Study
Abstract
One in seven of the approximately 2.2 million Department of Defense active duty military personnel are women. Among active duty servicewomen, about 40% are under 26 years old, and almost half are young, lower ranking enlisted personnel. This article will include a review of the literature on military women's health topics such including contraception access, pregnancy, and pregnancy outcomes after environmental exposures. In these early adult years, contraception use may not be consistent, leading to higher rates of unintended pregnancy that is similar to their civilian counterparts, but it may affect troop readiness. Women who become pregnant after deployment must be evacuated from theater. Complications in pregnancy that require immediate intervention, such as ectopic pregnancy, may be more difficult to diagnose and manage if far away from comprehensive medical services. Environmental exposures may affect the pregnancy outcome, or may produce delayed responses for future childbearing. Women face other gynecologic choices including menstrual suppression while deployed. Many of these issues have not been fully studied, sample sizes are small or methodological flaws exist in the analysis limiting conclusions that can be drawn. Further research with greater rigor, larger sample sizes, and careful design are needed to address many of these questions.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Defense Health Agency (formerly TRICARE Management Activity)
- Congressionally Mandated: No
- Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
- Release Date/Publication: January 01, 2016
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Citation: Krulewitch CJ. Reproductive Health of Active Duty Women in Medically Austere Environments. Mil Med. 2016 Jan;181(1 Suppl):63-9.
Study
Abstract
OBJECTIVE:
To examine the clinical utility and psychometric properties of the Traumatic Brain Injury Quality of Life (TBI-QOL) scale in a US military population.
PARTICIPANTS:
One hundred fifty-two US military service members (age: M = 34.3, SD = 9.4; 89.5% men) prospectively enrolled from the Walter Reed National Military Medical Center and other nationwide community outreach initiatives. Participants included 99 service members who had sustained a mild traumatic brain injury (TBI) and 53 injured or noninjured controls without TBI (n = 29 and n = 24, respectively).
PROCEDURE:
Participants completed the TBI-QOL scale and 5 other behavioral measures, on average, 33.8 months postinjury (SD = 37.9).
MAIN OUTCOME MEASURES:
Fourteen TBI-QOL subscales; Neurobehavioral Symptom Inventory; Posttraumatic Stress Disorder Checklist-Civilian version; Alcohol Use Disorders Identification Test; Combat Exposure Scale.
RESULTS:
The internal consistency reliability of the TBI-QOL scales ranged from α = .91 to α = .98. The convergent and discriminant validity of the 14 TBI-QOL subscales was high. The mild TBI group had significantly worse scores on 10 of the 14 TBI-QOL subscales than the control group (range, P < .001 to P = .043). Effect sizes ranged from medium to very large (d = 0.35 to d = 1.13). The largest differences were found on the Cognition-General Concerns (d = 1.13), Executive Function (d = 0.94), Grief-Loss (d = 0.88), Pain Interference (d = 0.83), and Headache Pain (d = 0.83) subscales.
CONCLUSION:
These results support the use of the TBI-QOL scale as a measure of health-related quality of life in a mild TBI military sample. Additional research is recommended to further evaluate the clinical utility of the TBI-QOL scale in both military and civilian settings.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Defense and Veterans Brain Injury Center
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: January 01, 2016
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Citation: Lange RT, Brickell TA, Bailie JM, Tulsky DS, French LM. Clinical Utility and Psychometric Properties of the Traumatic Brain Injury Quality of Life Scale (TBI-QOL) in US Military Service Members. J Head Trauma Rehabil. 2016 Jan-Feb;31(1):62-78.
Study
Abstract
OBJECTIVE:
To explore the taxonomy of combat-related mild traumatic brain injury (mTBI) based on symptom patterns.
PARTICIPANTS:
Up to 1341 military personnel who experienced a combat-related mTBI within 2 years of evaluation.
MEASURES:
Neurobehavioral Symptom Inventory and PTSD Checklist-Civilian Version (PCL-C).
