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Initial Evaluation and Implementation of Simulation-based Death Notification Training for Military Residents. 基于模拟的军人住院医师死亡通报训练的初步评估与实施。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-30 DOI: 10.1093/milmed/usaf649
Marion Legay, Guillaume Vanderperre, Anaelle Leroux, Emilie Roméo, Matthieu Patient, Christophe Dubecq, Jean Sébastien Bladé, Henri de Lesquen, Laurys Boudin

Introduction: Notifying a patient's family that the patient has died is a delicate and sensitive task in medical practice. This is particularly true in the military population due to the frequent unexpected and sudden nature of death. Medical students in France receive no systematic training in death notification, either in civilian or military settings. Therefore, the researchers sought to (1) assess the initial level of training of military medical residents in announcing death, (2) design an adapted simulation-based training program after the observation of possible gaps, (3) evaluate its impact on their perceived self-efficacy, and (4) assess the program's long-term relevance.

Materials and methods: The researchers conducted an observational study followed by a simulation-based educational intervention. First, a questionnaire was distributed to two cohorts of military medical residents, who began their residency in 2023 and 2024. The questionnaire assessed their training level, experience, and perceptions regarding death announcement. Based on the findings, a tailored theoretical and practical simulation-based training was developed and delivered. Pre- and post-training self-assessment questionnaires and a 5-month follow-up survey were used to evaluate the impact and retention of learning outcomes.

Results: A total of 72 residents (45%) completed the initial questionnaire. The mean age of the participants was 25 ± 1.5 years, and 61% of the respondents were female. Most participants (57/72, 79%) specialized in general practice. Only 19% (14/72) had previously announced a death, and 44% (32/72) declared that they had received some form of related training during their curriculum, which was simulation-based for 35% (25/72). Of the 14 residents who had to announce a death, 9 (65%) felt little or not at all prepared. Overall, 40 residents participated in the simulation-based training, which led to a statistically significant improvement (P < .05) in eight out of 10 assessed skills. At 5-month follow-up, all residents who had to deliver a death notification reported the training as useful.

Conclusions: The initial assessment revealed a clear need for specialized training in announcing death for future military physicians. The implemented simulation-based program significantly enhanced the residents' sense of self-efficacy. There is strong support for integrating the program into the curriculum annually, as it appears to effectively improve the quality of care provided to grieving families.

在医疗实践中,通知病人家属病人已经死亡是一项微妙而敏感的任务。这在军人群体中尤其如此,因为死亡往往是意外和突然的。法国的医科学生没有接受过关于死亡通知的系统培训,无论是在民用还是军事环境中。因此,研究者试图(1)评估军队住院医师宣布死亡的初始训练水平,(2)在观察可能的差距后设计一个适应性的基于模拟的训练计划,(3)评估其对他们感知自我效能的影响,以及(4)评估计划的长期相关性。材料和方法:研究人员进行了一项观察性研究,随后进行了基于模拟的教育干预。首先,对两组分别于2023年和2024年开始住院的军事医疗住院医师发放调查问卷。调查问卷评估了他们的培训水平、经验和对死亡宣布的看法。根据研究结果,开发并提供了量身定制的理论和实践模拟培训。采用培训前后自我评估问卷和5个月的随访调查来评估学习成果的影响和保留。结果:共有72名居民(45%)完成了初始问卷。参与者的平均年龄为25±1.5岁,61%的受访者为女性。大多数参与者(57/72,79%)是全科医生。只有19%(14/72)的学生以前宣布过死亡,44%(32/72)的学生声称他们在课程中接受过某种形式的相关培训,其中35%(25/72)的学生接受过基于模拟的培训。在14名不得不宣布死亡的居民中,9名(65%)感到很少或根本没有准备。总的来说,有40名住院医生参加了模拟训练,这导致了统计学上显著的改善(P结论:初步评估表明,明确需要对未来的军医进行宣布死亡的专门培训。实施模拟方案后,居民的自我效能感显著增强。人们强烈支持将该项目纳入每年的课程,因为它似乎有效地提高了为悲伤家庭提供的护理质量。
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引用次数: 0
A Scoping Review of Risk Factors of Postpartum Depression among Military Personnel and Spouses. 军人及其配偶产后抑郁危险因素的范围分析。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-30 DOI: 10.1093/milmed/usag005
Catherine Biegel, Hailee Poulin, Sophia Silvia, Geoffrey McCullen

Introduction: In recent years, there has been increased recognition and awareness surrounding mental health among US military personnel. However, the prevalence of postpartum depression (PPD) among female service members is significantly higher than that of the general US population. There is currently a gap in the literature characterizing the unique factors of the military experience accounting for the higher predisposition to PPD relative to civilian Americans. This qualitative review aims to address this gap by isolating risk factors which have been consistently identified in the available literature as contributing to the prevalence discrepancy.

Materials and methods: A MeSH database-built search utilizing key terms "postpartum depression" and "military" was used to gather sources that fit the inclusion criteria. These sources were analyzed for explicitly identified PPD risk factors pertaining to US military personnel and spouses.

Results: Of the 14 sources meeting inclusion criteria, a history of a mental health disorder and a lack of social support were identified in seven distinct articles as significant risk factors for PPD among military personnel. Low rank and pay, as well as deployments of self and/or spouse, were specified in six papers. A history of depression, history of anxiety, and exposure to combat were identified in five papers. Four papers isolated branch of service and young age as risk factors. Factors that were recognized in three papers or less included, but are not limited to: tobacco use, history of PTSD, history of sexual assault, low education attainment, high number of child dependents, race, and job stress.

