S Fullerton, Amy B Adler, Joshua C Morganstein, Dori B Reissman, Quinn M Biggs, Christina L La Croix, Alexandra Blumhorst, Robert J Ursano

Introduction: The National Guard (NG) served as a critical component of the U.S. response to the coronavirus disease 2019 pandemic. Understanding the impact of types of pandemic-related disaster work on mental health responses can aid in sustaining NG service members' health and preparation for subsequent activations and future pandemics.

Materials and methods: We surveyed 1,363 NG unit (NGU) service members (88% Army; 80% enlisted; 32% 30 to 39 years old; 84% male) following activation in response to the pandemic. Surveys were administered between August and December 2020, which was approximately 2 to 3 months post-activation. Surveys assessed overall activation stress, participation in different types of disaster work, probable post-traumatic stress disorder (PTSD), anxiety and depression, and anger. A disaster work stress scale assessed different types of disaster work during activation and associated stress levels. For each individual, we calculated an overall work task stress (WTS) scaled score, with a maximum score of 100. Logistic regression analyses were conducted to examine the relationship of high-stress disaster work tasks to post-activation PTSD, anxiety and depression, and anger, adjusting for socio-demographic and service-related variables. The study was approved by the Institutional Review Board of the Uniformed Services University (USU) in Bethesda, MD.

Results: Among NGU service members, 12.7% (n = 172) described their activation as very/extremely stressful. The work tasks with the highest scaled scores were as follows: (1) Patient transportation (WTS scaled score = 100); (2) working with the dead (WTS = 82.2); and (3) working with families of coronavirus disease 2019 patients (WTS = 72.7). For each individual's work tasks, we identified the work task associated with the highest WTS score. The top one-third of WTS scores were classified as the high-stress group. Approximately 9% of participants (n = 111) had probable PTSD, 6.7% (n = 85) had clinically significant anxiety and depression, and 12.3% (n = 156) had high anger. Multivariable logistic regression analyses, adjusting for covariates, found that NGU service members exposed to the highest level of disaster WTS were more likely to report PTSD (odds ratio [OR] = 1.48 [95% confidence interval [CI] = 1.13-1.94], χ2 = 7.98), anxiety and depression (OR = 1.91 [95% CI = 1.17-3.13]; χ2 = 6.67), and anger (OR = 1.63 [95% CI = 1.13-2.37]; χ2 = 6.66) post-activation.

Conclusions: Identifying work tasks associated with high levels of stress can help detect individuals at risk for adverse mental health responses post-exposure. Distinguishing features of high-stress work conditions can be generalized to other types of work conditions and disaster response and are important targets for planning and preventive efforts.

导言:国民警卫队(NG)是美国应对 2019 年冠状病毒疾病大流行的重要组成部分。了解与大流行病相关的灾难工作类型对心理健康应对措施的影响有助于维持国民警卫队成员的健康,并为随后的行动和未来的大流行病做好准备:我们调查了 1,363 名 NG 部队 (NGU) 服役人员(88% 为陆军;80% 为士兵;32% 年龄在 30 至 39 岁之间;84% 为男性)在启动大流行应对工作后的情况。调查是在 2020 年 8 月至 12 月期间进行的,大约是激活后的 2 至 3 个月。调查评估了总体激活压力、参与不同类型灾难工作的情况、可能的创伤后应激障碍(PTSD)、焦虑和抑郁以及愤怒。灾难工作压力量表评估了激活期间不同类型的灾难工作以及相关的压力水平。我们为每个人计算了工作任务压力(WTS)总分,最高分为 100 分。我们进行了逻辑回归分析,以研究高压力灾难工作任务与激活后创伤后应激障碍、焦虑和抑郁以及愤怒之间的关系,并对社会人口学和服务相关变量进行了调整。该研究获得了马里兰州贝塞斯达统一服务大学(USU)机构审查委员会的批准:在 NGU 服役人员中,12.7%(n = 172)的人认为他们的工作压力非常大。得分最高的工作任务如下:(1) 运送病人(WTS 量表得分 = 100);(2) 与死者打交道(WTS = 82.2);(3) 与 2019 年冠状病毒病病人家属打交道(WTS = 72.7)。对于每个人的工作任务,我们确定了与最高 WTS 分数相关的工作任务。WTS 分数最高的三分之一被划分为高压力组。约 9% 的参与者(n = 111)可能患有创伤后应激障碍,6.7% 的参与者(n = 85)患有临床上严重的焦虑症和抑郁症,12.3% 的参与者(n = 156)患有高度愤怒症。在对协变量进行调整后,多变量逻辑回归分析发现,暴露于最高级别灾难 WTS 的 NGU 服役人员更有可能报告创伤后应激障碍(几率比 [OR] = 1.48 [95% 置信区间 [CI] = 1.13-1.94]; χ2 = 7.98)、焦虑和抑郁(OR = 1.91 [95% CI = 1.17-3.13]; χ2 = 6.67)以及愤怒(OR = 1.63 [95% CI = 1.13-2.37]; χ2 = 6.66):结论:识别与高压力相关的工作任务有助于发现暴露后可能出现不良心理健康反应的个体。高压力工作条件的特征可以推广到其他类型的工作条件和灾难响应中,是规划和预防工作的重要目标。
