Military Medicine最新文献

Background: Musculoskeletal injuries (MSKIs) represent the most substantial and enduring threat to U.S. military readiness. Previous studies have focused on narrow surveillance periods, single branches of service, and used variable approaches for MSKI identification and classification. Therefore, the goals of this retrospective population study were to report the incidence, prevalence, and types of MSKIs sustained by active duty service members (ADSMs) across four Services in direct care (DC) and private sector care (PC) settings over fiscal years (FYs) 2010-2021, and to quantify and describe associated health care utilization and PC costs over the same period.

Methods: This study included ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Head/Neck, Upper Extremity (UE), Spine (upper back, middle back, lower back, pelvic), and Lower Extremity (LE) MSKIs in ADSMs, associated health care utilization, and PC costs were derived by querying electronic health records from DC, PC claims, and theater medical data from the Military Health System Data Repository. Patient episodes of care and associated PC costs related to MSKIs in DC and PC settings were classified into mutually exclusive outpatient encounter categories and acute inpatient stays, body regions, and Services.

Results: Over FY10-21, the most prevalent MSKIs were LE (24-29%) followed by Spine (17-20%), UE (14-16%), and Head/Neck (6-8%). Across FY10-21, soldiers were more likely to sustain LE MSKI than Airmen (risk ratio 1.12-1.30) and Marines demonstrated an increasing risk of LE MSKI prevalence and incidence (relative to Airmen) over the study period. The rise in prevalence of LE, Spine, UE, and Head/Neck MSKIs over FY10-21 was accompanied by increased health care utilization and reliance on PC care, especially same-day surgeries (SDS). PC reliance for SDS increased across body regions from FY10 to its peak in FY20 (Head/Neck: 22.7% to 49.7%, Spine: 37.1% to 57.0%, LE: 38.6% to 51.5%, UE: 40.4% to 53.5%). In FY21, the MHS incurred the highest PC costs for LE MSKIs ($132,242,289), followed by Spine ($98,738,863), UE ($92,118,071), and Head/Neck ($42,718,754).

Conclusions: To our knowledge, this is the first population study of MSKIs in ADSMs spanning the ICD-10 CM transition (FY15-16) that includes the four Services. Across Services, MSKIs in the U.S. military remain a prevalent and persistent problem. Consistent with prior research, the LE was the most common and costly body region affected by MSKIs. Service members with MSKIs demonstrated an increasing reliance on PC for MSKI care, particularly SDS, over the study period. Expanding future research efforts to include all Services to assess risk factors and patient outcomes for treatments across DC and PC settings is vital to mitigate the threat posed by MSKIs to the readiness of the U.S. Armed Forces.

Introduction: Headache is the most overwhelmingly reported symptom following mild traumatic brain injury (mTBI). The upper cervical spine has been implicated in headache etiology, and cervical dysfunction may result in neck pain that influences the experience of headache. Sleep problem is the second most reported symptom following mTBI. We explored the contribution of neck pain (as a potential proxy for cervical dysfunction) on headache burden along with the contribution of sleep quantity following mTBI.

Materials and methods: Retrospective data from a repository consisting of service members recruited from primary care, with (N = 493) and without a history of mTBI (N = 63), was used for analysis. Portions of the Neurobehavioral Symptom Inventory, Pittsburgh Sleep Quality Index, and Orebro Musculoskeletal Pain Questionnaire were used for headache, sleep, and neck pain measures.

Results: Demographic and military characteristics that differed between groups were treated as covariates in analyses. Group comparisons revealed significant differences in the expected direction on all measures: mTBI > controls on headache and neck pain; controls > mTBI on sleep quantity. Regression revealed that neck pain accounted for the most variance in headache score, followed by group membership and sleep quantity. When analyzing groups separately, no difference in the pattern of results was revealed in the mTBI group. In the control group, variance in headache score was only significantly related to neck pain.

Conclusions: Amongst service members who sought service from primary care, neck pain explains more variance in headache burden than mTBI history or sleep quantity, supporting that cervical dysfunction may be a salient factor associated with headache. Neck functioning may be a potential area of intervention in the management of headaches.

Introduction: The lack of adequate diverse representation (racially, socioeconomically, gender, second career applicants, student parents, etc.) within secondary education in the United States has proven to be a challenging and complex, multifaceted problem, and despite ongoing efforts, one that continues to remain unsolved. These disparities are well known and documented at all levels of education. The Uniformed Services University of Health Sciences is the nation's only fully federally funded medical school and capitalizes on the preexisting diversity and exceptional training already existing within the U.S. military's enlisted force through the Enlisted to Medical Degree Preparatory Program (EMDP2). This study aims to investigate how a novel program at a unique military medical school influences medical school class cohorts.

