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The Impact of Military Tobacco Control Policy: A Systematic Review. 军事烟草控制政策的影响:系统回顾。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usad507
Muhamad Arham Bin Hashim, Khairul Fikri Bin Sebri, Muhammad Faiz Bin Mohd Hanim, Diyana Shereen Binti Anwar, Nawwal Alwani Binti Mohd Radzi, Ahmad Farhan Bin Ahmad Fuad, Budi Aslinie Binti Md Sabri
<p><strong>Introduction: </strong>Tobacco use is synonymous with the military. Despite that military personnel are trained to follow commands, opportunities exist to implement various tobacco control strategies. We conducted a systematic review to evaluate the impact of tobacco control policy employed in military settings.</p><p><strong>Materials and methods: </strong>We searched for published English articles in Medline, Web of Science, Scopus, and Google Scholar databases using relevant subject headings without year restriction. We included randomized controlled trials, nonrandomized controlled trials, case-control, cohort, controlled before and after, and uncontrolled before and after studies evaluating the impact of tobacco control policy in the military population. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, three independent reviewers independently screened initially identified articles, reviewed the full text, and extracted the data and any disagreements resolved by consensus after data recheck. Five reviewers used a validated tool to assess the quality of the included studies. The primary outcome was the reduction of any tobacco or nicotine-contained products (TNCPs) use among the troops. The impacts of the tobacco control policy were synthesized and analyzed qualitatively. This study is registered with the International Prospective Register of Systematic Review (CRD42022314117).</p><p><strong>Results: </strong>Fourteen studies were included in the analysis from 5372 studies screened. Most of the studies were from the USA, and fractions were from Thailand, France, and Taiwan. These studies were methodologically heterogeneous. Most studies employed a total ban policy on TNCP use during basic military training or operational deployment as the primary strategy. Other methods utilized were the brief tobacco intervention, targeted treatment, support, and counseling provided through telephone or mailing systems, the adjunctive behavioral intervention, providing free nicotine gum, the "Pharsai clinic", active and regular smoking restriction, and interventions aimed at intrapersonal, interpersonal, and organizational levels. There is a moderate quality of evidence that the tobacco control policies effectively reduced the prevalence of TNCP use, increased the cessation rate, reduced the intake, and lowered the dependency. The adjunctive interventions provided after the total ban on TNCP use may increase its effectiveness. However, findings from this review need to be carefully considered as the definition of TNCP use status was not universal between studies and lacked a biochemical validation procedure.</p><p><strong>Conclusions: </strong>There is reasonable evidence to support that the tobacco control policy employed in the military population has multiple positive impacts in reducing the prevalence of TNCP use, increasing the cessation rates, reducing the intake, and lowering dependency. Other evi
介绍:吸烟是军人的代名词。尽管军人接受的训练是服从命令,但仍有机会实施各种烟草控制策略。我们进行了一项系统综述,以评估在军事环境中采用的烟草控制政策的影响:我们使用相关主题词在 Medline、Web of Science、Scopus 和 Google Scholar 数据库中搜索已发表的英文文章,没有年份限制。我们纳入了评估控烟政策对军队人群影响的随机对照试验、非随机对照试验、病例对照、队列、前后对照和前后非对照研究。按照《系统综述和元分析首选报告项目》指南,三位独立审稿人独立筛选了初步确定的文章,审阅了全文,提取了数据,并在数据复核后就任何分歧达成了共识。五位审稿人使用有效工具对纳入研究的质量进行评估。主要结果是部队中任何烟草或含尼古丁产品(TNCPs)使用的减少。对控烟政策的影响进行了综合和定性分析。本研究已在国际系统综述前瞻性注册中心注册(CRD42022314117):从筛选出的 5372 项研究中,有 14 项被纳入分析。大部分研究来自美国,部分来自泰国、法国和台湾。这些研究在方法上存在差异。大多数研究采用了在基础军事训练或作战部署期间全面禁止使用 TNCP 的政策作为主要策略。其他方法包括简短烟草干预、通过电话或邮件系统提供有针对性的治疗、支持和咨询、辅助行为干预、提供免费尼古丁口香糖、"Pharsai 诊所"、积极定期限制吸烟,以及针对人内、人际和组织层面的干预。有中等质量的证据表明,控烟政策有效降低了 TNCP 的使用率,提高了戒烟率,减少了摄入量,降低了依赖性。全面禁止TNCP使用后提供的辅助干预措施可能会提高其有效性。然而,由于各研究对TNCP使用状况的定义不尽相同,且缺乏生化验证程序,因此需要谨慎考虑本综述的结论:有合理的证据支持在军队人群中采用的控烟政策在降低TNCP使用率、提高戒烟率、减少摄入量和降低依赖性方面具有多重积极影响。要实现烟草终极目标,还需要充分利用其他循证策略。
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引用次数: 0
The Feasibility and Efficacy of Warrior Health and Fitness: A 3-Month Fitness and Nutrition Program for Veterans. 战士健康与健身》的可行性和有效性:为期 3 个月的退伍军人健身和营养计划。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae185
Sarah D Horwitz, Rachel A Millstein, Megan D McCarthy, Ryan Vanderweit, Jaime Fernandez, Armando R Hernandez, Victoria Wilson, Nicolette Maggiolo, Emily Collins, Ron Hirschberg, Philip Cefalo, Louisa G Sylvia