RESULTS:
Cluster analysis revealed the following 4 subtypes: primarily psychiatric (posttraumatic stress disorder) group, a cognitive group, a mixed symptom group, and a good recovery group. The posttraumatic stress disorder cluster (21.9% of the sample) reported symptoms related to hyperarousal and dissociation/depression with few complaints related to cognition or headaches. The cognitive group (21.5% of the sample) had primarily cognitive and headache complaints with few mood symptoms. The mixed profile cluster included 18.6% of the sample and was characterized by a combination of mood complaints (hyperarousal and dissociation/depression), cognitive complaints, and headaches. The largest cluster (37.8% of the sample) had an overall low symptom profile and was labeled the "good recovery" group.
CONCLUSIONS:
The results support a unique taxonomy for combat-related mTBI. The clinical differences among these subtypes indicate a need for unique treatment resources and programs.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Defense and Veterans Brain Injury Center/Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: January 01, 2016
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Citation: Bailie JM, Kennedy JE, French LM, Marshall K, Prokhore, et.al., Profile Analysis of the Neurobehavioral and Psychiatric Symptoms Following Combat-Related Mild Traumatic Brain Injury. J Head Trauma Rehabil. 2016 Jan-Feb;31(1):2-12.
Study
Abstract
BACKGROUND:
Inconsistent findings between studies of gender differences in mental health outcomes in military samples have left open questions of differential prevalence in posttraumatic stress disorder (PTSD) among all United States Army soldiers and in differential psychosocial and comorbid risk and protective factor profiles and their association with receipt of treatment.
METHODS:
This study assesses the prevalence and risk factors of screening positive for PTSD for men and women based on two large, population-based Army samples obtained as part of the 2005 and 2008 U.S. Department of Defense Surveys of Health Related Behaviors among Active Duty Military Personnel.
RESULTS:
The study showed that overall rates of PTSD, as measured by several cutoffs of the PTSD Checklist, are similar between active duty men and women, with rates increasing in both men and women between the two study time points. Depression and problem alcohol use were strongly associated with a positive PTSD screen in both genders, and combat exposure was significantly associated with a positive PTSD screen in men. Overall, active duty men and women who met criteria for PTSD were equally likely to receive mental health counseling or treatment, though gender differences in treatment receipt varied by age, race, social support (presence of spouse at duty station), history of sexual abuse, illness, depression, alcohol use, and combat exposure.
CONCLUSIONS:
The study demonstrates that the prevalence of PTSD as well as the overall utilization of mental health services is similar for active duty men compared with women. However, there are significant gender differences in predictors of positive PTSD screens and receipt of PTSD treatment.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Walter Reed National Military Medical Center
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: January 01, 2016
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Citation: Hourani L, Williams J, Bray RM, Wilk JE, Hoge CW. Gender Differences in Posttraumatic Stress Disorder and Help Seeking in the U.S. Army. J Womens Health (Larchmt). 2016 Jan;25(1):22-31.
Study
Abstract
This report summarizes frequencies and timing of first and recurrent episodes of back pain treated in the U.S. Military Health System among more than 2 million military members who began active service between July 2000 and June 2012. In the population overall, at least 5% were affected by clinically significant back pain within 6 months and 10% within 13 months of beginning active service; and 34% had at least one episode of back pain while in active service during the surveillance period. After initial episodes of back pain, more than half (54%) of those affected had at least one recurrent episode; and after first recurrences, 65% had second recurrences while still in active service. In general, back pain episode-free periods preceding initial and between successive episodes markedly decreased during the period. Frequencies and timing of back pain episodes varied in relation to service branch, gender, and occupation. Acute back pain is a common disorder that is unpredictable in onset and often debilitating. Its prevention should be a military medical research objective of high priority.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Armed Forces Health Surveillance Center
- Congressionally Mandated: No
- Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
- Release Date/Publication: January 01, 2016
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Citation: Brundage JF, Hu Z, Clark LL. Durations of service until first and recurrent episodes of clinically significant back pain, active component military members: changes among new accessions to service since calendar year 2000. MSMR. 2016 Jan;23(1):7-15.
Study
Abstract
BACKGROUND:
Numerous studies document higher substance use among military men after deployment; similar studies focused on military women are limited.
OBJECTIVES:
This study examines alcohol use of active duty women and deployment factors, social/environmental/attitudinal factors, and psychological/intrapersonal factors.
METHODS:
Secondary data analysis of the 2011 Survey of Health-Related Behavior of active duty military personnel was conducted using bivariate statistics and multiple regression analyses with Alcohol Use Disorders Identification Test scores as the dependent variable.