Methods: This study used a traditional thematic qualitative analysis format. Thematic qualitative analysis is a method for identifying, analyzing, organizing, describing, and reporting themes found within survey responses. One hundred nine surveys via SurveyMonkey© were sent to EMDP2 students. Thirty-six surveys were returned for a response rate of 33%. Two co-investigators carefully read each participant response and coded independently line-by-line with constant comparison of each quote. NVivo© software was used to store the data as the counts progressed.

Results: After completion of data collection, results identified the following themes among survey responses being accepted, bridging the gap, feeling valued, gratitude, prior experiences, and professionalism.

Conclusions: Students with prior military experience have a significant impact on our institutions medical school classes. These students provide mentorship and professionalism to their fellow classmates. This study helps educators understand the perspectives and challenges faced by prior-service medical students and appreciate how to use the prior experience of these unique prior-service members to benefit the entire class.

Introduction: Wastewater surveillance is an important technique to monitor public health and is being studied extensively for pandemic prevention, force health protection and readiness, and as a potential early warning system for chem-bio defense. Wastewater surveillance has traditionally relied on techniques such as quantitative PCR or targeted sequencing, both of which are microbe- or disease-specific tools. Newer pan-viral metagenomics strategies may provide higher specificity for pathogens of interest, resulting in a lower false negative rate and reduced sequencing of undesired background nucleic acids. One such system, VirCapSeq-VERT, has been developed to target all vertebrate virus pathogens; until recently, its application has been limited to clinical samples. The objective of this study was to use VirCapSeq-VERT to interrogate wastewater samples from the U.S. Air Force Academy (USAFA), Colorado Springs, Colorado, to determine its utility in assessing complex samples and its potential application in public health surveillance.

Materials and methods: Biweekly samples were analyzed from February 2022 through May 2023. Samples were collected from the wastewater treatment facility at USAFA before treatment and stored at -20 °C until total nucleic acid (tNA: DNA and RNA) extraction. tNA was then subject to the probe-based capture system, VirCapSeq, and run through a collection of public bioinformatics pipelines to identify captured viral pathogens and perform phylogenetic analysis. It was determined by the USAFA IRB that the study was non-human subject research and was deemed exempt.

Results: In total, 68 families of viruses were identified, comprising thousands of individual strains. This study focused on viruses responsible for gastrointestinal dysfunction as a test of the use of the VirCapSeq-VERT to identify human pathogenic viruses within a complex and highly enriched biological sample. Four enteric viruses dominated the wastewater samples, with Adenoviridae most prevalent before the cadet winter recess (December 17, 2022-January 4, 2023) and Astroviridae most abundant thereafter.

Conclusion: Although gastroenteritis outbreaks at USAFA are commonly attributed to norovirus because of clinical presentation and the acute nature of the illness-often diagnosed and treated without confirmatory stool testing-this virus was not found in high prevalence in these wastewater samples. Among adenoviruses, F serotype 41 predominated, suggesting a role in gastrointestinal infections among the cadet population. Phylogenetic investigation of adenovirus and norovirus exposed common variants with seasonal distributions. These findings may prompt correlational studies to assess the clinical predictive capability of VirCapSeq-VERT and to determine the utility of wastewater monitoring as an outbreak early warning system.

Introduction: Military personnel confront heightened risks of musculoskeletal injuries (MSIs) because of the demanding nature of their duties, contributing to restricted active duty and financial burdens. Although preventable factors like training and physical fitness influence some injuries, understanding the enduring effects of previous MSIs on physical fitness in military personnel remains a critical gap. This study aimed to systematically review and meta-analyze this impact.

Materials and methods: In accordance with PRISMA guidelines, a systematic review with meta-analysis was conducted, focusing on military personnel with and without a history of MSIs. Physical fitness components were assessed via observational studies, with isokinetic peak torque values as primary metrics. Quality assessments utilized the NIH Quality Assessment Tool and GRADE framework.

Results: Out of 36 papers, 6 met inclusion criteria, with 4 included in the meta-analysis. Across 1,267 participants, individuals with prior MSIs exhibited a significant reduction in the pooled effect size for isokinetic peak muscle force, with d+ = -0.25 (95% CI: -0.36 to -0.13), notably affecting knee and shoulder regions. These findings underscore the pervasive impact of MSIs on military personnel's physical performance, necessitating targeted interventions.

Conclusion: Military personnel with prior MSIs exhibit enduring deficits in isokinetic peak muscle force, particularly in knee and shoulder regions. However, evidence on the impact of previous injuries on other physical fitness components remains limited. Further research is crucial to understanding the multifaceted impact of MSIs on diverse aspects of physical performance, informing comprehensive injury prevention strategies and optimizing performance outcomes among military personnel.