Conclusions: Women in the military and spouses of military personnel are subject to an environment with distinct stressors, increasing their predisposition for PPD. Identifying specific risk factors is critical for quality screening, diagnosis, and care of PPD among this population. Significant risk factors consistently isolated from the available literature include history of mental health disorders, lack of adequate social support, low rank and pay, deployment of self or spouse, history of combat exposure, branch of service, and young maternal age. Findings of this review also suggest that early detection via thorough screening and disease mitigation by means of a 12-week maternity leave led to lower rates of PPD and better disease outcomes. Military-specific family health resources are widely available across branches of service and individual bases, though the use and quality of these resources are inconsistent. Providers of women experiencing at least one of these stressors should increase PPD precautions and refer patients to the appropriate preventative and acute care.

近年来,美国军人对心理健康的认识和认识有所提高。然而,女性服役人员产后抑郁症(PPD)的患病率明显高于美国总人口。目前,在描述军事经历的独特因素导致相对于平民美国人更高的PPD易感性方面,文献中存在空白。本定性综述旨在通过隔离现有文献中一致确定的导致患病率差异的风险因素来解决这一差距。材料和方法:利用关键词“产后抑郁”和“军事”建立MeSH数据库进行搜索,收集符合纳入标准的来源。对这些来源进行分析,明确确定与美国军事人员及其配偶有关的PPD风险因素。结果:在符合纳入标准的14个来源中,有7篇不同的文章确定了精神健康障碍史和缺乏社会支持是军人PPD的重要危险因素。六份文件详细说明了低级别和低薪酬,以及自己和/或配偶的部署。抑郁史、焦虑史和战斗经历在五篇论文中被确定。四篇论文分离了军种和年龄作为危险因素。在三篇或更少的论文中被确认的因素包括但不限于:吸烟、创伤后应激障碍史、性侵犯史、低教育程度、大量儿童依赖者、种族和工作压力。结论:军人及军人配偶所处的应激环境具有明显的应激源,增加了她们患PPD的易感性。确定特定的危险因素对于这一人群中PPD的高质量筛查、诊断和护理至关重要。从现有文献中一直孤立出来的重要风险因素包括精神病史、缺乏足够的社会支持、低军衔和工资、自己或配偶的部署、战斗暴露史、服务部门和年轻的母亲年龄。本综述的发现还表明,通过彻底筛查的早期发现和通过12周产假的方式缓解疾病,可以降低产后抑郁症的发病率和改善疾病结局。各军兵种和个别基地广泛提供针对军队的家庭保健资源,但这些资源的使用和质量参差不齐。经历至少一种压力源的妇女的提供者应该增加PPD预防措施,并将患者转介到适当的预防和急性护理。
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引用次数: 0
Major Adverse Coronary Events Status Post Percutaneous Coronary Intervention in Veterans Exposed to Agent Orange Versus Non-Exposed. 暴露于橙剂与未暴露于橙剂的退伍军人经皮冠状动脉介入治疗后的主要不良冠状动脉事件状况。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-28 DOI: 10.1093/milmed/usaf627
Sarah Neveills, Marguerite Engler, Catherine Battaglia, Laura Kaizer, Madhura Gokhale, Robert Leonard
<p><strong>Introduction: </strong>United States Veterans who served in Vietnam, the Korean Demilitarized Zone, or Thailand Air Force bases from 1962 to 1971 were likely exposed to Agent Orange, as approximately 107 million pounds of the chemical were sprayed in the areas where the fighting occurred. Agent Orange was an herbicide used by the United States military to kill the jungle, foliage, tall grasses, bushes, and weeds. Agent Orange contained 2,3,7,8-tetrachlorodibenzo-p-dioxin, the most toxic form of dioxin, which has been associated with multiple disease processes and cardiac issues.</p><p><strong>Materials and methods: </strong>An original quantitative descriptive, retrospective cohort, secondary data analysis study was conducted utilizing data collected by the Veterans Health Administration (VHA) via the Cardiovascular Assessment, Reporting, and Tracking System for Cath Labs and the Computerized Patient Record System. A new and innovative Structured Query Language report was created for data mining. Statistical tests included Chi-square tests, two-sample t-tests, prevalence, logistic regression, and odds ratios. A secondary analysis was conducted to assess for confounders, associations, and differences.</p><p><strong>Results: </strong>Veterans exposed to Agent Orange status post (s/p) percutaneous coronary intervention (PCI) have significantly higher body mass index (P ≤ .01), with a higher percentage of obesity (45.4% vs. 41.0%) and severe obesity (7.0% vs. 6.1%). There is a higher prevalence of those exposed to Agent Orange in the white (85% vs. 79.3%, P ≤ .01) and non-Hispanic/Latino (93.9% vs. 92.9%, P ≤ .01) male population. There is a higher prevalence of hypertension (91.3% vs. 90.7%, P = .03), hyperlipidemia (91.7% vs. 90.1%, P ≤ .01), and diabetes (53.5% vs. 49.8%, P ≤ .01) in those exposed vs. non-exposed. Lastly, there is a higher prevalence (1.8% vs. 1.5%) and fully adjusted odds 1.22 (95%CI: 1.08, 1.37; P = .0011) of coronary artery bypass graft surgery (CABG).</p><p><strong>Conclusions: </strong>Veterans exposed to Agent Orange are high-risk cardiovascular patients with a higher prevalence and odds of CABG s/p PCI. The increased prevalence of hypertension, hyperlipidemia, obesity, severe obesity, and diabetes in Veterans exposed to Agent Orange s/p PCI suggests that Agent Orange may contribute to the development of these disease processes. Strengths include the quality and longevity of the data collected, the Promise to Address Comprehensive Toxics (PACT) Act supporting Agent Orange research, and the advanced age of the Veterans increases the likelihood of cardiovascular disease. Weaknesses include the inability to quantify and confirm Agent Orange exposure, the inability to determine causation, and the VHA registrar's office could have erroneously assigned the Agent Orange disability flag by not verifying the service location. This study impacts the care of the Veterans s/p PCI; providers should assess the comorbidities, co
简介:1962年至1971年间在越南、朝鲜非军事区或泰国空军基地服役的美国退伍军人可能接触过橙剂,大约1.07亿磅的化学物质被喷洒在战斗发生的地区。橙剂是美国军方使用的一种除草剂,用来杀死丛林、树叶、高草、灌木和杂草。橙剂含有2,3,7,8-四氯二苯并-对二恶英,这是二恶英中毒性最大的一种,与多种疾病进程和心脏问题有关。材料和方法:一项原始的定量描述性、回顾性队列、二次数据分析研究利用退伍军人健康管理局(VHA)通过导管实验室心血管评估、报告和跟踪系统和计算机化患者记录系统收集的数据进行。为数据挖掘创建了一个新的、创新的结构化查询语言报告。统计检验包括卡方检验、双样本t检验、患病率、logistic回归和优势比。进行二次分析以评估混杂因素、关联和差异。结果:暴露于橙剂的退伍军人经皮冠状动脉介入治疗(PCI)后状态(s/p)体重指数(p≤。01),肥胖比例(45.4%比41.0%)和重度肥胖比例(7.0%比6.1%)更高。接触过橙剂的白人患病率较高(85% vs. 79.3%, P≤。01)和非西班牙裔/拉丁裔(93.9% vs. 92.9%, P≤。01)男性人口。高血压患病率较高(91.3% vs. 90.7%, P =。03)、高脂血症(91.7% vs. 90.1%, P≤。01),糖尿病(53.5% vs 49.8%, P≤。01)。最后,有更高的患病率(1.8%比1.5%)和完全调整的优势1.22 (95%CI: 1.08, 1.37; P =。0011)冠状动脉搭桥手术(CABG)。结论:暴露于橙剂的退伍军人是高危心血管患者,CABG /p PCI的患病率和几率较高。暴露于橙剂s/p PCI的退伍军人中高血压、高脂血症、肥胖、严重肥胖和糖尿病患病率的增加表明橙剂可能有助于这些疾病的发展。其优势包括所收集数据的质量和寿命,《解决全面有毒物质承诺法案》(PACT)支持橙剂研究,以及退伍军人的高龄增加了患心血管疾病的可能性。缺点包括无法量化和确认橙剂暴露,无法确定因果关系,并且VHA注册办公室可能由于未验证服务位置而错误地分配了橙剂残疾标志。本研究对退伍军人s/p PCI护理的影响;提供者应评估合并症、冠状动脉疾病进展、受影响的血管数量、心脏血管扭曲程度、冠状动脉病变位置、病变大小和所需支架数量,以确定重复PCI是否优于CABG治疗。未来的研究应包括PACT法案筛查中暴露于橙剂的新分类退伍军人,CABG结果,冠状动脉病变特征,支架类型以及最初PCI时处方的药物。
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引用次数: 0
Non-Anticoagulated Fresh Whole Blood Syringe Transfusion as an Alternative for Military Hemorrhage Resuscitation in Austere Environments. 非抗凝新鲜全血注射器输注作为严峻环境下军事出血复苏的替代方法。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-27 DOI: 10.1093/milmed/usaf564
Christopher J Scheiber, Sarah Glier, Justin Magin, Mark Hanlon, Matthew Vander Ploeg, Bryan Obika, Herman Freeman, Om Dave, Andrew Tolksdorf, Richard D Neading, Alexander Doyal, Alan Smeltz