RESULTS:
Nearly 94% had low risk for alcohol use disorders. Length of combat experience and extent of combat exposure were unrelated to Alcohol Use Disorders Identification Test scores; noncombat deployment was unrelated after controlling for marital status, age of first drink, pay grade, and branch of service. Significant motivators (p < 0.001) for drinking were "like/enjoy drinking," "drink to cheer up," "drink to forget problems," and significant deterrents were "cost of alcohol" and "fear of upsetting family/friends if used alcohol." Anger propensity, risk propensity, lifetime prevalence of suicidal ideation, and depressed mood were significant predictors in the regression model after controlling for covariates.
CONCLUSION:
Findings suggest that some active duty women use alcohol to cope with adverse emotional states, whereas others use alcohol consistent with propensity for high-risk behaviors.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Defense Health Agency (formerly TRICARE Management Activity)
- Congressionally Mandated: No
- Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
- Release Date/Publication: January 01, 2016
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Citation: Jeffery DD, Mattiko M. Alcohol Use Among Active Duty Women: Analysis AUDIT Scores From the 2011 Health-Related Behavior Survey of Active Duty Military Personnel. Mil Med. 2016 Jan;181(1 Suppl):99-108.
Study
Abstract
To determine if Toxoplasma gondii IgG antibody prevalence is declining in HIV-infected persons, we analyzed data (1984-2013) from the US Military HIV Natural History Study. We found that T. gondii seroprevalence at enrollment was associated with age and decreased significantly after 1995 (P=0.004), similar to the general US population.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: January 01, 2016
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Citation: O'Bryan TA, Okulicz JF, Bradley WP, Ganesan A, Merritt SE, Agan BK. Toxoplasma gondii seroprevalence: 30-year trend in an HIV-infected US military cohort. Diagn Microbiol Infect Dis. 2016 Jan;84(1):34-5.
Study
Abstract
BACKGROUND:
Sudden cardiac death associated with physical exertion (SCD/E) is a complicated pathophysiological event. This study aims to calculate the incidence rate of SCD/E in the US military population from 2005 to 2010, to characterise the demographic and cardiovascular risk profiles of decedents, and to evaluate aetiologies of and circumstances surrounding the deaths.
METHODS:
Perimortem and other relevant data were collected from the Armed Forces Medical Examiners Tracking System, Armed Forces Health Longitudinal Technology Application, and Defense Medical Epidemiology Database for decedents meeting SCD/E case definition. Incidence rates were calculated and compared using negative binomial regression.
RESULTS:
The incidence of SCD/E in the Active Component (ie, full-time active duty) US military from 2005 to 2010 was 1.63 per 100 000 person-years (py): 0.98 and 3.84 per 100 000 py in those aged <35 and ≥35 years, respectively. Atherosclerotic cardiovascular disease was the leading cause of death overall (55%) and in the ≥35-year age group (78%), whereas the leading cause of death in the <35-year age group (31%) could not be precisely determined and was termed idiopathic SCD/E (iSCD/E). SCD/E was more common in males than females (incidence rate ratio (IRR) = 5.28, 95% CI 2.16 to 12.93) and more common in blacks than whites (IRR=2.60, 95% CI 1.81 to 3.72). All female cases were black.
CONCLUSIONS:
From 2005 to 2010, the incidence of SCD/E in US military members aged <35 years was similar to most reported corresponding civilian SCD rates. However, the leading cause of death was iSCD/E and not cardiomyopathy. Improved surveillance and age-based prevention strategies may reduce these rates.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: January 01, 2016
-
Citation: Smallman DP, Webber BJ, Mazuchowski EL, Scher AI, Jones SO, Cantrell JA. Sudden cardiac death associated with physical exertion in the US military, 2005-2010. Br J Sports Med. 2016 Jan;50(2):118-23.
Study
Abstract
IMPORTANCE:
The term golden hour was coined to encourage urgency of trauma care. In 2009, Secretary of Defense Robert M. Gates mandated prehospital helicopter transport of critically injured combat casualties in 60 minutes or less.
OBJECTIVES:
To compare morbidity and mortality outcomes for casualties before vs after the mandate and for those who underwent prehospital helicopter transport in 60 minutes or less vs more than 60 minutes.