Introduction: Veterans are at risk for mental and physical health problems but may not seek traditional health care services. Wellness-based interventions, including exercise and nutrition, have been associated with improvements in physical and mental health among this population. This study explores the acceptability, feasibility, and efficacy of a 3-month health and fitness program for veterans.

Materials and methods: Participants in 2 time-based cohorts from 2019 to 2023 (cohort 1: n = 261; cohort 2: n = 256) were cleared by a physician to participate. Participants then completed a fitness test and self-reported surveys (e.g., quality of life, sleep, and pain) before and after the 3-month program. Participants were recruited to participate at one of three sites: Boston, MA Fort Myers, FL, or Tampa, FL. The 3-month program consisted of weekly, supervised group fitness and one-on-one sessions, nutritional consultations, yoga, and other wellness activities. Primary program outcomes were measured by fitness assessments, self-report surveys, program completion, and program satisfaction. Fitness assessments included measures of weight, body mass index, grip strength, waist to hip ratio, body fat, lean mass, fat mass, heart rate, and blood pressure (BP). Self-report measures included quality of life, depression, loneliness, sleep quality, pain intensity, and pain interference.

Results: In cohort 1, significant improvements were found for measures of weight (P = .01), left-handed grip strength (P < .01), body fat percent (P < .01), and quality of life (P < .01). In cohort 2, significant improvements were found for measures of waist:hip ratio (P = .02), right and left-handed grip strength (P < .01), body mass index (P = .02), body fat percent (P < .01), and quality of life (P = .02). For both cohorts, pain intensity (cohort 1: P = .01, cohort 2: P < .001) and pain interference (cohort 1: P = .02, cohort 2: P < .001) increased significantly.

Conclusions: These data suggest that a 3-month health and fitness program for veterans is acceptable and feasible and may improve physical and mental health outcomes. Considerations for program retention and assessment completion are discussed.

导言:退伍军人面临精神和身体健康问题的风险,但他们可能不会寻求传统的医疗保健服务。以健康为基础的干预措施(包括运动和营养)与改善退伍军人的身体和心理健康息息相关。本研究探讨了针对退伍军人的为期 3 个月的健康和健身计划的可接受性、可行性和有效性:从 2019 年到 2023 年的 2 个时间队列(队列 1:n = 261;队列 2:n = 256)中的参与者均由医生批准参加。然后,参与者在为期 3 个月的计划前后完成体能测试和自我报告调查(如生活质量、睡眠和疼痛)。参与者在以下三个地点之一接受招募:马萨诸塞州波士顿、佛罗里达州迈尔斯堡或佛罗里达州坦帕。为期 3 个月的计划包括每周一次有监督的集体健身和一对一课程、营养咨询、瑜伽和其他健康活动。计划的主要成果通过健身评估、自我报告调查、计划完成情况和计划满意度来衡量。体能评估包括体重、体重指数、握力、腰臀比、体脂、瘦肉率、脂肪率、心率和血压(BP)。自我报告测量包括生活质量、抑郁、孤独感、睡眠质量、疼痛强度和疼痛干扰:结果:在队列 1 中,体重(P = .01)、左手握力(P 结论:在队列 2 中,体重和左手握力均有明显改善:这些数据表明,针对退伍军人的为期 3 个月的健康和健身计划是可以接受的、可行的,并且可以改善身心健康状况。文中还讨论了保留计划和完成评估的注意事项。
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引用次数: 0
Tobacco use Prevalence in the Military Health System: A Retrospective Study. 军队卫生系统中的烟草使用流行率:一项回顾性研究。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae208
Steven Patrick, Colleen Boyle, Daniel LaMorte, Michael Dore

Introduction: Tobacco use is prevalent and has traditionally been higher in the U.S. Military population than in the civilian population, but studies are limited. The goal of this study was to evaluate tobacco use and tobacco cessation counseling within the US Military health system (MHS).

Materials and methods: This was a retrospective study assessing tobacco use and cessation counseling rates within the MHS from July 2016 to March 2022. Data for military tobacco use were obtained from the Defense Health Agency (DHA) Dashboard. US civilian tobacco rates were obtained from the Center for Disease Control and Prevention (CDC).

