Journal of Military and Veterans Health最新文献

Importance: Since 2001, 3.5 million United States service members deployed overseas in support of the post-9711 Global War on Terror. While healthy and fit upon deployment, veterans have experienced many complex and often unexplainable illnesses and chronic diseases, with more than 520 000 being diagnosed with cancer. With the implementation of the VA MISSION and PACT Acts, post-911 veterans are increasingly being seen in non-VHA healthcare facilities by non-physician providers.

Objective: To assess the readiness of registered and advanced practice nurses to provide knowledgeable and competent healthcare for post-9/11 veterans in the civilian healthcare system.

Design setting and participants: A web-based survey was administered by the HunterSeven Foundation (a Veteran-founded non-profit organisation), with 541 nurse respondents.

Primary outcomes and measures: Questions were designed to assess military knowledge, comfort level caring for veterans, self-reported proficiency and prior training of participants. Mean differences were compared using a restricted maximum likelihood, fixed-effects model, with incidence between groups estimated as log-binomial relative risks.

Results: Meaningful gaps in clinical knowledge of screening for and treatment of medically related conditions were identified. Our assessment also highlighted a sparseness of knowledge for making care recommendations based on apposite resources.

Conclusions and relevance: Cognitive biases among healthcare providers in the civilian sector may lead to missed and/or delayed diagnoses, therefore emphasising the need for additional training focused on caring for post-9/11 veterans.

Background: US Vietnam War Blue Water Navy veterans (BWN) conducted military operations on Vietnam's offshore waters and likely experienced various war-related exposures. The overall health of the BWN has never been systematically studied.

Purpose: Describe and compare BWN's health with other servicemembers and non-veterans of the Vietnam era.

Materials and methods: Survey of 45 067 randomly selected US Vietnam War theatre and non-theatre veterans and 6885 non-veterans.

Results: For 22 646 male respondents, self-reported health was contrasted by veteran status defined as BWN (n=985), theatre veterans (n=6717), non-theatre veterans (n=10 698) and non-veterans (n=4246). Exposure was service in the Vietnam War theatre. Collected were demographics, military service characteristics, lifestyle factors and health conditions. Adjusted odds ratios (aOR) were calculated using multivariable logistic regression. Controlling for cigarette smoking and other covariates, respiratory cancer risk was highest in BWN vs other veterans (theatre: aOR 1.65; 95% CI 1.09, 2.50; non-theatre: aOR 1.77; 1.13, 2.77) and to non-veterans (aOR 1.78; 1.15, 2.74). Other findings showed BWN's health risks between theatre and non-theatre veterans.

Conclusion: There was a higher risk for respiratory cancers in BWN. Other risks were less than theatre veterans but greater than non-theatre or non-veterans, indicating a potential role of military exposures in BWN's health.

Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction (DGBI) that affects about 10% of the adult population in the United States. IBS pathoetiology understanding has evolved and clinical management improved despite the underdevelopment of diagnostics. Within the Veterans Affairs (VA) system, the prevalence and impact of DGBIs are high. Yet there is a paucity of information on the patient demographic features. Our team examined the history and workup of patients referred to an IBS clinic within the VA's gastroenterology service through a systematic case series study to begin a quality improvement initiative.

Agent Orange, a dioxin-containing toxin, was used as an herbicide during the Vietnam War. Exposures to Agent Orange were initially linked to birth defects among Vietnamese civilians residing near aerially sprayed regions. Years later, returning South Korean and U.S. Veterans exposed to Agent Orange exhibited increased rates of malignancy, cardiovascular disease, diabetes and birth defects in their offspring. Growing evidence that herbicides and pesticides contribute to chronic diseases including neurodegeneration raises concern that Agent Orange exposures may have increased the risk for later development of peripheral or central nervous system (CNS) degeneration. This article reviews published data on the main systemic effects and the prevalence rates, relative risks, characteristics and correlates of Agent Orange-associated peripheral neuropathy and CNS dementia-associated diseases. The critical findings were that relatively high levels of Agent Orange exposure increased risk of developing peripheral neuropathy either alone or as a co-factor complication of diabetes mellitus and likely contributed to the pathogenesis of CNS degenerative diseases, including Alzheimer's, Parkinson's and vascular dementias. Given the protracted intervals between the Agent Orange exposures and disease emergence, additional research is needed to identify mechanistic correlates of the related neurological disorders, including lifestyle co-factors.

