Military Medicine最新文献

Introduction: In 2020, the U.S. Army began implementation of the Holistic Health and Fitness (H2F) system to reduce musculoskeletal injury (MSKI) rates and expedite rehabilitation after injury. The purpose of this study was to describe the rates and characteristics of incident MSKIs evaluated by H2F physical therapists (PTs) and athletic trainers (ATs) in a U.S. Army Stryker brigade combat team from October 2021 to September 2022.

Materials and methods: In this retrospective observational study, we used negative binomial models and the H2F injury tracker and Army administrative data to estimate MSKI incidence rates for the overall brigade and within strata of battalion, age, sex, rank, race, and ethnicity. We repeated these estimates when standardized to the overall brigade population by battalion, age, sex, and rank. We characterized distributions of time from injury to evaluation, limited duty days (i.e., time-loss), and activity at time of injury. This research was determined exempt by academic and military Institutional Review Boards.

Results: The embedded H2F PTs and ATs evaluated 2,140 incident MSKIs in the brigade (4,780 person-years) for an overall rate of 39.1 MSKIs per 1,000 person-months. Battalion rates ranged from 31.8 (field artillery) to 50.0 (infantry) and did not change substantially after standardization. Embedded H2F PTs and ATs evaluated 63% of MSKIs within 1 week of onset, managed 59% without assigning time-loss, and found 51% of MSKIs occurred during unit physical fitness training.

Conclusions: These findings are consistent with the a priori expectation that embedded providers and the H2F system expedited access to MSKI evaluation and treatment. A strength of this study was our ability to estimate MSKI incidence rates and characterize MSKI evaluated in the H2F environment using a novel injury tracker coupled with administrative data. A limitation is that because of data deidentification, we could not measure cumulative time-loss. This descriptive observational study will help inform the findings of subsequent research on the effect of H2F implementation on MSKI outcomes.

Introduction: Airway compromise is an urgent and life-threatening challenge that commonly occurs on the battlefield. Effective airway management on the battlefield is critical for reducing preventable deaths. This review summarizes the existing literature on airway management in the deployed combat setting.

Materials and methods: We conducted a scoping review using the PRISMA-ScR checklist. We used PubMed and Google Scholar to identify relevant literature from 2001 to 2025 which reflects the years for the Global War On Terrorism. Studies were eligible if they reported on airway interventions in the combat setting.

Results: There were 30 airway studies that met inclusion for this review. Of the studies included in this review, 3 were focused on endotracheal intubation (ETI), 3 were focused on cricothyrotomy, 1 was focused on supraglottic airways, and 23 evaluated more than 1 airway method. The studies included 4 prospective observational studies, and 25 retrospective observational studies. Overall, ETI was the most commonly reported airway procedure with the majority performed by medical officers in both the fixed and prehospital settings. Cricothyrotomy was the second most commonly reported with a relatively low incidence and high complication. Multiple studies highlighted gaps in skills training as well as technology as a complicating factors.

Conclusions: Effective airway management is critical for reducing preventable deaths on the battlefield. Endotracheal intubation is the most common advanced airway intervention, while cricothyrotomy and supraglottic airways are less common and show variable success. Ongoing gaps in training, documentation, and equipment access highlight the need for standardized airway protocols and improved training programs to improve battlefield survival among casualties requiring an advanced airway.

Hereditary spherocytosis and sickle cell disease are two distinct hematologic diseases that affect the morphology of the red blood cell, causing implications related to splenic sequestration. Concurrent disease is very rare, with even fewer reported instances requiring surgical intervention. Furthermore, an individual with a third concomitant hematologic abnormality such as Factor VII deficiency, which degrades the normal clotting cascade, has not previously been reported. We describe an active-duty servicemember with known hereditary spherocytosis, sickle cell trait, and Factor VII deficiency who had recurrent worsening pain crises post-flight. The resulting hepatobiliary and splenic damage that ensued ultimately required splenectomy. These diseases in combination further enhance risks associated with splenic damage and intra-operative bleeding, with special consideration for intra-operative risk management and long-term sequala from end-organ damage. The military population exacerbates these conditions where physical exertion, high-altitude travel, and rapid geographic reassignment are considered the norm. This case of a servicemember with a unique disease triad managed successfully with surgical correction underscores the importance of individualized care planning and consideration of duty readiness.

Introduction: Sacrococcygeal pilonidal disease (PD) is a common surgical problem in the U.S. Military. Despite recent advancements, treatment strategies remain heterogenous and incompletely described, particularly among the active duty component in the Military Health System (MHS). This study's objectives were to identify the burden of PD and describe current healthcare utilization and treatment patterns in the MHS during a recent 10-year study period.

Materials and methods: The study population included all active duty U.S. service members with at least one PD diagnosis in the MHS Data Repository between January 1, 2013, and December 31, 2022. For each patient, the first PD diagnosis during the study period was the incident case, and a subsequent case was defined as a second PD diagnosis >30 days after the first and categorized as recurrent (procedure performed at incident encounter) or persistent (no procedure performed at incident encounter). Procedures were identified by Current Procedural Terminology codes.

Results: During the study period, 25,039 active duty service members were diagnosed with an incident case of PD. The study population was mostly male, less than 30 years old, enlisted, and in the Army or Navy. The overall incidence rate was 1.7 per 1,000 person-years. Prevalence of recurrence was 44.6% (2,494 of 5,598) and persistence was 50.1% (9,731 of 19,441). Overall, there were 115,387 medical encounters with a PD diagnosis during the study period, and service members in the top 25% for healthcare utilization had ≥11 encounters with a PD diagnosis.