Introduction: Military field medicine providers often operate in resource-limited environments where improvization with available equipment is essential. Whole blood transfusion has had significant benefits in treating severely injured trauma patients in these settings. Current protocols often mandate anticoagulant-containing intravenous (IV) fluid bags for fresh whole blood transfusion, which can pose logistical challenges for forward-placed medical units. This study explores the feasibility of using a syringe without anticoagulant as an alternative method.

Materials and methods: Whole blood was collected from healthy volunteer donors and divided into syringes with and without citrate-phosphate-dextrose (CPD) solution. Samples were stored for varying durations and infused through a standard IV setup to simulate transfusion conditions. To assess coagulation, infusion rate under standardized infusion pressure, clot mass, and coagulation parameters (PT/INR, PTT) was measured. Hemolysis was assessed by measuring plasma hemoglobin, potassium, lactate dehydrogenase (LDH), bilirubin pre- and post-infusion at either 100 mL/minute, 200 mL/minute or maximal manual compression.

Results: We performed a nested analysis of variance (ANOVA) analysis on coagulation and hemolysis parameters. Tukey post-hoc testing was used to determine mean subgroup differences. Analyses were carried out using R version 4.3.0 (R Core Team, 2024). Significant differences were observed in infusion rates across different storage times but not between CPD and non-CPD conditions. There was significantly greater clot burden in non-CPD groups compared to CPD at 30 minutes (6.5 ± 2.1 g) and 60 minutes (8.8 ± 1.9 g), but no significant difference was observed in the 30 second (0.001 ± 2.0 g) and 5 minute (1.1 ± 2.0 g) groups. Coagulation parameters (INR, PT, and PTT) showed no significant differences based on storage time but were impacted by the presence of CPD. Hemolysis markers indicated significant changes in plasma hemoglobin with higher infusion rates but no significant alterations in LDH, potassium, or bilirubin at any of the infusion rates.

Conclusions: These findings suggest that non-anticoagulated fresh whole blood may be transfused within 5 minutes at infusion rates of 100 mL/minute or less with no significant clot burden and no evidence of hemolysis. Longer storage times and faster infusion rates may also be clinical safe but require further investigation. This study indicates that there may be some potential use of this method in military units executing a fresh whole blood draw with short donor-to-recipient times.