{"title":"Types of COVID-19 Disaster Work and Psychological Responses in National Guard Service Members.","authors":"Holly B Herberman Mash, Carol S Fullerton, Amy B Adler, Joshua C Morganstein, Dori B Reissman, Quinn M Biggs, Christina L La Croix, Alexandra Blumhorst, Robert J Ursano","doi":"10.1093/milmed/usae228","DOIUrl":"10.1093/milmed/usae228","url":null,"abstract":"<p><strong>Introduction: </strong>The National Guard (NG) served as a critical component of the U.S. response to the coronavirus disease 2019 pandemic. Understanding the impact of types of pandemic-related disaster work on mental health responses can aid in sustaining NG service members' health and preparation for subsequent activations and future pandemics.</p><p><strong>Materials and methods: </strong>We surveyed 1,363 NG unit (NGU) service members (88% Army; 80% enlisted; 32% 30 to 39 years old; 84% male) following activation in response to the pandemic. Surveys were administered between August and December 2020, which was approximately 2 to 3 months post-activation. Surveys assessed overall activation stress, participation in different types of disaster work, probable post-traumatic stress disorder (PTSD), anxiety and depression, and anger. A disaster work stress scale assessed different types of disaster work during activation and associated stress levels. For each individual, we calculated an overall work task stress (WTS) scaled score, with a maximum score of 100. Logistic regression analyses were conducted to examine the relationship of high-stress disaster work tasks to post-activation PTSD, anxiety and depression, and anger, adjusting for socio-demographic and service-related variables. The study was approved by the Institutional Review Board of the Uniformed Services University (USU) in Bethesda, MD.</p><p><strong>Results: </strong>Among NGU service members, 12.7% (n = 172) described their activation as very/extremely stressful. The work tasks with the highest scaled scores were as follows: (1) Patient transportation (WTS scaled score = 100); (2) working with the dead (WTS = 82.2); and (3) working with families of coronavirus disease 2019 patients (WTS = 72.7). For each individual's work tasks, we identified the work task associated with the highest WTS score. The top one-third of WTS scores were classified as the high-stress group. Approximately 9% of participants (n = 111) had probable PTSD, 6.7% (n = 85) had clinically significant anxiety and depression, and 12.3% (n = 156) had high anger. Multivariable logistic regression analyses, adjusting for covariates, found that NGU service members exposed to the highest level of disaster WTS were more likely to report PTSD (odds ratio [OR] = 1.48 [95% confidence interval [CI] = 1.13-1.94], χ2 = 7.98), anxiety and depression (OR = 1.91 [95% CI = 1.17-3.13]; χ2 = 6.67), and anger (OR = 1.63 [95% CI = 1.13-2.37]; χ2 = 6.66) post-activation.</p><p><strong>Conclusions: </strong>Identifying work tasks associated with high levels of stress can help detect individuals at risk for adverse mental health responses post-exposure. Distinguishing features of high-stress work conditions can be generalized to other types of work conditions and disaster response and are important targets for planning and preventive efforts.</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":"140958478","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
Gender and Mentorship in Military Medicine: A Survey Study. 军事医学中的性别与导师制度:调查研究。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae261