Population: Patients 18+ currently enrolled in direct care in military treatment facilities (MTFs) who had at least one direct primary care or well care gynecology encounter during the measurement years. Current tobacco use is defined as the presence of one coded indicator which included ICD 10CM codes, MEDCIN (a system of standardized medical terminology) Terms, and Vitals. Tobacco use is defined as the use of any form of tobacco (cigarette, cigar, vaping, or smokeless). The prevalence of tobacco use per month was analyzed from July 2016 through March 2022. After searching specifically for procedure codes for tobacco cessation counseling, a month-to- month trend of the rate of tobacco cessation counseling was also established.

Results: Data from 1.8 million patients were analyzed. Overall tobacco use within the MHS (including military dependents and retirees) decreased 1.68% (29.94 to 28.26%) from 2016 to 2022. Rates decreased by 3.24% (29.94 to 26.70%) from July 2016 to March 2021 before increasing by 1.56% (26.70 to 28.26%) from March 2021 to March 2022. Tobacco cessation counseling declined by 17.4% (28.4 to 11%) from July 2016 to March 2022. In comparison to the civilian population, tobacco use was 15.0% higher in the MHS.

Conclusions: Tobacco use remains common in the United States but is more prevalent in both active duty military and military retirees than civilians. Tobacco cessation counseling within the MHS steadily declined from 2016 to 2022. While there has been an overall reduction in rates of tobacco use in the military population over the last 5 years there was an increase over the last 2 years. Further research is needed to elucidate tobacco use, the effect of tobacco cessation counseling in the military, and the potential role of tobacco cessation medications in reducing tobacco use within the MHS.