Introduction: Risk for depression is heightened among male service members/veterans relative to civilians. Research suggests social support protects service members/veterans from depressive symptoms, but most studies focus on positive social support. Negative social support, which can include unwanted emotional involvement or social negativity, could be more impactful on depressive symptoms than positive; however, this has not been examined in military samples. Moreover, it is unclear whether positive interactions buffer the effects of negative interactions.

Materials and methods: SM/Vs (N = 508) were recruited online using convenience sampling and completed demographics, and measures of depression and social exchange frequencies, a metric of positive and negative social support. This secondary data analysis was drawn from a parent study that was approved by an institutional review board. A correlation comparison calculator compared the strength of bivariate associations of positive social exchanges and negative social exchanges with depression. Linear regression examined the simultaneous effects of positive and negative social exchanges, and subsequently examined whether positive social exchanges moderated the association of negative social exchanges and depression.

Results: The positive bivariate association of negative exchanges and depression (r = 0.48, P < .001) was statistically stronger than the negative bivariate association of positive exchanges and depression (r = -0.40, P < .001). A regression analysis revealed that higher negative exchanges were positively associated with depression (partial r = 0.40, P < .001) and higher positive exchanges were negatively associated with depression (partial r = -0.32, P < .001) after accounting for covariates, but positive exchanges did not mitigate the association of negative exchanges and depression (P > .05).

Conclusions: Decreasing the frequency of negative social exchanges is associated with lower depressive symptoms and may have a stronger relationship with depression than positive exchanges, suggesting independent pathways to depression. Longitudinal assessments are needed to determine the potential directionality of these relationships and to address the limitations associated with convenience sampling and cross-sectional data collection.

Introduction: US service members experience high rates of back pain. Guidelines prioritize nonpharmacologic treatment (NPT) as first-line pain treatments; however, NPT utilization patterns research is limited. This study examined NPT patterns of care within the first 10 weeks following an index back pain diagnosis.

Materials and methods: Data were from the Substance Use and Psychological Injury Combat Study and included 222,427 active duty soldiers with an index back pain diagnosis following return from Afghanistan/Iraq deployment in 2008-2014. We fit a series of latent class analysis models to identify homogenous subgroups of soldiers with NPT utilization during the 10-week period and measured associations with soldier characteristics and clinical characteristics within 90 days before the back pain diagnosis, with the distinct NPT utilization classes. Approval for this study was granted by the Brandeis University Committee for Protection of Human Subjects (Institutional Review Board #14153) and the Uniformed Services University Institutional Review Board.

Results: Only half of the soldiers received any NPT within their 10-week early treatment window. Latent class analysis identified 4 classes over the 10-week early treatment window: Class 1 (None/Low NPT, 65%); Class 2 (High and Decreasing NPT, 15%); Class 3 (Low and Increasing NPT, 13%), and Class 4 (Sustained NPT, 7%). Soldier clinical characteristics from the 90-day preperiod window were most important in distinguishing class membership in relation to Class 1, particularly comorbid pain conditions, diagnosis of traumatic brain injury, receipt of prescription opioids, and receipt of invasive surgery.

Conclusions: Patterns of weekly NPT utilization during an early treatment window following a new back pain diagnosis varied temporally, with approximately half of soldiers using NPT. Half of the soldiers did not receive any NPT within their 10-week early treatment window, which highlights opportunities for increasing use of NPT utilization among military members with a new back pain episode. Future research is needed in the Military Health System to examine the extent to which NPT patterns are associated with pain management outcomes.

Introduction: First-line treatments for chronic pain include selected complementary and integrative health therapies, including spinal manipulation, acupuncture, yoga, and massage; and standard rehabilitative care, including physical and occupational therapies. This study aimed to uncover critical factors that contribute to pain impact and the effectiveness of complementary and integrative health therapies and standard rehabilitative care among people with chronic pain, with a focus on the role of sleep-related impairment.

Materials and methods: We conducted a secondary analysis of data from a pragmatic randomized clinical trial of 280 U.S. active duty service members with chronic pain.

Results: Our study's multiple mediation analysis examined the indirect effect of complementary and integrative health therapies on pain impact through fatigue (β = - 0.43; 95% CI, -0.99 to -0.07). When stratified by sleep-related impairment, participants with T scores above the median of 62 demonstrated a significant negative indirect effect of complementary and integrative health therapies through fatigue (β = - 0.80; 95% CI, -2.31 to -0.14). This negative indirect effect was not significant for participants with sleep-related impairment T scores below the median (β = - 0.64; 95% CI, -1.48 to 0.07).

Conclusion: These findings suggest that complementary and integrative health therapies are particularly effective in reducing pain impact for individuals with higher levels of sleep-related impairment, and that the effect of complementary and integrative health therapies is supported primarily by reducing fatigue.