DESIGN, SETTING, AND PARTICIPANTS:
A retrospective descriptive analysis of battlefield data examined 21 089 US military casualties that occurred during the Afghanistan conflict from September 11, 2001, to March 31, 2014. Analysis was conducted from September 1, 2014, to January 21, 2015.
MAIN OUTCOMES AND MEASURES:
Data for all casualties were analyzed according to whether they occurred before or after the mandate. Detailed data for those who underwent prehospital helicopter transport were analyzed according to whether they occurred before or after the mandate and whether they occurred in 60 minutes or less vs more than 60 minutes. Casualties with minor wounds were excluded. Mortality and morbidity outcomes and treatment capability-related variables were compared.
RESULTS:
For the total casualty population, the percentage killed in action (16.0% [386 of 2411] vs 9.9% [964 of 9755]; P < .001) and the case fatality rate ([CFR] 13.7 [469 of 3429] vs 7.6 [1344 of 17 660]; P < .001) were higher before vs after the mandate, while the percentage died of wounds (4.1% [83 of 2025] vs 4.3% [380 of 8791]; P = .71) remained unchanged. Decline in CFR after the mandate was associated with an increasing percentage of casualties transported in 60 minutes or less (regression coefficient, -0.141; P < .001), with projected vs actual CFR equating to 359 lives saved. Among 4542 casualties (mean injury severity score, 17.3; mortality, 10.1% [457 of 4542]) with detailed data, there was a decrease in median transport time after the mandate (90 min vs 43 min; P < .001) and an increase in missions achieving prehospital helicopter transport in 60 minutes or less (24.8% [181 of 731] vs 75.2% [2867 of 3811]; P < .001). When adjusted for injury severity score and time period, the percentage killed in action was lower for those critically injured who received a blood transfusion (6.8% [40 of 589] vs 51.0% [249 of 488]; P < .001) and were transported in 60 minutes or less (25.7% [205 of 799] vs 30.2% [84 of 278]; P < .01), while the percentage died of wounds was lower among those critically injured initially treated by combat support hospitals (9.1% [48 of 530] vs 15.7% [86 of 547]; P < .01). Acute morbidity was higher among those critically injured who were transported in 60 minutes or less (36.9% [295 of 799] vs 27.3% [76 of 278]; P < .01), those severely and critically injured initially treated at combat support hospitals (severely injured, 51.1% [161 of 315] vs 33.1% [104 of 314]; P < .001; and critically injured, 39.8% [211 of 530] vs 29.3% [160 of 547]; P < .001), and casualties who received a blood transfusion (50.2% [618 of 1231] vs 3.7% [121 of 3311]; P < .001), emphasizing the need for timely advanced treatment.
CONCLUSIONS AND RELEVANCE:
A mandate made in 2009 by Secretary of Defense Gates reduced the time between combat injury and receiving definitive care. Prehospital transport time and treatment capability are important factors for casualty survival on the battlefield.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: January 01, 2016
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Citation: Kotwal RS, Howard JT, Orman JA, Tarpey BW, Bailey JA, Champion HR, Mabry RL, Holcomb JB, Gross KR. The Effect of a Golden Hour Policy on the Morbidity and Mortality of Combat Casualties. JAMA Surg. 2016 Jan 1;151(1):15-24.
Study
Abstract
BACKGROUND:
Although interventions exist to reduce violent crime, optimal implementation requires accurate targeting. We report the results of an attempt to develop an actuarial model using machine learning methods to predict future violent crimes among US Army soldiers.
METHOD:
A consolidated administrative database for all 975 057 soldiers in the US Army in 2004-2009 was created in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Of these soldiers, 5771 committed a first founded major physical violent crime (murder-manslaughter, kidnapping, aggravated arson, aggravated assault, robbery) over that time period. Temporally prior administrative records measuring socio-demographic, Army career, criminal justice, medical/pharmacy, and contextual variables were used to build an actuarial model for these crimes separately among men and women using machine learning methods (cross-validated stepwise regression, random forests, penalized regressions). The model was then validated in an independent 2011-2013 sample.
RESULTS:
Key predictors were indicators of disadvantaged social/socioeconomic status, early career stage, prior crime, and mental disorder treatment. Area under the receiver-operating characteristic curve was 0.80-0.82 in 2004-2009 and 0.77 in the 2011-2013 validation sample. Of all administratively recorded crimes, 36.2-33.1% (male-female) were committed by the 5% of soldiers having the highest predicted risk in 2004-2009 and an even higher proportion (50.5%) in the 2011-2013 validation sample.