导言:烟草使用在美国军人中十分普遍,且传统上高于平民,但相关研究却十分有限。本研究旨在评估美国军事卫生系统(MHS)内的烟草使用和戒烟咨询情况:这是一项回顾性研究,旨在评估 2016 年 7 月至 2022 年 3 月期间美国军事卫生系统内的烟草使用率和戒烟咨询率。军队烟草使用数据来自国防卫生局(DHA)Dashboard。美国平民烟草使用率来自疾病控制和预防中心(CDC):目前在军队治疗机构 (MTF) 接受直接治疗的 18 岁以上患者,他们在测量年期间至少接受过一次直接初级治疗或妇科保健。当前烟草使用定义为存在一个编码指标,其中包括 ICD 10CM 代码、MEDCIN(标准化医疗术语系统)术语和生命体征。烟草使用是指使用任何形式的烟草(香烟、雪茄、烟雾剂或无烟)。我们分析了从 2016 年 7 月到 2022 年 3 月的每月烟草使用流行率。在专门搜索了戒烟咨询的程序代码后,还确定了戒烟咨询率的逐月趋势:结果:分析了 180 万名患者的数据。从 2016 年到 2022 年,卫生部(包括军人家属和退休人员)的总体烟草使用率下降了 1.68%(从 29.94% 降至 28.26%)。从 2016 年 7 月到 2021 年 3 月,吸烟率下降了 3.24%(从 29.94% 到 26.70%),然后从 2021 年 3 月到 2022 年 3 月,吸烟率又上升了 1.56%(从 26.70% 到 28.26%)。从 2016 年 7 月到 2022 年 3 月,戒烟咨询减少了 17.4%(从 28.4% 到 11%)。与平民人口相比,MHS 的烟草使用率高出 15.0%:在美国,烟草使用仍然很普遍,但现役军人和退役军人的烟草使用率高于平民。从 2016 年到 2022 年,MHS 中的戒烟咨询稳步下降。在过去 5 年中,军人吸烟率总体有所下降,但在过去 2 年中有所上升。需要进一步开展研究,以阐明军队中的烟草使用情况、戒烟咨询的效果以及戒烟药物在减少军队中烟草使用方面的潜在作用。
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引用次数: 0
Implementation of a "Health Equity Rounds" Curriculum in a Military Internal Medicine Residency Program: A Pilot Study. 在军事内科住院医师培训项目中实施 "健康公平巡回 "课程:试点研究。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae236
Veronica Wright, William Hirschfeld, Erika Walker, Ezra Klein, Kevin White, Jessica Bunin
<p><strong>Introduction: </strong>Health disparities in the Military Health System (MHS) have been consistently documented despite the system ensuring equal access to care for its beneficiaries. Research has shown that social, economic, and political factors (i.e., Social Determinants of Health) and health care-specific factors like provider bias and systemic discrimination are key drivers of health disparities in the general population. Medical education focused on introducing these concepts using case-based learning has led to effective learning of health equity terminology. However, a significant gap exists in identifying optimal teaching approaches to develop skills to recognize these factors in actual clinical cases. This begs the million-dollar question: can case-based learning help trainees acquire the skills needed to identify the main factors contributing to health disparities in the MHS?</p><p><strong>Materials and methods: </strong>A longitudinal case-based curriculum was developed in which clinical cases from the Internal Medicine Wards, Medical Intensive Care Unit, or General Internal Medicine Clinic at the National Capital Consortium were solicited from trainees and analyzed for evidence of health care provider bias and systemic forms of discrimination using small groups. The National Capital Consortium Internal Medicine Residency Program implemented this pilot study in November 2021. A retrospective pretest-posttest survey assessing trainee reactions to the curriculum and changes in self-reported confidence in skills was used for curriculum assessment. Survey data were analyzed using a paired samples t-test.</p><p><strong>Results: </strong>The survey was administered during the last session of the 2022-2023 academic year, with 14 of the 23 available trainees completing it: a 60.8% response rate. Overall, 93% reported that the cases selected that academic year were engaging; the skills they were taught were practice-changing, and the educational value of the curriculum was good, very good, or excellent. Confidence ratings, assessed via a 5-point Likert Scale, demonstrated a statistically significant increase in self-reported confidence in the following skill domains with large effect sizes: identification of bias and systemic discrimination in clinical cases-change in mean: 1.07 (Pre: 3.29, Post: 4.36), P < .001, g = 1.38; recognizing and mitigating personal biases-change in mean: 0.71 (Pre: 3.50, Post: 4.21), P <.001, g = 1.10; participating in a discussion about health care provider bias and systemic discrimination-change in mean: 0.79 (Pre: 3.57, Post: 4.36), P  = .001, g = 1.06; and leading a discussion about bias and systemic discrimination-change in mean: 1.00 (Pre: 2.93, Post: 3.93), P = .002, g = 0.98.</p><p><strong>Conclusions: </strong>As the need to address health disparities in the United States becomes more pressing, so does the need for military physicians to recognize the drivers of these disparities within the MHS. R
导言:尽管军队医疗系统确保其受益人能够平等地获得医疗服务,但军队医疗系统中的健康差异一直被记录在案。研究表明,社会、经济和政治因素(即 "健康的社会决定因素")以及医疗保健方面的特定因素(如提供者的偏见和系统性歧视)是造成普通人群健康差异的主要原因。医学教育侧重于通过基于案例的学习来介绍这些概念,从而有效地学习健康公平术语。然而,在确定最佳教学方法以培养在实际临床病例中识别这些因素的技能方面,还存在很大差距。这就提出了一个价值百万美元的问题:基于病例的学习能否帮助受训者掌握识别造成医疗卫生系统健康差异的主要因素所需的技能?我们开发了一个纵向病例课程,向受训者征集来自国家首都联盟内科病房、医疗重症监护室或普通内科诊所的临床病例,并以小组形式分析医疗服务提供者偏见和系统性歧视形式的证据。国家首都联盟内科住院医师培训项目于 2021 年 11 月实施了这项试点研究。课程评估采用了一项回顾性的前测-后测调查,评估学员对课程的反应以及自我技能信心的变化。调查数据采用配对样本t检验进行分析:调查在 2022-2023 学年的最后一学期进行,23 名学员中有 14 人完成了调查,回复率为 60.8%。总体而言,93%的学员表示该学年选择的案例很有吸引力,所教授的技能改变了他们的实践,课程的教育价值为好、很好或优秀。通过 5 点李克特量表评估的信心评级显示,在以下技能领域,自我报告的信心有了统计上的显著提高,且影响大小较大:在临床案例中识别偏见和系统性歧视--平均值的变化:1.07 (前:3.29,后:4.36),P 结论:随着解决美国健康不平等问题的需求日益迫切,军医们也需要认识到这些不平等问题在医疗卫生系统中的驱动因素。这项 "健康公平巡回讲座 "试点研究的结果表明,基于病例的学习可能是一种最佳的教学方法,可提高军事内科受训人员识别和认识医疗服务提供者的偏见和系统性歧视对来自医疗服务系统的临床病例的影响的技能。
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引用次数: 0
Why Veterans Choose VA Versus non-VA Emergency Care: A Qualitative Study. 退伍军人为何选择退伍军人事务部与非退伍军人事务部的急诊护理:定性研究。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae259
Anita A Vashi, Emily P Wong, Jacqueline R Egelfeld, Steve M Asch, Andrea L Nevedal

Introduction: In ensuring the timely delivery of emergency care to Veterans, Veterans Affairs (VA) offers both emergency care services in its own facilities and, increasingly, purchases care for Veterans in non-VA (community) emergency department (ED) settings. Although in recent years emergency care coverage has become the single largest contributor to VA community care spending, no study to date has examined Veteran decision-making as it relates to ED setting choice. The purpose of this study is to identify and describe reasons why Veterans choose VA versus non-VA emergency care settings.

