Military Medicine最新文献

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.

Introduction: The Military Health System (MHS) has faced multiple changes and challenges over the last decade including the Defense Health Agency (DHA) merger, deployment of MHS GENESIS, military treatment facility (MTF) realignment, and the COVID-19 pandemic. We sought to understand the impact of these events on MHS beneficiary care by comparing Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs) for avoidable hospitalizations between beneficiaries with a designated direct care primary care manager (PCM) and those with a designated private sector PCM.

Materials and methods: We used the MHS Data Repository to conduct a cross-sectional study of TRICARE Prime beneficiaries aged 18 to 64 years during fiscal years 2021-2024. Crude and adjusted risk ratios were used to determine risk by PCM type for each AHRQ PQI. Logistic regression models were used to estimate unadjusted and adjusted odds ratios for admissions for any of the PQIs. This study was found exempt by the Institutional Review Board of the Uniformed Services University of the Health Sciences.

Results: We identified a total of 490,236 hospital admissions by patients in the MHS with a designated primary care manager (PCM) during the study period. Of the total admissions, 2.85% were associated with PQIs, 2.70% by direct care PCM at a military treatment facility, and 3.75% by a private sector PCM. Rate of admission for several of these conditions on a scale per 1,000 hospitalizations showed lower rates of avoidable hospitalizations in patients with a direct care PCM, but adjusted analysis showed lower overall risk of avoidable hospitalizations for patients with a private sector PCM. Additionally, several individual characteristics, including Black race and comorbidities had higher odds of avoidable hospitalization.

Conclusions: Our findings show that beneficiaries with a private sector PCM had lower odds of an avoidable hospitalization, supporting existing concerns that current staffing shortages have impacted direct care capabilities. With the push to increase force lethality, MHS stabilization is needed to rebuild a ready medical force that can support a medically ready force.

Introduction: Basic military training is crucial for preparing civilians for military life. This period prepares them with physical and cognitive skills required for military service. However, basic military training is marked by a high incidence of musculoskeletal injuries. In addition, female sex has been identified as a risk factor in military training courses, contributing to higher medical treatment costs and reduced operational readiness.

Objective: To investigate the incidence of musculoskeletal symptoms and injuries in male and female recruits during sixteen weeks of Brazilian Marine Basic Military Training, as well as to assess their potential risk factors.

Methods: A total of 626 military recruits were enrolled in the training period. The study was divided into two phases. Firstly, a cross-sectional analysis included body composition assessment and physical fitness tests. Secondly, a retrospective analysis included the application of the Nordic Musculoskeletal Symptoms Questionnaire (NMQ) at the end of the course to assess the musculoskeletal complaints experienced by the recruits. A logistic regression analysis investigated factors associated with injuries, adjusting for physical fitness variables. Data analysis was performed using Jamovi software, with a significance level set at 0.05.

Results: The NMQ revealed that women had a higher risk in the following categories: any symptom, symptoms that resulted in time loss from duties, symptoms that required medical attention, symptoms in the 7 days preceding the baseline evaluation, trunk injuries, upper and lower limbs injuries. However, after adjusting for physical fitness variables, the fitness-related factors associated with the incidence of musculoskeletal symptoms were body fat percentage and running performance only for symptoms that led to medical consultation or duty restriction. Sex was associated only with the week in which the NMQ was administered. The activities associated with a higher risk of injuries in women were drill and ceremonies, load carriage marching, and obstacle courses.

Conclusions: The present study identified that sex, body fat percentage, and running performance were risk factors for musculoskeletal symptoms in recruits. Additionally, physical training, loaded marching, and running were the activities most associated with injuries during the training course.

Introduction: Aerobic exercise and cold exposure modulate lipid mediator production, which may optimize physiological resilience. The Yukon Arctic Ultra (YAU), a 692-km self-provisioned multiday endurance event, offers a unique opportunity to examine lipidomic adaptations to nutrients and environmental and physical stress. This study aimed to identify lipid mediators responsive in YAU athletes compared to control participants.

Methods: Nine athletes and six controls were recruited from the 2017 and 2019 YAU events. Targeted liquid chromatography-tandem mass spectrometry/mass spectrometry-based signaling lipidomic analysis was conducted on serum samples collected from participants at pre-event, during the event, and post-event time points.

Results: Athletes and controls did not differ significantly in age, body mass index (BMI), fat mass index (FMI), or fat-free mass index. During the event, athletes exhibited significant reductions in BMI, fat mass, and FMI, whereas no changes were observed in controls. Athletes showed higher baseline levels of anti-inflammatory oxylipins, including resolvin D2 and lipoxin A4 (LXA4), and lower levels of the pro-inflammatory leukotriene E4 compared to controls. Linoleic acid- and α-linolenic acid-derived oxylipins were also elevated in athletes. Notably, these anti-inflammatory lipids remained elevated throughout the event. Certain hydroxy-eicosapentaenoic acids demonstrated a declining trend during the event in athletes.