简介:军事野战医疗提供者经常在资源有限的环境中工作,在这种环境中,利用现有设备进行改进是必不可少的。在这些情况下,全血输血在治疗严重创伤患者方面具有显著的益处。目前的方案通常要求在新鲜全血输注时使用含有抗凝剂的静脉输液袋,这可能给前沿医疗单位带来后勤挑战。本研究探讨了使用无抗凝剂注射器作为替代方法的可行性。材料与方法:采集健康志愿献血者全血,分为含和不含柠檬酸-磷酸盐-葡萄糖(CPD)溶液的注射器。样品保存不同的时间,并通过标准的静脉注射装置来模拟输血条件。为了评估凝血,测量了标准化输注压力下的输注速率、凝块质量和凝血参数(PT/INR, PTT)。通过测定血浆血红蛋白、钾、乳酸脱氢酶(LDH)、胆红素在100ml /分钟、200ml /分钟或最大手动按压下输注前后的溶血情况来评估。结果:我们对凝血和溶血参数进行了嵌套方差分析(ANOVA)。采用Tukey事后检验来确定平均亚组差异。使用R 4.3.0版本(R Core Team, 2024)进行分析。在不同的储存时间内观察到输液速率的显著差异,但在CPD和非CPD条件下没有显著差异。与CPD组相比,非CPD组在30分钟(6.5±2.1 g)和60分钟(8.8±1.9 g)时的凝块负担显著增加,但在30秒(0.001±2.0 g)和5分钟(1.1±2.0 g)时无显著差异。凝血参数(INR、PT和PTT)在储存时间上无显著差异,但受到CPD存在的影响。溶血标志物显示血浆血红蛋白随输注速率升高而发生显著变化,但在任何输注速率下LDH、钾或胆红素均无显著变化。结论:这些研究结果表明,以100ml /分钟或更低的输注速率在5分钟内输注无抗凝血的新鲜全血,没有明显的凝块负担,没有溶血的证据。更长的储存时间和更快的输注速度也可能是临床安全的,但需要进一步的研究。本研究表明,这种方法可能在军事单位执行新鲜全血抽取,供者到接受者的时间较短。
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引用次数: 0
Public Battles: The U.S. Military's Digital Messaging on Behavioral Health and Violence Prevention. 公共战斗:美国军方的行为健康和暴力预防的数字信息。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-27 DOI: 10.1093/milmed/usag003
Anna Segura, Kimberly A Rhoades, Brandon Neglio, Amy M Smith Slep, Richard E Heyman

Introduction: This study examined how the U.S. Department of Defense (DoD) and military branches disseminate information about behavioral health topics, including sexual assault and harassment, mental health, resilience, substance use, suicide, and other violence-related issues, through their official media platforms and online newsletters. This is key since a significant number of military personnel experience these issues, yet available health services remain underutilized. The goal is to analyze the frequency, timing, and content of the DoD, military branches, and installations' messaging around these behavioral health topics across their digital communication channels.

Materials and methods: Researchers manually collected data from official social media accounts (i.e., Twitter, Facebook, Instagram) and online newsletters of the DoD, military branches, and installations from January to November 2021. Data was coded for behavioral health topics, content types, and evidence-based interventions. Engagement metrics were also analyzed for social media posts. The Institutional Review Board of New York University approved the study protocol.

Results: The study found notable variations in how frequently different behavioral health topics were addressed across the DoD, military branches, and installations, with sexual assault and harassment, mental health, and suicide prevention being the most prevalent. Messaging often aligned with designated awareness months. The most common content shared about the included behavioral health topics focused on providing information and details about available services, although fewer posts addressed military culture, policies, or program/initiative effectiveness. Social media engagement was highest for mental health, sexual assault and harassment, and suicide-related topics.

Conclusions: The findings suggest a lack of coordination and standardization in the military's digital health communication strategies, which can lead to ineffective and undesired outcomes. This study has also identified missed opportunities in military digital communications to leverage evidence-based best practices. Recommendations include developing a cohesive, systematic framework to guide consistent, effective messaging across branches and platforms to better reach and engage the military population on critical behavioral health issues. Although the study provides valuable insights, limitations include its manual data collection process, single-year timeframe, and focus on only three social media platforms. Future studies should expand the scope by including other social media platforms with distinct user demographics and engagement patterns, as well as extended timeframes, to better understand the full landscape of military digital health communication.

本研究调查了美国国防部(DoD)和军事部门如何通过其官方媒体平台和在线新闻通讯传播有关行为健康主题的信息,包括性侵犯和骚扰、心理健康、恢复力、物质使用、自杀和其他与暴力相关的问题。这是关键,因为许多军事人员都有这些问题,但现有的保健服务仍未得到充分利用。目标是分析国防部、军事部门和设施在其数字通信渠道中围绕这些行为健康主题的消息传递的频率、时间和内容。材料和方法:研究人员在2021年1月至11月期间,从国防部、军事部门和设施的官方社交媒体账户(即Twitter、Facebook、Instagram)和在线时事通讯中手动收集数据。数据被编码为行为健康主题、内容类型和基于证据的干预措施。我们还分析了社交媒体帖子的参与度指标。纽约大学机构审查委员会批准了这项研究方案。结果:该研究发现,在国防部、军事部门和设施中,不同行为健康主题的处理频率存在显著差异,其中性侵犯和骚扰、心理健康和自杀预防最为普遍。消息传递通常与指定的意识月保持一致。关于所包括的行为健康主题的最常见内容集中于提供有关现有服务的信息和细节,尽管涉及军事文化、政策或方案/倡议有效性的帖子较少。在心理健康、性侵犯和性骚扰以及自杀相关话题上,社交媒体参与度最高。结论:研究结果表明,军队的数字健康通信策略缺乏协调和标准化,这可能导致无效和不期望的结果。该研究还确定了军事数字通信中利用循证最佳实践的错失机会。建议包括制定一个连贯、系统的框架,指导各军种和平台之间一致、有效的信息传递,以便更好地接触到军人,让他们参与关键的行为健康问题。尽管这项研究提供了有价值的见解,但其局限性包括人工数据收集过程,一年的时间框架,以及只关注三个社交媒体平台。未来的研究应扩大范围,包括其他具有不同用户人口统计和参与模式的社交媒体平台,以及延长的时间框架,以更好地了解军事数字健康通信的全面情况。
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引用次数: 0
Hypospadias Prevalence and Risk Factors in a United States Military Beneficiary Birth Cohort, 2010-2020. 2010-2020年美国军人受益出生队列尿道下裂患病率及危险因素
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-27 DOI: 10.1093/milmed/usaf635
Paul Patterson, Clinton Hall, Anna T Bukowinski, Gia R Gumbs, Jacob S Hogue, Ava Marie S Conlin, Celeste J Romano

Introduction: Hypospadias is a congenital birth defect characterized by abnormal placement of the urethral opening in male infants. In the United States, hypospadias prevalence is estimated to be ∼60-80 per 10,000 male live births; however, reported estimates are higher among births to military beneficiaries. The present study leveraged a cohort of births among military families to investigate reportedly high hypospadias prevalence in a military birth cohort from 2010 to 2020.