Materials and methods: Veterans Health Administration data were used to identify geographically diverse Veterans who recently used emergency care. We conducted semi-structured telephone interviews from December 2018 through March 2020 with 50 Veterans to understand the factors Veterans consider when deciding where to obtain ED care. Interviews were audio-recorded and transcribed verbatim. We conducted a directed content analysis of interview transcripts and developed a matrix to summarize and categorize each Veteran's decision-making process to compare participants and to identify common patterns.

Results: When choosing between VA and non-VA-EDs, Veterans described 3 distinct patterns of decision-making: (1) choosing the closest ED (often community) for acute conditions; (2) traveling farther for VA care due to preference and financial coverage; and (3) selecting VA when both types of ED care were equidistant. Perceptions of community resources, condition-specific needs, financial considerations, and personal preferences dominated the decision-making. For example, most Veterans (74%) rated their acuity as high, and self-perceived severity/urgency of their condition was the most cited factor influencing where Veterans decided to go for ED care.

Conclusions: Our qualitative results help provide insight into how and why Veterans choose to seek emergency care. As the number of Veterans treated in non-VA EDs continues to rise, VA and non-VA ED providers as well as policy makers may benefit from understanding the challenges Veterans face when making this decision.

导言:为确保及时为退伍军人提供急诊服务,退伍军人事务部(VA)既在其自有设施内提供急诊服务,也越来越多地在非退伍军人事务部(VA)(社区)急诊科(ED)为退伍军人购买急诊服务。尽管近年来急诊护理已成为退伍军人事务部社区护理支出的最大来源,但迄今为止还没有任何研究对退伍军人在选择急诊室时的决策进行过调查。本研究的目的是确定并描述退伍军人选择退伍军人健康管理局与非退伍军人健康管理局急诊护理机构的原因:退伍军人健康管理局的数据用于识别最近使用过急诊护理的不同地域的退伍军人。从 2018 年 12 月到 2020 年 3 月,我们对 50 名退伍军人进行了半结构化电话访谈,以了解退伍军人在决定去哪里获得急诊护理时考虑的因素。我们对访谈进行了录音和逐字转录。我们对访谈记录进行了定向内容分析,并开发了一个矩阵,对每位退伍军人的决策过程进行总结和分类,以便对参与者进行比较并找出共同的模式:在选择退伍军人医院和非退伍军人医院急诊室时,退伍军人描述了三种不同的决策模式:(1) 急性病选择最近的急诊室(通常是社区);(2) 出于偏好和经济承受能力的考虑,前往较远的退伍军人医院就医;(3) 当两种急诊室距离相等时,选择退伍军人医院。对社区资源的看法、特定病情的需求、经济因素和个人偏好在决策中占主导地位。例如,大多数退伍军人(74%)认为自己的病情严重,而自我感觉病情严重/紧急程度是影响退伍军人决定去哪里接受急诊室治疗的最主要因素:我们的定性结果有助于深入了解退伍军人选择急诊护理的方式和原因。随着在非退伍军人急诊室接受治疗的退伍军人人数不断增加,退伍军人和非退伍军人急诊室提供者以及政策制定者可能会从了解退伍军人在做出这一决定时所面临的挑战中受益。
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引用次数: 0
Movement Quality Assessment of Army Reserve Officers' Training Corps Cadets: A Report of Validity and Normative Data. 陆军后备军官训练团学员运动质量评估:有效性和规范性数据报告。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae266
Erin Lally, Hayley Ericksen, Madison Mach, Jennifer Earl-Boehm

Introduction: Movement quality screening in early-career military populations, like Army Reserve Officers' Training Corps (AROTC) cadets, could decrease the negative impact of musculoskeletal injury observed within the military. Movement quality screening techniques should be valid before being pursued in the field. Normative data describing movement quality of AROTC cadets are also needed. Therefore, the aims of this study were to determine criterion validity of several movement quality assessments and report normative jump-landing kinematics of AROTC cadets.

Materials and methods: This cross-sectional research was approved by the Institutional Review Board. As part of a larger study, 20 AROTC cadets (21.3 ± 3.4 years; 1.7 ± 0.1 m; 73.8 ± 14.8 kg) had 3-dimensional (3D) and 2-dimensional (2D) kinematic data collected simultaneously while performing a jump-landing task. Variables of interest were 3D hip and knee sagittal, frontal, and transverse joint angles at maximum knee flexion. An experienced rater calculated sagittal and frontal 2D joint angles at maximum knee flexion. Averages of 2D and 3D angles were calculated to describe normative data and for further data analysis. Bivariate correlations between 3D and 2D variables were used to determine criterion validity.