Rebekah Cole, Kaitlin Zurbrugg, Yen Lee, Ting Dong, Jessica Bunin, Guinevere Granite, Amber Barak, Sherri L Rudinsky

Introduction: Mentorship is essential for professional development and advancement within the military. In civilian medicine, the intersection between gender and mentorship holds important implications for research opportunities, academic success, and career progression. However, the intersection of gender and mentorship has not yet been explored within the field of military medicine. The purpose of this study, therefore, was to investigate the role of gender in mentorship within the field of military medicine.

Materials and methods: We investigated gender and mentorship within military medicine by developing and distributing a 16-item Likert survey to active-duty military physicians. We used the Chi-squared test of independence and the independent samples t-test to examine the role of gender in mentorship among the 16 questions.

Results: The male respondents reported more same-gender mentors than females (male [M]: 61.9% vs. female [F]: 33.0%), whereas the female respondents had significantly more mentors of the opposite gender than males (M: 12.4% vs. F: 47.3%). A higher proportion of males indicated no preference compared to females. Conversely, a significant preference for a same-sex mentor was expressed by female respondents compared to male respondents (M: 5.2% vs. F: 30.1%). In contrast, female respondents considered having a mentor more important than their male counterparts (t(206) = -2.26, P = .012, F: 3.86 vs. M: 3.57). Both male and female respondents had significantly more female mentees ($chi _{left( 1 right)}^2$ = 12.92, P < .001, Cramer's V = 0.254).

Conclusions: While the female participants in our study preferred female mentors, the male participants had more same-gender mentors than the female participants. In addition, more females reported that they did not have the time to be mentored. Our results, therefore, suggest that training males to be better mentors to females and providing accessible mentorship training to females may promote equitable career development within military medicine.

导言:在军队中,导师制对专业发展和晋升至关重要。在民用医学领域,性别与导师制之间的交叉对研究机会、学术成功和职业发展具有重要影响。然而,在军事医学领域,性别与导师制之间的交集尚未得到探讨。因此,本研究旨在调查性别在军事医学领域导师制中的作用:我们制定并向现役军医分发了一份包含 16 个项目的李克特调查问卷,以此调查军事医学领域中的性别与导师关系。我们使用卡方检验(Chi-squared test of independence)和独立样本 t 检验(independent samples t-test)来研究 16 个问题中性别在导师关系中的作用:结果:男性受访者报告的同性导师多于女性(男性[M]:61.9% 对女性[F]:33.0%),而女性受访者报告的异性导师明显多于男性(男性[M]:12.4% 对女性[F]:47.3%)。与女性相比,男性表示没有偏好的比例更高。相反,与男性受访者相比,女性受访者对同性导师有明显偏好(男:5.2%;女:30.1%)。相比之下,女性受访者认为导师比男性受访者更重要(t(206) = -2.26,P = .012,女方:3.86 对男方:3.57)。男性和女性受访者都有明显更多的女性被指导者($chi _{left( 1 right)}^2$=12.92,P 结论:虽然我们研究中的女性参与者更喜欢女性导师,但男性参与者拥有的同性导师要多于女性参与者。此外,更多女性表示她们没有时间接受指导。因此,我们的研究结果表明,培训男性成为女性更好的导师,并为女性提供方便的导师培训,可以促进军事医学领域的公平职业发展。
{"title":"Gender and Mentorship in Military Medicine: A Survey Study.","authors":"Rebekah Cole, Kaitlin Zurbrugg, Yen Lee, Ting Dong, Jessica Bunin, Guinevere Granite, Amber Barak, Sherri L Rudinsky","doi":"10.1093/milmed/usae261","DOIUrl":"10.1093/milmed/usae261","url":null,"abstract":"<p><strong>Introduction: </strong>Mentorship is essential for professional development and advancement within the military. In civilian medicine, the intersection between gender and mentorship holds important implications for research opportunities, academic success, and career progression. However, the intersection of gender and mentorship has not yet been explored within the field of military medicine. The purpose of this study, therefore, was to investigate the role of gender in mentorship within the field of military medicine.