Materials and methods: The Birth and Infant Health Research program data identified male live births among military medical (i.e., TRICARE) beneficiaries, January 2010 through December 2020. Hypospadias cases were identified in TRICARE claims data by 1 inpatient or 2 outpatient diagnoses during infancy; more conservative case definitions were also assessed (e.g., 2 diagnoses within (1) 1 year, (2) 3 months, and (3) 1 month of life). To examine characteristics associated with hypospadias, adjusted prevalence ratios (PRs) with 95% CIs were calculated using modified Poisson regression models.

Results: The prevalence of hypospadias was 111.6 per 10,000 military-connected male live births. Estimates were high (>110.0 per 10,000) for both military and non-military pregnant parents, with PRs indicating a slight positive association for military parents (PR 1.07, 95% CI 1.00-1.14). Requiring 2 diagnoses by age 3 months yielded a prevalence of 79.5 per 10,000; associations by military status were attenuated (1.03, 95% CI 0.96-1.11).

Conclusions: Reportedly elevated hypospadias among military-connected births is likely influenced by broad case ascertainment methods rather than military occupational exposures. These findings underscore the importance of evaluating differences in surveillance case definitions and considering associated data limitations (e.g., reliability of diagnosis codes) when comparing prevalence estimates.

尿道下裂是一种先天性出生缺陷,其特征是男婴尿道开口位置异常。在美国,尿道下裂的患病率估计为每10,000名男性活产约60-80例;然而,据报道,军人受益人的出生率更高。本研究利用军人家庭中的出生队列来调查据报道2010年至2020年军人出生队列中尿道下裂的高患病率。材料和方法:出生和婴儿健康研究方案的数据确定了2010年1月至2020年12月军队医疗(即TRICARE)受益人中的男性活产。尿道下裂病例在TRICARE索赔数据中由1名住院患者或2名门诊患者在婴儿期确诊;还评估了更保守的病例定义(例如,在(1)年,(2)3个月和(3)1个月内诊断出2例)。为了检查与尿道下裂相关的特征,使用改进的泊松回归模型计算95% ci的校正患病率(pr)。结果:尿道下裂患病率为111.6 / 10000。对军人和非军人怀孕父母的估计都很高(每10000人中有110.0人怀孕),PR表明军人父母有轻微的正相关(PR 1.07, 95% CI 1.00-1.14)。要求在3个月大时进行两次诊断,患病率为79.5 / 10,000;军人身份的相关性减弱(1.03,95% CI 0.96-1.11)。结论:据报道,在与军队有关的出生中,尿道下裂升高可能受到广泛病例确定方法的影响,而不是军事职业暴露。这些发现强调了在比较患病率估计值时评估监测病例定义差异和考虑相关数据限制(例如诊断代码的可靠性)的重要性。
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引用次数: 0
The Effect of Simulated Altitude on Vision in Military Personnel Following Small-Incision Lenticule Extraction. 模拟海拔对军事人员小切口晶状体摘除后视力的影响。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-27 DOI: 10.1093/milmed/usaf608
Charisma B Evangelista, Carter S Tisdale, Samantha B Rodgers, Timothy A Soeken, Toan M Trinh, Ryan Mackie, José E Capó-Aponte

Introduction: The United States (U.S.) Military has been performing laser refractive surgery to enhance combat readiness, operational capability, and the quality of life for service members since fiscal year 2000. The latest laser refractive surgery adopted by the U.S. Military is small-incision lenticule extraction (SMILE) (Carl Zeiss Meditec AG, Jena, Germany), a type of keratorefractive lenticule extraction (KLEx). However, a limited number of studies have been conducted to determine whether varying levels of altitude have any effect on vision following the procedure. The purpose of this study was to evaluate the effect of decreased barometric pressure and atmospheric oxygen tension (simulated increased altitude up to 22,500 ft) on refractive stability in patients who have undergone bilateral SMILE.

Material and methods: Study subjects included active duty military personnel who had undergone bilateral SMILE using the VisuMax femtosecond laser (Carl Zeiss Meditec AG) for the correction of myopia. After being cleared to participate in the study by a military flight medicine physician, each participant underwent altitude chamber training. Uncorrected visual acuity (UCVA), 5% low contrast (LC) UCVA, refractive error, corneal thickness, and anterior chamber volume and depth were each measured at ground level, 10,000 ft, 15,000 ft, 18,000 ft, and 22,500 ft simulated altitude in a hypobaric chamber. Mixed-effects linear regression models were used to evaluate the statistical significance of changes in individual outcome measures across different altitudes.

Results: Data from 34 eyes (17 participants) was collected during the study. A statistically significant increase was found in UCVA (-0.04 ± 0.01 LogMAR; P < .001) and LC UCVA (-0.05 ± 0.01 LogMAR; P < .001) as simulated altitude increased from ground level to 22,500 ft. A myopic shift (-0.14 ± 0.05 D; P = .050) was observed at 22,500 ft, as well as decreases in corneal thickness at central (-3.94 ± 0.83 µm; P < .001) and thinnest point (-3.65 ± 0.90 µm; P < .001). There were no statistically significant changes in mean keratometry, anterior chamber volume, or anterior chamber depth.

Conclusion: The current study suggests that while high altitude may influence certain aspects of visual performance and corneal properties, overall visual acuity and anterior segment parameters remain stable in military personnel who underwent SMILE.