Results: Moderate correlations were found between 2D and 3D hip frontal plane angles (P = .05, r =-0.33), 2D and 3D knee sagittal plane angles (P = .04, r = 0.35), and 2D and 3D knee frontal plane angles (P = .03, r = -0.36). Normative values of knee and hip kinematics demonstrated averages of 17.58° of knee adduction, 16.48° of knee external rotation, 11.57° of hip abduction, 10.76° of hip internal rotation, and 103.47° of knee flexion during landings. However, ranges demonstrated that landing patterns vary within AROTC cadets.

Conclusions: The normative values of 3D jump-landing kinematic data indicate that movement quality varies greatly within AROTC cadets, and some cadets display potentially injurious movements. Therefore, screening movement quality could be beneficial to determine musculoskeletal injury risk in AROTC cadets. Based on the correlations discovered in this study, we recommend the 2D techniques used in this study be researched further as they may serve as alternatives to expensive, timely 3D techniques that could be better utilized in military environments.

导言:对军队后备军官训练团(AROTC)学员等早期职业军人进行运动质量筛查,可以减少军队中观察到的肌肉骨骼损伤的负面影响。运动质量筛查技术在实战中应用之前应该是有效的。此外,还需要描述 AROTC 学员运动质量的标准数据。因此,本研究的目的是确定几种运动质量评估的标准有效性,并报告美国陆军预备役军官训练营学员的规范性跳跃落地运动学数据:这项横断面研究获得了机构审查委员会的批准。作为一项大型研究的一部分,20 名 AROTC 学员(21.3 ± 3.4 岁;1.7 ± 0.1 米;73.8 ± 14.8 千克)在执行起跳落地任务时,同时收集了三维(3D)和二维(2D)运动学数据。三维髋关节和膝关节矢状角、正面角和横向角是膝关节最大屈曲时的相关变量。一名经验丰富的评分员计算膝关节最大屈曲时的矢状角和正面 2D 关节角度。计算二维和三维角度的平均值是为了描述常模数据和进行进一步的数据分析。三维和二维变量之间的双变量相关性用于确定标准有效性:结果:二维和三维髋关节额平面角度(P = .05,r =-0.33)、二维和三维膝关节矢状平面角度(P = .04,r = 0.35)以及二维和三维膝关节额平面角度(P = .03,r =-0.36)之间存在中度相关性。膝关节和髋关节运动学标准值显示,着地时膝关节平均内收 17.58°,膝关节平均外旋 16.48°,髋关节平均外展 11.57°,髋关节平均内旋 10.76°,膝关节平均屈曲 103.47°。然而,范围显示,陆军预备役学员的着陆模式各不相同:三维跳跃落地运动学数据的标准值表明,美国陆军预备役军官训练营学员的动作质量差异很大,有些学员的动作可能会造成伤害。因此,对动作质量进行筛查有助于确定 AROTC 学员肌肉骨骼受伤的风险。基于本研究中发现的相关性,我们建议进一步研究本研究中使用的二维技术,因为它们可以替代昂贵、及时的三维技术,在军事环境中更好地发挥作用。
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引用次数: 0
Glucagon-Like Peptide-1 Receptor Agonists and Sodium Glucose Cotransporter-2 Inhibitors and Cardiorespiratory Fitness Interaction. 胰高血糖素样肽-1 受体激动剂和葡萄糖钠转运体-2 抑制剂与心肺功能的相互作用。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae311
David Ni, Peter Kokkinos, Eric S Nylen

Introduction: Cardiorespiratory fitness (CRF) is a stronger predictor of mortality than traditional risk factors and is a neglected vital sign of health. Enhanced fitness is a cornerstone in diabetes management and is most often delivered concurrently with pharmacological agents, which can have an opposing impact, as has been reported with metformin. Considering the rapid evolution of diabetes medications with improved cardiovascular outcomes, such as glucagon-like peptide-1 receptor agonists and sodium glucose cotransporter-2 inhibitors, it is of importance to consider the influence of these vis-a-vis effects on CRF.

Materials and methods: Combining the words glucagon-like peptide-1 receptor agonists and sodium glucose cotransporter-2 inhibitors with cardiorespiratory fitness, an online search was done using PubMed, Embase, Scopus, Web of Science, Scientific Electronic Library Online, and Cochrane.

Results: There were only a few randomized controlled studies that included CRF, and the results were mostly neutral. A handful of smaller studies detected improved CRF using sodium glucose cotransporter-2 inhibitors in patients with congestive heart failure.

Conclusions: Since CRF is a superior prognosticator for cardiovascular outcomes and both medications can cause lean muscle mass loss, the current review highlights the paucity of relevant interactive analysis.

