Military Medicine最新文献

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.

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.

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.

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.

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.

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.

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.

Introduction: Lateral patellar instability is characterized by patellar subluxation or dislocation secondary to traumatic injury, ligamentous laxity, or other pathoanatomy of the knee. Management often requires surgical stabilization via a tibial-tubercle osteotomy. The purpose of this study is to determine if patella alta is a risk factor for poor postoperative outcomes and return to activity following a medializing tibial-tubercle osteotomy in a young, active-duty military population.

Materials and methods: This is a retrospective review of 42 military patients who received a medializing tibial-tubercle osteotomy for recurrent lateral patellar with a minimum of 2-year follow-up. No other stabilization procedures (i.e., medial patellofemoral ligament reconstruction) were offered or performed during the study period. t-Test, Chi square, and univariate logistic regression were used to determine if patella alta was associated Single Assessment Numeric Evaluation (SANE) scores, postoperative pain, recurrent instability, need for revision surgery, or an adverse outcome resulting in military activity limitations or medical separation.

Results: Of the 42 subjects, 30 were found to have patella alta as defined by Insall-Salvati index, Caton-Deschamps index, or patellar tendon length to patella length ratios. No significant relationship was identified between patella alta and post-operative SANE score (P = .752), post-operative pain (P = .673), recurrent dislocation (P = .248), revision surgery (P = .868) or adverse outcomes requiring permanent activity modifications or medical separation from the military (P = .071). Male sex was found to be protective of adverse outcomes (P = .042).

Conclusion: These data suggest that patella alta is not an independent risk factor for poor outcomes following a medializing tibial-tubercle osteotomy for the management of lateral patella instability in a military population. Female sex is a significant predictor of adverse outcomes. A larger study is warranted to confirm these findings and further investigate the significance of patella alta in patients receiving stabilization procedures for lateral patella instability.

Introduction: The potential consequences of alcohol mixed with energy drinks (AMED) consumption are of concern, but research to date has yielded conflicting results on how this mixing relates to alcohol outcomes. How AMED might relate to particular at-risk populations, such as military personnel, and the longitudinal consequences are unknown. This research examines the relationship between AMED use with alcohol problems using 6 years of data, among Reserve and National Guard (R/NG) soldiers, a population at risk for both heavy use of caffeine and alcohol.

Materials and methods: The current analyses used 6 years of annual survey data, collected from soldiers (n = 485) participating in Operation: SAFETY, a longitudinal cohort study of U.S. Army R/NG soldiers and their spouses. Generalized estimating equation models were used to examine the relationship between past-year use of energy drinks mixed with alcohol (yes/no) on the likelihood of having an AUDIT score ≥8 (yes/no), indicative of problems with alcohol. Adjusted models controlled for age, sex, and symptoms of PTSD. The study was approved by the Institutional Review Board at the University at Buffalo, and vetted by the Army Human Research Protections Office, the Office of the Chief, the Army Reserve, and the Adjutant General of the National Guard. All participants provided informed consent to participate.

Results: At the first assessment, over half of the sample reported AMED in their lifetime, and 14.4% reported AMED in the past year. Reporting past-year mixing of energy drinks with alcohol was significantly related to higher odds of likely problems with alcohol (Odds Ratio (OR), 2.01; 95% CI, 1.51-2.66; P < .001) over time (Table 1). This remained true in adjusted models, after accounting for sex, age, and PTSD symptom levels (Adjusted Odds Ratio (AOR), 1.88; 95% Confidence Interval (CI), 1.39-2.54; P < .001).

Conclusions: Soldiers are already at greater risk for problems with alcohol compared to their civilian counterparts; the current analyses suggest that using energy drinks combined with alcohol may increase this risk for some individuals. Further research is needed to explore the context in which energy drinks and alcohol are used to inform future prevention messaging and interventions.

Introduction: This study aimed to analyze the surgical outcomes of complex elbow fracture-dislocations treated at a Korean military hospital and to present optimal approaches and fixation strategies according to injury subtype.

Materials and methods: A retrospective review was conducted on 10 patients who underwent surgical treatment for complex elbow fracture-dislocations between May 2023 and December 2024. Demographic data, injury mechanisms, fracture subtype, surgical approach, fixation methods, and clinical outcomes were reviewed. Functional outcomes were assessed using the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) score, and Mayo Elbow Performance Score (MEPS). Radiographic bone union and postoperative complications were also evaluated.

Results: The mean follow-up period was 14.5 months. All fractures achieved radiographic union at a mean of 9.1 weeks. At final follow-up, the mean VAS was 1.8, DASH 11.4, and MEPS 87.5, indicating generally good to excellent outcomes in most cases. The average range of motion was 8°-139° in flexion-extension and 74°-75° in pronation-supination. No cases of re-dislocation or nonunion were observed.

Conclusions: Complex elbow fracture-dislocations remain rare but challenging injuries. Proper selection of surgical approach and fixation method according to injury subtype can lead to favorable clinical outcomes. This study, the first from a Korean military hospital, provides practical insight into individualized surgical management.