Purpose: Performing well in combat requires military service members to be in peak physical shape. Although each branch of the United States military has fitness guidelines and assessments, there are no exact prescriptions for physical training programs. The absence of a standardised approach may lead to suboptimal physical performance and increased risk of musculoskeletal injury. To address this gap, we evaluated the feasibility of a pilot combat conditioning program based on linear periodisation.

Methods: Twenty-nine garrisoned US Marine Corps service members (25 men, 4 women; 23.5±4.4 years) enrolled in our 11-week conditioning program that was supervised by a strength and conditioning professional. Military-specific (physical/combat fitness tests) and general (treadmill-based maximal exercise test) assessments were performed at baseline and 11 weeks. Training and injury logs were maintained throughout the duration of the program.

Results: Approximately 80% (23/29) of service members completed the entire program. Cardiorespiratory fitness (Peak VO^2; +8.10±10.9%; p=0.011), upper-body strength (pull-ups; +47.0±58.2%; p<0.001) and core strength (abdominal crunches; +9.2±23.3%; p=0.029) significantly increased from pre- to post-training. No statistically significant improvement or worsening was noted in any other performance assessment measure. Eight (28%) participants reported minor musculoskeletal concerns, of which only one required medical attention (injury rate 1.3 injuries/100 person-months).

Conclusion: A protocolised linear periodisation training program was feasible and demonstrated improvements in fitness in a group of garrisoned Marines with low injury rates. Other military units may benefit from a similar approach.

Symptom-based conditions such as chronic fatigue syndrome (CFS) and medically unexplained multi-symptom illness (MSI) are fairly common in the general population and are also important veteran's health concerns due to their higher frequency among U.S. veterans who served during the 1990-1991 Gulf War. CFS, MSI, and other symptom-based conditions are often associated with considerable morbidity due to fatigue, chronic pain, neurologic symptoms, and other symptoms that can impair the quality of life. This article discusses several important issues of methodology that arise in population studies of CFS and MSI. These include the exclusion criteria that have been used in population studies to define CFS-like illness and unexplained MSI, the potential for false positive and false negative assessments of illness status, the potential for sex differences, and the poorly understood natural history of these symptom-based conditions across the life span. As an empirical example of these methodology issues, we examined existing data from a 2005 follow-up survey. We found that 64.9% (762 of 1,175) of female Gulf War veterans and 53.4% (2,530 of 4,739) of male Gulf War veterans had 1 or more exclusionary medical conditions. The prevalence among veterans with one or more exclusionary medical conditions increased markedly by age among females and those with a low income.

BACKGROUND: Nationwide surveys in the United States found that certain health-related factors, in particular cigarette smoking and obesity, were more prevalent in veterans than in non-veterans. PURPOSE: The objective of this paper was to compare health-related characteristics and dietary intakes between veterans and non-veterans in the Multiethnic Cohort. MATERIALS AND METHODS: The cohort participants (aged 45-75 years), residing in Hawaii and California at baseline, completed a mailed questionnaire on diet, medical history, and lifestyle in 1993-1996. The current analyses included 20,939 men (14,975 veterans and 5,964 non-veterans) who returned a survey questionnaire on military service in 2007. RESULTS: Compared to non-veterans, veterans were more likely to be overweight and obese (BMI≥25, 61% vs. 55%), former smokers (54% vs. 47%), heavier consumers of red and processed meat, and lighter consumers of fruits and vegetables. Within the veteran group, enlisted men were more likely to be obese, to have a history of smoking, to consume more processed meat and to consume smaller amounts of dairy products and fruits than officers. CONCLUSION: The findings imply that veterans as a group are at somewhat higher risk of developing lifestyle-related chronic diseases than are non-veterans. Comparisons of actual differences in disease incidence and mortality in the Multiethnic Cohort between veterans and non-veterans will require several more years of follow-up.