简介心肺功能(CRF)比传统的风险因素更能预测死亡率,是一个被忽视的重要健康指标。增强体质是糖尿病治疗的基石,通常与药物治疗同时进行,而药物治疗可能会产生相反的影响,二甲双胍就是一个例子。考虑到具有改善心血管效果的糖尿病药物(如胰高血糖素样肽-1 受体激动剂和钠葡萄糖共转运体-2 抑制剂)的快速发展,考虑这些药物对 CRF 的影响具有重要意义:将胰高血糖素样肽-1 受体激动剂和钠葡萄糖共转运体-2 抑制剂与心肺功能相结合,使用 PubMed、Embase、Scopus、Web of Science、Scientific Electronic Library Online 和 Cochrane 进行在线搜索:结果:只有少数随机对照研究包含了心肺功能,结果大多是中性的。少数规模较小的研究发现,使用钠葡萄糖共转运体-2抑制剂可改善充血性心力衰竭患者的CRF:结论:由于 CRF 是心血管预后的较佳指标,而这两种药物都会导致瘦肌肉质量下降,因此本综述强调了相关互动分析的缺乏。
{"title":"Glucagon-Like Peptide-1 Receptor Agonists and Sodium Glucose Cotransporter-2 Inhibitors and Cardiorespiratory Fitness Interaction.","authors":"David Ni, Peter Kokkinos, Eric S Nylen","doi":"10.1093/milmed/usae311","DOIUrl":"10.1093/milmed/usae311","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiorespiratory fitness (CRF) is a stronger predictor of mortality than traditional risk factors and is a neglected vital sign of health. Enhanced fitness is a cornerstone in diabetes management and is most often delivered concurrently with pharmacological agents, which can have an opposing impact, as has been reported with metformin. Considering the rapid evolution of diabetes medications with improved cardiovascular outcomes, such as glucagon-like peptide-1 receptor agonists and sodium glucose cotransporter-2 inhibitors, it is of importance to consider the influence of these vis-a-vis effects on CRF.</p><p><strong>Materials and methods: </strong>Combining the words glucagon-like peptide-1 receptor agonists and sodium glucose cotransporter-2 inhibitors with cardiorespiratory fitness, an online search was done using PubMed, Embase, Scopus, Web of Science, Scientific Electronic Library Online, and Cochrane.</p><p><strong>Results: </strong>There were only a few randomized controlled studies that included CRF, and the results were mostly neutral. A handful of smaller studies detected improved CRF using sodium glucose cotransporter-2 inhibitors in patients with congestive heart failure.</p><p><strong>Conclusions: </strong>Since CRF is a superior prognosticator for cardiovascular outcomes and both medications can cause lean muscle mass loss, the current review highlights the paucity of relevant interactive analysis.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141317667","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
Delayed Pressure Urticaria Associated With Altitude Chamber Training Responsive to Cyclosporine and Omalizumab. 对环孢素和奥马珠单抗有反应的高海拔室内训练引起的延迟性压力性荨麻疹
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae333
Veronica C Alix, Samuel L Weiss, Kevin M White

Delayed pressure urticaria (DPU) is a subset of chronic inducible urticaria. It is characterized by the formation of wheals anytime between 30 minutes and 24 hours after stimulus exposure of localized pressure application. In this case report, we discuss a military flight crew member with no significant past medical history who developed DPU following rapid decompression in an altitude chamber. The chamber training included an uneventful ascent to 45,000 feet, higher than he had been previously, and a rapid decompression. About 16 hours later, he developed pruritic swelling of his hands and feet, along with diffuse deep nodular swelling, erythematous plaques, and erythematous nodules. His DPU was refractory to monotherapy treatment with antihistamines, and he continued to develop lesions in weight-bearing areas. Control of symptoms was achieved through combination treatment of a second-generation antihistamine, a leukotriene receptor antagonist, and an immunosuppressant (cyclosporine). His waiver to return to flight status was denied while on cyclosporine. He was transitioned to a monoclonal antibody that binds free immunoglobin E (omalizumab) with resolution of symptoms and was cleared to return to active duty.