Discussion: YAU athletes exhibit a distinct lipidomic signature marked by persistently elevated anti-inflammatory oxylipins, likely reflecting a complex interplay between adipose tissue and skeletal muscle. Overall, the oxylipin shifts point to anti-inflammatory and thermogenic adaptations that support physiological resilience during physical, nutrient, and environmental stress in austere circumstances.

Introduction: Approximately 50% of the United States (U.S.) adult population uses at least one dietary supplement (DS). Higher DS use is reported among occupations with high physical fitness demands. As of 2021, roughly 75% of U.S. military service members (SMs) used at least one DS weekly. The primary objective of this quality improvement project was to characterize the DS environment on two U.S. military installations.

Materials and methods: Fort Drum in the United States and Camp Buehring in Kuwait were surveyed from March to August 2024. A team of 12 health professionals (Registered Dietitian Nutritionists, Health Educators, and Certified Strength and Conditioning Specialists) analyzed 1,209 unique DS sold on Fort Drum and/or Camp Buehring. By analyzing the DS labels, our team assessed DS for dosage of vitamins and minerals, caffeine content, presence of stimulants and prohibited substances, as well as for the Operation Supplement Safety (OPSS)-vetted third-party certification organization seals.

Results: Of the 1,209 unique DS examined, 250 (21%) contained a proprietary blend, matrix, or complex. Additionally, 461 (38%) had more than 200% of the established Daily Value for at least one vitamin or mineral, 63 (5%) contained more than 200 mg of caffeine per serving, and 87 (7%) were found to contain multiple stimulants. Only 120 (10%) of the DS were certified by an OPSS-vetted third-party certifying agency. No prohibited substances were identified on the labels of the evaluated DS.

Conclusions: Given the significant risk to medical readiness, it behooves the Department of Defense (DoD) to more closely monitor DS sold on installations. As the lead organization for supplement education and mandatory safety training, OPSS should play a central role in reassessing the vetting process of DS sold on military installations. Integrating OPSS into this process would help mitigate the risk of SMs inadvertently consuming prohibited substances.

Introduction: Rapid, intravenous (IV) infusion is critical for resuscitation in emergency medicine. Needleless connectors improve safety by reducing the risk of bloodstream infection transmission and air embolism; however, needleless connectors also significantly limit flow rates. Although prior studies demonstrated that 3-way and 4-way "high-flow" stopcocks have flow rates noninferior to uninterrupted catheter tubing, the performance of 1- and 2-way high-flow stopcocks remains poorly understood. This study evaluated flow rates across various catheter connection adjuncts to identify optimal devices for resuscitation efficacy.

Materials and methods: A 500-mL infusion circuit of 0.9% normal saline was tested with needleless connectors, standard and high-flow stopcocks under gravity (0 mm Hg) and pressurized (300 mm Hg) conditions. A 16-gauge IV catheter connected directly to IV tubing served as the control. Fluid volume was measured gravimetrically over 120 seconds, and flow rate was calculated. Each condition was repeated in quadruplicate. Data were analyzed via 2-way analysis of variance and follow-on Tukey's post hoc testing, with multiplicity-adjusted statistical significance defined as P < .05.

Results: The use of needleless connectors significantly decreased flow compared to control in both the gravity cohort (0.95 ± 0.018 mL/second vs. 1.19 ± 0.05 mL/second, P < .0001) and the pressurized cohort (3.10 ± 0.048 mL/second vs. 3.46 ± 0.072 mL/second, P < .0001). The use of high-flow 2-way stopcocks did not significantly reduce flow in either gravity (1.21 ± 0.05 mL/second, P = .932) or pressurized cohorts (3.42 ± 0.048 mL/second, P = .957) compared to control. In addition, the use of high-flow 3-way stopcocks did not significantly reduce flow in gravity (1.240 ± 0.02 mL/second, P = .368) or pressurized cohorts (3.43 ± 0.064 mL/second, P = .986) compared to control.

Conclusion: In an idealized system, the use of high-flow stopcocks allows for an 8%-10% increase in flow rate compared to needleless connectors, correlating to an additional 400 mL of fluid delivered over a 20-minute period. The 2-way high-flow stopcock could provide a significant advantage by delivering increased flow rates while offering a compact design that maintains a low operational footprint. Given the impact of rapid fluid administration in trauma and resuscitation, high-flow stopcocks may enhance emergency care efficiency in austere combat environments.