CONCLUSIONS:
Although these results suggest that the models could be used to target soldiers at high risk of violent crime perpetration for preventive interventions, final implementation decisions would require further validation and weighing of predicted effectiveness against intervention costs and competing risks.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: January 01, 2016
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Citation: Rosellini AJ, Monahan J, Street AE, Heeringa SG, Hill ED, Petukhova M. et.al., Predicting non-familial major physical violent crime perpetration in the US Army from administrative data. Psychol Med. 2016 Jan;46(2):303-16.
Study
Abstract
BACKGROUND:
The moderate level of protection conferred by influenza vaccines is well-known, but the vaccine's ability to attenuate symptom severity among vaccinated individuals (i.e., vaccine failures) has not been established.
METHODS:
We enrolled otherwise healthy adults who presented with influenza-like illness (ILI) at five US military hospitals between 2009 and 2014. Influenza was diagnosed and subtyped by PCR. Individual and composite severity scores were compared between those who had vs. had not received the seasonal influenza vaccine >14 days prior to enrollment.
RESULTS:
A total of 155 cases of influenza (A/H1N1, n=69; A/H3N2, n=66; A/untyped, n=3; B, n=17) were identified, of whom 111 (72%; A/H1N1, n=44; A/H3N2, n=52; A/untyped, n=3; B, n=12) had been vaccinated. Women were significantly less likely to be vaccinated than men (49% vs. 89%; p<0.01). In multivariate analysis, vaccinated individuals were significantly less likely to report a fever >101°F (OR 0.24; 95% CI [0.10, 0.62]) and more likely to report myalgias (OR 3.31; 95% CI [1.22, 8.97]) than vaccinated individuals. Among patients with A/H3N2 infection, upper respiratory and total symptom severity scores were significantly lower for vaccinated patients during the first 2 days of illness, and differences in total symptom severity persisted over 7 days (p<0.05 for all comparisons). Differences across additional symptom categories (lower respiratory and systemic) were also observed throughout 7 days of illness in bivariate analyses. Differences in symptom severity were not observed between vaccinated and unvaccinated participants with A/H1N1 infection.
CONCLUSIONS:
Among patients with A/H3N2 infection, receipt of seasonal influenza vaccine was associated with reduced symptom severity. Patient-centered discussion about the benefits of influenza vaccination should be expanded to include the possibility that the vaccine could attenuate symptoms.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences/Walter Reed National Military Medical Center
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: December 01, 2015
-
Citation: Deiss RG, Arnold JC, Chen WJ, Echols S, Fairchok MP, Schofield C, et.al., Vaccine-associated reduction in symptom severity among patients with influenza A/H3N2 disease. Vaccine. 2015 Dec 16;33(51):7160-7.
Study
Abstract
BACKGROUND:
The progression from hospitalization for a respiratory infection to requiring substantial supportive therapy is a key stage of the influenza severity pyramid. Respiratory infections are responsible for 300,000-400,000 medical encounters each year among US military personnel, some of which progress to severe acute respiratory infections.
METHODS:
We obtained data on 11,086 hospitalizations for pneumonia and influenza (P&I) among non-recruit US military service members during the period of 1 January 2000 through 31 December 2012. From these, we identified 512 P&I hospitalizations that progressed to severe episodes using standard case definitions. We evaluated the effect of demographic and occupational characteristics, co-morbid conditions, and history of influenza vaccination on the risk of a hospitalized P&I case becoming a severe case. We also evaluated the risk of a severe outcome and the length of time since influenza vaccination (within 180, 60, and 30 days).