介绍:美国(U.S.)自2000财政年度以来,军方一直在进行激光屈光手术,以提高战备状态、作战能力和服务人员的生活质量。美国军方采用的最新激光屈光手术是小切口晶状体摘除术(SMILE)(卡尔蔡司医疗股份公司,耶拿,德国),一种角膜屈光性晶状体摘除术(KLEx)。然而,已经进行了有限数量的研究,以确定不同的海拔水平是否对手术后的视力有任何影响。本研究的目的是评估降低气压和大气氧张力(模拟海拔升高至22500英尺)对双侧SMILE患者屈光稳定性的影响。材料和方法:研究对象为使用VisuMax飞秒激光(卡尔蔡司Meditec AG)进行双侧SMILE矫正近视的现役军人。在被军事飞行医师批准参加研究后,每个参与者都进行了高空舱训练。未矫正视力(UCVA)、5%低对比度(LC) UCVA、屈光误差、角膜厚度、前房体积和深度分别在地面、10,000英尺、15,000英尺、18,000英尺和22500英尺的模拟高度进行测量。采用混合效应线性回归模型评价不同海拔地区个体结局指标变化的统计学意义。结果:共收集了34只眼(17名受试者)的数据。结论:目前的研究表明,虽然高海拔可能会影响视力和角膜特性的某些方面,但接受SMILE治疗的军人的整体视力和前段参数保持稳定。
{"title":"The Effect of Simulated Altitude on Vision in Military Personnel Following Small-Incision Lenticule Extraction.","authors":"Charisma B Evangelista, Carter S Tisdale, Samantha B Rodgers, Timothy A Soeken, Toan M Trinh, Ryan Mackie, José E Capó-Aponte","doi":"10.1093/milmed/usaf608","DOIUrl":"https://doi.org/10.1093/milmed/usaf608","url":null,"abstract":"<p><strong>Introduction: </strong>The United States (U.S.) Military has been performing laser refractive surgery to enhance combat readiness, operational capability, and the quality of life for service members since fiscal year 2000. The latest laser refractive surgery adopted by the U.S. Military is small-incision lenticule extraction (SMILE) (Carl Zeiss Meditec AG, Jena, Germany), a type of keratorefractive lenticule extraction (KLEx). However, a limited number of studies have been conducted to determine whether varying levels of altitude have any effect on vision following the procedure. The purpose of this study was to evaluate the effect of decreased barometric pressure and atmospheric oxygen tension (simulated increased altitude up to 22,500 ft) on refractive stability in patients who have undergone bilateral SMILE.</p><p><strong>Material and methods: </strong>Study subjects included active duty military personnel who had undergone bilateral SMILE using the VisuMax femtosecond laser (Carl Zeiss Meditec AG) for the correction of myopia. After being cleared to participate in the study by a military flight medicine physician, each participant underwent altitude chamber training. Uncorrected visual acuity (UCVA), 5% low contrast (LC) UCVA, refractive error, corneal thickness, and anterior chamber volume and depth were each measured at ground level, 10,000 ft, 15,000 ft, 18,000 ft, and 22,500 ft simulated altitude in a hypobaric chamber. Mixed-effects linear regression models were used to evaluate the statistical significance of changes in individual outcome measures across different altitudes.</p><p><strong>Results: </strong>Data from 34 eyes (17 participants) was collected during the study. A statistically significant increase was found in UCVA (-0.04 ± 0.01 LogMAR; P < .001) and LC UCVA (-0.05 ± 0.01 LogMAR; P < .001) as simulated altitude increased from ground level to 22,500 ft. A myopic shift (-0.14 ± 0.05 D; P = .050) was observed at 22,500 ft, as well as decreases in corneal thickness at central (-3.94 ± 0.83 µm; P < .001) and thinnest point (-3.65 ± 0.90 µm; P < .001). There were no statistically significant changes in mean keratometry, anterior chamber volume, or anterior chamber depth.</p><p><strong>Conclusion: </strong>The current study suggests that while high altitude may influence certain aspects of visual performance and corneal properties, overall visual acuity and anterior segment parameters remain stable in military personnel who underwent SMILE.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146064868","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 Musculoskeletal Injury and Behavioral Health Diagnoses Among United States Army Active Duty Servicewomen in Ground Combat Versus Non-Ground Combat Specialties: An Update (2020-2023). 美国陆军现役妇女在地面战斗与非地面战斗专业中的肌肉骨骼损伤和行为健康诊断的比较:更新(2020-2023)。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-27 DOI: 10.1093/milmed/usaf642
Allison J Henkenius, Amanda Banaag, Tracey Perez Koehlmoos

Introduction: Historically, women in the U.S. Military have been prohibited from serving in ground combat occupational specialties (GCS) until the Secretary of Defense lifted the exclusion in January 2016, prompting studies into health outcomes for this new cohort. Phillips et al.(2016-2019) found that active duty servicewomen (ADSW) in GCS had lower odds of musculoskeletal injury (MSKI) and behavioral health (BH) diagnoses than peers in non-ground combat specialties (NGCS), likely because of a "healthy warrior" selection effect. With continued integration, cohort maturation, and factors such as the COVID-19 pandemic, this study updates MSKI and BH trends among ADSW from 2020 to 2023 and compares findings with the earlier cohort.

Materials and methods: This retrospective cross-sectional study used data from the Military Health System Data Repository (MDR), including all ADSW (n = 77,568) who served from January 1, 2020, to December 31, 2023. Women in the Guard, Reserve, or with pregnancy diagnoses during or in the year prior were excluded. Primary outcomes-MSKI and BH diagnoses-were identified via ICD-10 codes. Adjusted odds ratios (AORs) and 95% CIs were calculated using multivariable logistic regression, comparing GCS vs. NGCS ADSW while adjusting for age, race & ethnicity, rank, and BMI. Two-sample z-tests assessed differences from Phillips et al.s 2016 to 2019 estimates. This study received an exempt determination from the Institutional Review Board at the Uniformed Services University of the Health Sciences.