</p><p><strong>Materials and methods: </strong>We investigated gender and mentorship within military medicine by developing and distributing a 16-item Likert survey to active-duty military physicians. We used the Chi-squared test of independence and the independent samples t-test to examine the role of gender in mentorship among the 16 questions.</p><p><strong>Results: </strong>The male respondents reported more same-gender mentors than females (male [M]: 61.9% vs. female [F]: 33.0%), whereas the female respondents had significantly more mentors of the opposite gender than males (M: 12.4% vs. F: 47.3%). A higher proportion of males indicated no preference compared to females. Conversely, a significant preference for a same-sex mentor was expressed by female respondents compared to male respondents (M: 5.2% vs. F: 30.1%). In contrast, female respondents considered having a mentor more important than their male counterparts (t(206) = -2.26, P = .012, F: 3.86 vs. M: 3.57). Both male and female respondents had significantly more female mentees ($chi _{left( 1 right)}^2$ = 12.92, P < .001, Cramer's V = 0.254).</p><p><strong>Conclusions: </strong>While the female participants in our study preferred female mentors, the male participants had more same-gender mentors than the female participants. In addition, more females reported that they did not have the time to be mentored. Our results, therefore, suggest that training males to be better mentors to females and providing accessible mentorship training to females may promote equitable career development within military medicine.</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":"141070987","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
Analysis of Injury Metrics From Experimental Cardiac Injuries From Behind Armor Blunt Trauma Using Live Swine Tests: A Pilot Study. 利用活猪试验分析装甲后钝器伤造成的实验性心脏损伤指标:试点研究。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae297
Narayan Yoganandan, Alok Shah, Jared Koser, Lewis Somberg, Brian D Stemper, Valeta Carol Chancey, Joseph Barney McEntire
<p><strong>Introduction: </strong>Warfighters are issued hard body armor designed to defeat ballistic projectiles. The resulting backface deformation can injure different thoracoabdominal organs. Developed over decades ago, the behind armor blunt impact criterion of maximum 44 mm depth in clay continues to be used independent of armor type or impact location on the thoracoabdominal region covered by the armor. Because thoracoabdominal components have different energy absorption capabilities, their mode of failures and mechanical properties are different. These considerations underscore the lack of effectiveness of using the single standard to cover all thoracoabdominal components to represent the same level of injury risk. The objective of this pilot study is to conduct cardiac impact tests with a live animal model and analyze biomechanical injury candidate metrics for behind armor blunt trauma applications.</p><p><strong>Materials and methods: </strong>Live swine tests were conducted after obtaining approvals from the U.S. DoD. Trachea tubes. An intravenous line were introduced into the swine before administering anesthesia. Pressure transducers were inserted into lungs and aorta. An indenter simulating backface deformation profiles produced by body armor from military-relevant ballistics to human cadavers delivered impact to the heart region. The approved test protocol included 6-hour monitoring and necropsies. Indenter accelerometer signals were processed to compute the velocity and deflection, and their peak magnitudes were obtained. The deflection-time signal was normalized with respect to chest depth along the impact axis. The peak magnitude of the viscous criterion, kinetic energy, force, momentum and stiffness were obtained.