延迟性压力性荨麻疹(DPU)是慢性诱导性荨麻疹的一个分支。它的特点是在局部压力刺激后 30 分钟至 24 小时内的任何时间形成荨麻疹。在本病例报告中,我们讨论了一名既往无重大病史的军事机组人员在高空舱内快速减压后出现 DPU 的情况。高空舱训练包括平稳上升到 45,000 英尺(高于他之前的高度),然后快速减压。大约 16 小时后,他的手脚出现瘙痒性肿胀,并伴有弥漫性深层结节性肿胀、红斑和红斑结节。他的DPU对抗组胺药单药治疗无效,而且在负重部位继续出现皮损。通过联合使用第二代抗组胺药、白三烯受体拮抗剂和免疫抑制剂(环孢素),症状得到了控制。在服用环孢素期间,他恢复飞行状态的申请被拒绝。他转而使用一种能结合游离免疫球蛋白 E 的单克隆抗体(奥马珠单抗),症状得到缓解,并获准重返现役。
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引用次数: 0
Sick Call. 请病假。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae451
Alexander Williams

An internal medicine resident from Naval Medical Center San Diego uses poetry to contemplate how easily a future can be ended for an aspiring warfighter. This poem explores the power of military physicians to end a career and how distressing the process is for patient and doctor alike.

圣地亚哥海军医疗中心的一名内科住院医师用诗歌来思考,对于一名有抱负的战士来说,结束未来是多么容易。这首诗探讨了军医结束职业生涯的权力,以及这一过程对病人和医生来说是多么痛苦。
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引用次数: 0
Implementation of a High-Reliability Organization Framework in a Large Integrated Health Care System: A Pre-Post Quasi-Experimental Quality Improvement Project. 在大型综合医疗系统中实施高可靠性组织框架:前后期准实验性质量改进项目。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-02 DOI: 10.1093/milmed/usae511
Aaron M Sawyer, Sreedevi Thiyarajan, Keith Essen, Robin Pendley-Louis, Gary L Sculli, Edward E Yackel

Introduction: The purpose of this quality improvement (QI) project was to evaluate outcomes across Veterans Health Administration (VHA) hospital facilities engaged in an enterprise-wide implementation of a high-reliability organization (HRO) framework.

Materials and methods: This QI project relied on primary data drawn from 139 facilities nationwide from 2019 to 2023. Data sources included the All Employee Survey Patient Safety Culture (PSC) Module and patient safety reporting data derived from the Joint Patient Safety Reporting system. The project design applied a pre-post quasi-experimental design that examined within-cohort changes at pre-intervention, intervention, and 2 post-intervention follow-up timepoints. HRO interventions included a combination of training, leadership coaching, site assessments, and experiential learning. HRO interventions were initiated at 18 facilities beginning in 2019 (Cohort 1), 54 facilities in 2020 (Cohort 2), and 67 facilities in 2021 (Cohort 3). For between-cohort analyses, the relative degree of change within Cohort 1 sites was compared with all other sites.

Results: There were broad positive within-group trends for PSC scores across all sites, and domain-specific between-group differences in PSC Dimension 2-Risk Identification and Just Culture-and Dimension 4-Error Transparency and Risk Mitigation. For patient safety reporting, total events reported, and close calls increased for Cohort 1. The ratio of close calls to adverse events also increased for both Cohort 1 and all other VHA sites at post-intervention year 2.

Conclusions: The results of this QI project will inform further refinements to VHA's efforts to implement HRO principles and practices in the nation's largest integrated health system. In addition, the implementation practices may inform other large-scale, multi-level efforts to improve quality and patient safety.

简介:本质量改进(QI)项目的目的是评估退伍军人健康管理局(VHA)医院设施在全企业范围内实施高可靠性组织框架的成果:本质量改进(QI)项目旨在评估退伍军人健康管理局(VHA)医院设施在全企业范围内实施高可靠性组织(HRO)框架的成果:该 QI 项目依靠的是 2019 年至 2023 年期间从全国 139 家机构获得的原始数据。数据来源包括全体员工调查患者安全文化(PSC)模块和来自患者安全联合报告系统的患者安全报告数据。项目设计采用了前-后准实验设计,考察了干预前、干预和干预后两个随访时间点的队内变化。HRO 干预措施包括培训、领导力辅导、现场评估和体验式学习。HRO 干预措施于 2019 年在 18 家机构启动(队列 1),2020 年在 54 家机构启动(队列 2),2021 年在 67 家机构启动(队列 3)。在队列间分析中,比较了队列 1 机构与所有其他机构的相对变化程度:结果:所有医疗机构的 PSC 分数在组内呈广泛的正向趋势,而在 PSC 维度 2--风险识别与公正文化和维度 4--差错透明度与风险缓解方面则存在特定领域的组间差异。在患者安全报告方面,组群 1 报告的总事件数和险情报告数均有所增加。在干预后的第 2 年,群组 1 和所有其他退伍军人医疗服务机构的密切呼叫与不良事件的比率也有所上升:本 QI 项目的结果将为进一步完善 VHA 在全国最大的综合医疗系统中实施 HRO 原则和实践的工作提供参考。此外,实施实践还可为其他大规模、多层次的提高质量和患者安全的工作提供参考。
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引用次数: 0
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Military Medicine
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