Conclusions: Pilonidal disease imposes a significant burden on the MHS and is a threat to overall force medical readiness. Treatment strategies remain heterogeneous, and prospective studies are needed to refine clinical guidelines.

Introduction: Unintended pregnancy is linked to maternal depression, substance use, late prenatal care, low birthweight, and preterm birth. Our objective was to examine the incidence of unintended pregnancies in the military, the effects on maternal mental health and the effects of Social Determinants of Health (SDOH).

Materials and methods: This was an institutional research board-approved secondary analysis of two independent military datasets of pregnant individuals participating in two prospective clinical trials of a pregnancy mentorship program, collected 2012-2017 (n = 246) and 2018-2022 (n = 1,523), and compared to assess relationships of SDOH and maternal mental health measures for those with and without intended pregnancies.

Results: The rate of unintended pregnancy reported by participants was higher, 42.8% in 2012-2017 compared to 34.4% in 2018-2022. The rates of unintended pregnancy in both periods were lower than the national average and was lower in the second study period compared to the first. There were significantly higher scores for both anxiety and depression for those with unintended pregnancies, regardless of the sample. Over the same periods, the perception of support (as measured by the social support index) was higher in 2012-2017 compared to 2018-2022. Although the measures do not significantly differ by age, military branch, or rank, there was a significant relationship between the level of education and a lower rate of unintended pregnancy.

Conclusion: Exploration of Military Health System pregnancy data is important as it provides one of the best pictures of family and force readiness. The recent issue of unintended pregnancy and the increasing incidence of depression and anxiety, with lowered perceived support have long-term implications for the overall health and well-being of the U.S. military force, which demands continued investigation.

Survey research has long been a cornerstone of behavioral health and medical research. With the growth of Internet-based survey platforms, accelerated by the COVID-19 pandemic, conducting surveys completely online has become the standard. Online surveys provide the field with a fast, cost-effective method for gaining insights into relationships among health variables or in obtaining preliminary data to inform larger-scale studies. Additionally, online surveys enable researchers to recruit from a larger geographical area, thus increasing the generalizability of findings and, importantly, allowing participants to complete study activities completely de-identified. Although participating anonymously can increase one's comfort with disclosing sensitive or stigmatizing information, this can pose significant challenges to ensuring the legitimacy of participants' eligibility. This may be particularly true when compensation is available, increasing the likelihood of a prospective participant falsely reporting characteristics such as current or former military service. The following commentary provides an overview of the current landscape for researchers conducting military-related research via online surveys, with a specific emphasis on challenges in ensuring participants have a military background. In support of this, we present several real-world challenges for conducting de-identified online surveys, such as difficulties ensuring participants have a military background and preventing the use of "bots." Additionally, the evolving challenge of artificial intelligence is discussed in the context of its impact on knowledge-based screening methods such as the Military Screener Questionnaire. Alternative approaches, such as compensated screening surveys, are presented. Surveys will continue to be an important tool for advancing military medical research; however, researchers must discuss findings within the context of the inherent limitations of the methodology. The field should carefully monitor the evolving challenges to conducting online surveys.

Introduction: The Airborne Hazards and Open Burn Pits Registry (AHOBPR) examination was a service for Veterans with concerns about environmental exposures during military deployments. Interested Veterans enrolled in the AHOBPR online, completed a questionnaire, and indicated interest in a clinical examination by a Veterans Health Administration clinician. Several factors (e.g., COVID, unanticipated demand, and personnel turnover) resulted in a large number of pending examinations nationwide by 2022, prompting an evaluation and implementation effort to accelerate completion of high-quality examinations.Our objective was to assess Veterans' and clinical team members' perspectives of AHOBPR examinations to improve their delivery.

Meterials and methods: Qualitative interviews with Veterans who had completed an AHOBPR examination and clinical team members (CTMs) at 2 Veterans Affairs (VA) sites participating in our implementation. We recruited Veterans within 6 months of completing their examination and home facility complexity and performance metrics. We recruited CTMs for interviews from 2 purposefully selected VA facilities that completed all assessments conducted by our implementation team. Interviews were conducted between September 2022 and January 2023. We analyzed transcripts using rapid analysis. We apply the Promoting Action on Research Implementation in Health Service (PARiHS) framework to inform our interpretation of findings.

Results: Twenty-one Veterans and 9 CTMs from 2 sites completed interviews. Themes identified in the interviews were consistent with the PARiHS elements of evidence, context, and facilitation. Both Veterans and CTMs wanted evidence of appropriate knowledge about the AHOBPR and deployment and understanding AHOBPR structures and facility processes, including appropriate documentation of Veteran concerns. Contextually, Veterans and CTMs shared their strategies or experiences in clinical interactions especially the focus on developing patient-provider rapport and being prepared for examinations. Examples of facilitation included both groups' personal and professional motivations for conducting or pursuing examinations. Facilitation also involved local administrators and leaders providing the necessary staff, support, and resources.

Conclusions: Assessing Veteran and clinical team member (CTM) perceptions of AHOBPR examinations revealed clinically relevant opportunities important to addressing military and environmental exposure concerns of veterans (i.e., "exposure-informed care"). Clinical leaders can use the PARiHS framework and lessons learned from the AHOBPR experience to assess implementation and improve delivery of other novel services.