</p><p><strong>Results: </strong>Out of the 8 specimens, 2 were sham controls. The mean total body mass and soft tissue thickness at the impact site were 81.1 ± 4.1 kg and 3.8 ± 1.1 cm. The peak velocities ranged from 30 to 59 m/s, normalized deflections ranged from 15 to 21%, and energies ranged from 105 to 407 J. The range in momentum and stiffness were 7.0 to 13.9 kg-m/s and 22.3 to 79.9 N/m. The maximum forces and impulse data ranged from 2.9 to 11.7 kN and 1.9 to 5.8 N-s. The peak viscous criterion ranged from 2.0 to 5.3 m/s. One animal did not sustain any injuries, 2 had cardiac injuries, and others had lung and skeletal injuries.</p><p><strong>Conclusions: </strong>The present study applied blunt impact loads to the live swine cardiac region and determined potential candidate injury metrics for characterization. The sample size of 6 swine produced injuries ranging from none to pure skeletal to pure organ trauma. The viscous criterion metric associated with the response of the animal demonstrated a differing pattern than other variables with increasing velocity. These findings demonstrate that our live animal experimental design can be effectively used with testing additional samples to develop behind armor blunt
导言:为作战人员配备的硬质防弹衣可抵御弹道导弹。由此产生的后背变形可能会伤害不同的胸腹器官。几十年前制定的 "装甲后钝器撞击标准"(粘土中最大深度为 44 毫米)一直沿用至今,与装甲类型或装甲覆盖的胸腹区域的撞击位置无关。由于胸腹部部件的能量吸收能力不同,其失效模式和机械性能也不同。这些因素突出表明,使用单一标准覆盖所有胸腹部位来代表相同程度的伤害风险缺乏有效性。本试验研究的目的是使用活体动物模型进行心脏冲击试验,并分析装甲钝器创伤应用的生物力学损伤候选指标:在获得美国国防部批准后,进行了活猪试验。气管插管。在实施麻醉之前,将静脉注射管插入猪体内。将压力传感器插入肺部和主动脉。用压头模拟人体尸体的防弹衣在军事相关弹道中产生的背面变形情况,对心脏区域进行冲击。经批准的测试方案包括 6 小时监测和尸体解剖。对压头加速度计信号进行处理,以计算速度和挠度,并获得其峰值大小。挠度-时间信号沿冲击轴与胸腔深度进行了归一化处理。结果:在 8 个样本中,有 2 个是假对照组。撞击部位的平均体重和软组织厚度分别为 81.1 ± 4.1 千克和 3.8 ± 1.1 厘米。峰值速度为 30 至 59 m/s,归一化挠度为 15 至 21%,能量为 105 至 407 J。动量和刚度的范围分别为 7.0 至 13.9 kg-m/s 和 22.3 至 79.9 N/m。最大力和冲量数据范围为 2.9 至 11.7 kN 和 1.9 至 5.8 N-s。峰值粘性标准介于 2.0 至 5.3 米/秒之间。一只动物没有受伤,两只动物心脏受伤,其他动物肺部和骨骼受伤:本研究对活猪心脏部位施加了钝性冲击载荷,并确定了潜在的候选损伤指标。6 头猪的样本量产生了从无伤害到纯骨骼伤害再到纯器官创伤的各种伤害。随着速度的增加,与动物反应相关的粘性标准指标显示出与其他变量不同的模式。这些研究结果表明,我们的活体动物实验设计可以有效地用于测试更多样本,以风险曲线的形式制定心脏创伤的钝伤标准。获得的心脏创伤伤害标准可用于提高防弹衣的有效性,降低发病率和死亡率,并改善作战人员在作战行动中的战备状态。
{"title":"Analysis of Injury Metrics From Experimental Cardiac Injuries From Behind Armor Blunt Trauma Using Live Swine Tests: A Pilot Study.","authors":"Narayan Yoganandan, Alok Shah, Jared Koser, Lewis Somberg, Brian D Stemper, Valeta Carol Chancey, Joseph Barney McEntire","doi":"10.1093/milmed/usae297","DOIUrl":"10.1093/milmed/usae297","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Warfighters are issued hard body armor designed to defeat ballistic projectiles. The resulting backface deformation can injure different thoracoabdominal organs. Developed over decades ago, the behind armor blunt impact criterion of maximum 44 mm depth in clay continues to be used independent of armor type or impact location on the thoracoabdominal region covered by the armor. Because thoracoabdominal components have different energy absorption capabilities, their mode of failures and mechanical properties are different. These considerations underscore the lack of effectiveness of using the single standard to cover all thoracoabdominal components to represent the same level of injury risk. The objective of this pilot study is to conduct cardiac impact tests with a live animal model and analyze biomechanical injury candidate metrics for behind armor blunt trauma applications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Live swine tests were conducted after obtaining approvals from the U.S. DoD. Trachea tubes. An intravenous line were introduced into the swine before administering anesthesia. Pressure transducers were inserted into lungs and aorta. An indenter simulating backface deformation profiles produced by body armor from military-relevant ballistics to human cadavers delivered impact to the heart region. The approved test protocol included 6-hour monitoring and necropsies. Indenter accelerometer signals were processed to compute the velocity and deflection, and their peak magnitudes were obtained. The deflection-time signal was normalized with respect to chest depth along the impact axis. The peak magnitude of the viscous criterion, kinetic energy, force, momentum and stiffness were obtained.