Results: Of 77,568 ADSW, 5,024 (6.5%) served in GCS. Compared to NGCS, GCS women were younger (72.1% vs. 47.0% aged 18-23), more often enlisted (68.4% vs. 57.0%), and had lower obesity rates (8.4% vs. 12.6%), but higher rates of tobacco (7.7% vs. 7.6%), alcohol (7.9% vs. 6.7%), and substance use (2.5% vs. 1.9%). Adjusted analyses showed higher MSKI odds in GCS (AOR = 1.21, 95% CI: 1.13-1.30), a significant reversal from Phillips et al.(AOR = 0.86, 95% CI: 0.79-0.93; z = 6.01, P < .001). BH odds were lower in GCS (AOR = 0.83, 95% CI: 0.78-0.89), consistent with earlier findings (Phillips AOR = 0.87; 95% CI: 0.80-0.95).

Conclusions: The increase in MSKI odds for GCS women contrasts sharply with prior findings, suggesting the dissipation of the initial selection effect as more women enter and remain in combat roles. This shift may reflect greater exposure duration, cumulative physical demands, or pandemic-era fitness disruptions. The continued lower BH odds in GCS, despite higher substance use, may reflect resilience, unit cohesion, or underreporting tied to stigma. These findings highlight the need for targeted, female-specific injury prevention and confidential, destigmatized mental health support as the Army moves toward sex-neutral standards in combat fitness.

导读:从历史上看,美国军队中的女性一直被禁止在地面战斗职业专业(GCS)中服役,直到2016年1月国防部长取消了这一禁令,促使对这一新队列的健康结果进行了研究。Phillips等人(2016-2019)发现,与非地面战斗专业(NGCS)的同龄人相比,GCS中的现役女兵(ADSW)患肌肉骨骼损伤(MSKI)和行为健康(BH)诊断的几率更低,这可能是由于“健康战士”的选择效应。随着持续整合、队列成熟以及COVID-19大流行等因素的影响,本研究更新了2020年至2023年ADSW的MSKI和BH趋势,并将结果与早期队列进行了比较。材料和方法:本回顾性横断面研究使用来自军事卫生系统数据库(MDR)的数据,包括2020年1月1日至2023年12月31日服役的所有ADSW (n = 77,568)。在警卫队,预备役,或怀孕诊断期间或前一年的妇女被排除在外。主要结局- mski和BH诊断-通过ICD-10代码确定。采用多变量logistic回归计算校正优势比(AORs)和95% ci,比较GCS与NGCS ADSW,同时调整年龄、种族和民族、等级和BMI。双样本z检验评估了Phillips等人2016年至2019年估计的差异。这项研究获得了健康科学统一服务大学机构审查委员会的豁免决定。结果:77,568例ADSW中,5024例(6.5%)为GCS。与NGCS相比,GCS女性更年轻(72.1%对47.0%,年龄在18-23岁之间),更经常入伍(68.4%对57.0%),肥胖率更低(8.4%对12.6%),但吸烟率(7.7%对7.6%),酒精(7.9%对6.7%)和药物使用率(2.5%对1.9%)更高。调整后的分析显示,GCS女性的MSKI几率更高(AOR = 1.21, 95% CI: 1.13-1.30),这与Phillips等人的研究结果(AOR = 0.86, 95% CI: 0.79-0.93; z = 6.01, P)有显著的逆转。结论:GCS女性MSKI几率的增加与先前的研究结果形成鲜明对比,表明随着更多女性进入并继续担任战斗角色,初始选择效应会消散。这种转变可能反映了更长的暴露时间、累积的身体需求或大流行时期的健康中断。GCS中持续较低的BH几率,尽管较高的药物使用,可能反映了与耻辱相关的弹性,单位凝聚力或漏报。这些发现强调,随着陆军在战斗健身方面朝着性别中立的标准迈进,需要有针对性的、针对女性的伤害预防和保密的、去污名化的心理健康支持。
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引用次数: 0
Parental Leave Impact and Experience: A Survey of the U.S. Graduate Medical Education System. 育婴假的影响与经验:美国研究生医学教育系统的调查。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-27 DOI: 10.1093/milmed/usaf653
Caitlin M Drumm, Elizabeth V Schulz, Paolo C Martin, Tasha R Wyatt, Theodora C Dworak, Sami A Abuhamdeh

Introduction: Prior work conducted within U.S. civilian graduate medical education (GME) programs has uncovered negative perceptions of parenthood related to trainee wellness and performance. However, this subject remains understudied within U.S. military GME which affords trainees 12-18 weeks of paid parental leave.

Materials and methods: We disseminated a web-based survey to trainees, faculty physicians and program directors (PDs) at U.S. military GME programs querying participants on the impact of parenthood and parental leave on trainee wellness and performance. Applicable statistical analyses were utilized to assess differences between groups. Content analysis was used to identify themes within participant open-ended responses.

Results: The survey was completed by 211 respondents from 24 different medical or surgical specialties across the Military Health System. A majority of participants reported that their program's parental leave policy either somewhat or significantly decreased the stress of trainee parents (trainee 50.5% vs. faculty 60.6% vs. PDs 61.9%). Participants reported no impact of parental leave on trainee dedication to patient care, clinical performance, scholarly activities or standardized test scores. Participants reported a somewhat negative impact of training interruptions on the training experience of peers, with no significant difference in how they rated birth and non-birth parents (birth parent 2.44 vs. non-birth parent 2.48, P = .10, d = -0.11). Technical skills and procedural volume were both rated lower for birth parents versus non-birth parents (technical skills: birth parent 2.50 vs. non-birth parent 2.60, P ≤ .001; d = -0.25, procedural volume: birth parent 2.32 vs. non-birth parent 2.41, P <. 001; d = -0.23). Content analysis uncovered themes consistent with the survey data but also revealed persistent stigma surrounding use of full parental leave benefits within certain GME programs.