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of the 8 specimens, 2 were sham controls. The mean total body mass and soft tissue thickness at the impact site were 81.1 ± 4.1 kg and 3.8 ± 1.1 cm. The peak velocities ranged from 30 to 59 m/s, normalized deflections ranged from 15 to 21%, and energies ranged from 105 to 407 J. The range in momentum and stiffness were 7.0 to 13.9 kg-m/s and 22.3 to 79.9 N/m. The maximum forces and impulse data ranged from 2.9 to 11.7 kN and 1.9 to 5.8 N-s. The peak viscous criterion ranged from 2.0 to 5.3 m/s. One animal did not sustain any injuries, 2 had cardiac injuries, and others had lung and skeletal injuries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The present study applied blunt impact loads to the live swine cardiac region and determined potential candidate injury metrics for characterization. The sample size of 6 swine produced injuries ranging from none to pure skeletal to pure organ trauma. The viscous criterion metric associated with the response of the animal demonstrated a differing pattern than other variables with increasing velocity. These findings demonstrate that our live animal experimental design can be effectively used with testing additional samples to develop behind armor blunt","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":"141327674","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
Misuse of Tourniquets in Ukraine may be Costing More Lives and Limbs Than They Save. 乌克兰滥用止血带造成的生命和肢体损失可能超过其挽救的生命和肢体。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usad503
Rom A Stevens, Michael S Baker, Ostap B Zubach, Michael Samotowka

Hands-on training and social media sites have heavily emphasized the use of tourniquets to treat limb injuries during the Ukraine war. Tourniquet overuse or misuse can lead to significant tragedy-limb loss, physiologic complications, and even death. Casualty evacuation in Ukraine often exceeds 6 hours, and the liberal use of limb tourniquets may have unintentionally increased morbidity. Tourniquet application was appropriate in 24.6% of the wounded with tourniquets in one recent publication by a Ukrainian vascular surgeon. The longer a limb tourniquet is in place raises the risk of compartment syndrome, vascular thrombosis, rhabdomyolysis, and irreversible myonecrosis resulting in major tissue loss and often necessitating limb amputation. If bleeding is controlled with a tourniquet, attempts to remove the tourniquet as early as possible to avoid the negative consequences are essential. Training in tourniquet use without explaining possible limb loss and other complications resulting from tourniquets left in situ more than 2 hours makes use risky. Tourniquets should be loosened at one hour if the tactical situation allows, and the injury assessed to determine if major bleeding persists or to determine if other methods of hemostasis would be effective. Ukraine must improve the training so that everyone becomes aware of the risks of prolonged or improper tourniquet use. This tourniquet training information must be transmitted to military medical leaders, Ukrainian military medics, civilian volunteers, volunteers in Ukraine, and NATO trainers in allied countries conducting medical training for Ukrainian soldiers. A trauma registry and tracking through echelons of care can enhance performance improvement through timely feedback.

在乌克兰战争期间,实训和社交媒体网站都大力强调使用止血带治疗肢体损伤。止血带的过度使用或滥用可能导致重大悲剧--肢体缺失、生理并发症,甚至死亡。乌克兰的伤员后送时间通常超过 6 小时,随意使用四肢止血带可能会无意中增加发病率。在一位乌克兰血管外科医生最近发表的一篇文章中,有 24.6% 的伤员使用止血带是适当的。肢体使用止血带的时间越长,就越有可能引发室间隔综合症、血管血栓、横纹肌溶解和不可逆转的肌坏死,导致严重的组织损失,通常需要截肢。如果使用止血带控制了出血,则必须尽早去除止血带以避免不良后果。止血带使用培训中没有解释止血带留在原位超过 2 小时可能导致的肢体缺失和其他并发症,会使止血带的使用存在风险。如果战术情况允许,应在一小时后松开止血带,并对伤势进行评估,以确定是否仍有大出血,或确定其他止血方法是否有效。乌克兰必须改进培训,让每个人都意识到长时间或不正确使用止血带的风险。这种止血带培训信息必须传达给军队医疗领导、乌克兰军队医务人员、民间志愿者、在乌克兰的志愿者以及在盟国为乌克兰士兵进行医疗培训的北约培训师。建立创伤登记册并通过各级医疗机构进行追踪,可以通过及时反馈来提高绩效。
{"title":"Misuse of Tourniquets in Ukraine may be Costing More Lives and Limbs Than They Save.","authors":"Rom A Stevens, Michael S Baker, Ostap B Zubach, Michael Samotowka","doi":"10.1093/milmed/usad503","DOIUrl":"10.1093/milmed/usad503","url":null,"abstract":"<p><p>Hands-on training and social media sites have heavily emphasized the use of tourniquets to treat limb injuries during the Ukraine war. Tourniquet overuse or misuse can lead to significant tragedy-limb loss, physiologic complications, and even death. Casualty evacuation in Ukraine often exceeds 6 hours, and the liberal use of limb tourniquets may have unintentionally increased morbidity. Tourniquet application was appropriate in 24.6% of the wounded with tourniquets in one recent publication by a Ukrainian vascular surgeon. The longer a limb tourniquet is in place raises the risk of compartment syndrome, vascular thrombosis, rhabdomyolysis, and irreversible myonecrosis resulting in major tissue loss and often necessitating limb amputation. If bleeding is controlled with a tourniquet, attempts to remove the tourniquet as early as possible to avoid the negative consequences are essential. Training in tourniquet use without explaining possible limb loss and other complications resulting from tourniquets left in situ more than 2 hours makes use risky. Tourniquets should be loosened at one hour if the tactical situation allows, and the injury assessed to determine if major bleeding persists or to determine if other methods of hemostasis would be effective. Ukraine must improve the training so that everyone becomes aware of the risks of prolonged or improper tourniquet use. This tourniquet training information must be transmitted to military medical leaders, Ukrainian military medics, civilian volunteers, volunteers in Ukraine, and NATO trainers in allied countries conducting medical training for Ukrainian soldiers. A trauma registry and tracking through echelons of care can enhance performance improvement through timely feedback.</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":"139501777","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
期刊
Military Medicine
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1