Conclusions: The current parental leave policy within U.S. military GME is perceived to decrease parental stress and can have a positive impact on trainee wellness. While this policy has been effectively implemented with limited perceived impact on trainee performance, work remains to be done to promote full acceptance of parental leave within military GME.

导读:先前在美国民用研究生医学教育(GME)项目中进行的工作揭示了与培训生健康和表现相关的父母负面看法。然而,这一主题在美国军事GME中仍未得到充分研究,该GME为受训人员提供12-18周的带薪育儿假。材料和方法:我们向美国军事GME项目的学员、教员医师和项目主任(pd)分发了一份基于网络的调查,询问参与者为人父母和育儿假对学员健康和表现的影响。采用适用的统计分析来评估组间差异。内容分析用于确定参与者开放式回答中的主题。结果:该调查由211名受访者完成,他们来自军队卫生系统24个不同的医学或外科专业。大多数参与者报告说,他们项目的产假政策在一定程度上或显著地减轻了实习父母的压力(实习父母50.5%,教师60.6%,博士61.9%)。参与者报告说,育婴假对实习生对病人护理、临床表现、学术活动或标准化考试成绩的奉献精神没有影响。参与者报告说,培训中断对同伴的培训体验有一定的负面影响,他们对亲生父母和非亲生父母的评价没有显著差异(亲生父母2.44 vs.非亲生父母2.48,P =。10, d = -0.11)。与非亲生父母相比,亲生父母的技术技能和程序量都被评为较低(技术技能:亲生父母2.50 vs非亲生父母2.60,P≤0.001;d = -0.25,程序量:亲生父母2.32 vs非亲生父母2.41,P结论:美国军事GME目前的育儿假政策被认为可以减少父母的压力,并对受训人员的健康产生积极影响。虽然这一政策得到了有效实施,但对受训人员的表现影响有限,但要在军训中全面接受育婴假,还有很多工作要做。
{"title":"Parental Leave Impact and Experience: A Survey of the U.S. Graduate Medical Education System.","authors":"Caitlin M Drumm, Elizabeth V Schulz, Paolo C Martin, Tasha R Wyatt, Theodora C Dworak, Sami A Abuhamdeh","doi":"10.1093/milmed/usaf653","DOIUrl":"https://doi.org/10.1093/milmed/usaf653","url":null,"abstract":"<p><strong>Introduction: </strong>Prior work conducted within U.S. civilian graduate medical education (GME) programs has uncovered negative perceptions of parenthood related to trainee wellness and performance. However, this subject remains understudied within U.S. military GME which affords trainees 12-18 weeks of paid parental leave.</p><p><strong>Materials and methods: </strong>We disseminated a web-based survey to trainees, faculty physicians and program directors (PDs) at U.S. military GME programs querying participants on the impact of parenthood and parental leave on trainee wellness and performance. Applicable statistical analyses were utilized to assess differences between groups. Content analysis was used to identify themes within participant open-ended responses.</p><p><strong>Results: </strong>The survey was completed by 211 respondents from 24 different medical or surgical specialties across the Military Health System. A majority of participants reported that their program's parental leave policy either somewhat or significantly decreased the stress of trainee parents (trainee 50.5% vs. faculty 60.6% vs. PDs 61.9%). Participants reported no impact of parental leave on trainee dedication to patient care, clinical performance, scholarly activities or standardized test scores. Participants reported a somewhat negative impact of training interruptions on the training experience of peers, with no significant difference in how they rated birth and non-birth parents (birth parent 2.44 vs. non-birth parent 2.48, P = .10, d = -0.11). Technical skills and procedural volume were both rated lower for birth parents versus non-birth parents (technical skills: birth parent 2.50 vs. non-birth parent 2.60, P ≤ .001; d = -0.25, procedural volume: birth parent 2.32 vs. non-birth parent 2.41, P <. 001; d = -0.23). Content analysis uncovered themes consistent with the survey data but also revealed persistent stigma surrounding use of full parental leave benefits within certain GME programs.</p><p><strong>Conclusions: </strong>The current parental leave policy within U.S. military GME is perceived to decrease parental stress and can have a positive impact on trainee wellness. While this policy has been effectively implemented with limited perceived impact on trainee performance, work remains to be done to promote full acceptance of parental leave within military GME.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146064617","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
The Great Imitator: Syphilitic Hepatitis Presenting as a Mimic to Autoimmune Liver Disease. 伟大的模仿者:梅毒肝炎表现为自身免疫性肝病的模仿者
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-22 DOI: 10.1093/milmed/usaf631
John Stanavage, Jared S Magee, Adam M Tritsch

Syphilis is known to mimic other disease presentations, but is seldom documented as mimicking autoimmune hepatitis with positive autoantibodies. We present a case of a 34-year-old male on pre-exposure prophylaxis (PrEP) for HIV with prior negative syphilis screening presenting with epigastric pain and constitutional symptoms. He endorsed anal sex practices with a monogamous male partner. Laboratory testing revealed elevated aminotransferases, alkaline phosphatase, and bilirubin, along with positive smooth muscle antibodies. A rapid plasma reagin and treponemal antibodies were reactive. He was treated with benzathine penicillin G with resolution of liver function derangements and autoimmune titer elevations.

梅毒是已知的模仿其他疾病的表现,但很少被记录为模仿自身免疫性肝炎阳性自身抗体。我们提出一个34岁的男性病例暴露前预防(PrEP)艾滋病毒与先前的梅毒筛查阴性呈现胃脘痛和体质症状。他支持与一夫一妻制的男性伴侣进行肛交。实验室检测显示转氨酶、碱性磷酸酶和胆红素升高,同时平滑肌抗体阳性。快速血浆reagin和密螺旋体抗体反应。患者给予苄星青霉素G治疗,肝功能紊乱和自身免疫滴度升高得到缓解。
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引用次数: 0
期刊
Military Medicine
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