RESULTS:
The median age of subjects at the time of the P&I episode was 32 years (range, 28-40) and subjects were predominantly male (89.5%). In a univariate analysis, demographic risk factors for a severe episode included service in the US Air Force (RR=1.6 relative to US Army, 95%CI 1.3-2.1), US Coast Guard (RR=2.1, 1.2-3.7) or US Navy (RR=1.4, 1.1-1.8). Being born in the US and recent influenza vaccination (within 180 days of episode) were protective against developing severe disease. Among co-morbid conditions, univariate risk factors for severe disease included chronic renal or liver disease (RR=4.98, 95%CI 4.1-6.1), diseases of the circulatory system (RR=3.1, 95%CI 2.6-3.7), diabetes mellitus (RR=2.3, 95%CI 1.5-3.6), obesity (RR=1.6, 95%CI 1.2-2.1), cancer (RR=1.6, 95%CI 1.3-2.0), and chronic obstructive pulmonary disease (RR=1.4, 95%CI 1.1-1.7). Although many of the risk factors found to be significant in univariate analysis were no longer significant under a multivariate analysis, receipt of any influenza vaccine within 180 days of episode remained protective (RR=0.81, 95%CI 0.67-0.99), while serving in the US Coast Guard (RR=1.9, 95%CI 1.1-3.4) or US Air Force (RR=1. 5, 95%CI 1.2-2.0), presence of renal or liver disease (RR=3.6, 95%CI 2.9-4.6), and diseases of the circulatory system (RR=2.2, 95%CI 1.8-2.8), remained significantly associated with a higher risk of developing severe disease.
CONCLUSIONS:
In a large cohort, after adjusting for many possible risk factors, influenza vaccination was protective against severe episodes among P&I hospitalizations. The service-specific (US Coast Guard or US Air Force) increased risk may represent some differences in data (e.g., coding or reporting practices) as opposed to genuine differences in physiological outcome. Our findings suggest that renal and liver disease as well as diseases of the circulatory system may contribute to influenza severity in this population independently of age and other potential comorbidities. These findings provide additional evidence for the prioritization of specific risk groups within the US military for influenza vaccination.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Armed Forces Health Surveillance Center
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: December 01, 2015
-
Citation: Van Kerkhove MD, Cooper MJ, Cost AA, Sanchez JL, Riley S. Risk factors for severe outcomes among members of the United States military hospitalized with pneumonia and influenza, 2000-2012. Vaccine. 2015 Dec 8;33(49):6970-6.
Study
Abstract
Combat operations in Iraq and Afghanistan have resulted in up to 8.8% of combat-related casualties suffering burns. From World War I through Desert Storm, burns have been associated with approximately 4% of the combat-related deaths. Experiencing a blast injury and exposure to killing and death while deployed has been shown to increase suicide risk. Although several studies of military populations have investigated risk factors for death among burn patients during the acute phase, no studies have reported mortality rates, cause-of-death, or the prevalence of suicide after hospital discharge. This study examined the case fatality rate, causes of death, and the prevalence of suicide among 830 combat burn patients discharged from the sole burn center in the U.S. Department of Defense, between March 7, 2003 and March 6, 2013. Cause-of-death was determined through the Armed Forces Medical Examiner's Office and the Office of the Secretary of Defense's National Death Index. A total of 11 deaths occurred among the 830 burn survivors, for an overall case fatality rate of 1.3%. Of the 11 who died, five deaths were related to accidental poisoning by exposure to drugs; three were related to operations of war (two after returning to the war zone), and the remaining three died from other accidental causes (one explosion and two vehicle crashes). There was no indication of suicide or suspicion of suicide as a cause-of-death for the former patients included in this study, suggesting that combat burn injury did not appear to increase the risk of death by suicide in our study population. Further research is needed to understand the factors that contribute to the apparent resilience of combat burn survivors.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: December 01, 2015
-
Citation: Escolas SM, Archuleta DJ, Orman JA, Chung KK, Renz EM. Postdischarge Cause-of-Death Analysis of Combat-Related Burn Patients. J Burn Care Res. 2015 Dec 1.
Study
Abstract
OBJECTIVES:
Unintended pregnancy among active-duty women in the United States military, 2011.
STUDY DESIGN:
Cross-sectional data came from the 2011 Department of Defense Health Related Behaviors Survey of Active Duty Military Personnel; 9038 women provided data on unintended pregnancy. Unintended pregnancy rates were calculated for all women and by available background characteristics, including military branch, marital status (married versus unmarried), pay grade (enlisted versus officer) and deployment in the previous 12months. Multivariable logistic regression testing for associations between unintended pregnancy and subgroups was also performed.
RESULTS:
The unintended pregnancy rate was 72/1000 women. Married women (odds ratio (OR) 1.30, 95% confidence interval (CI) 1.11-1.54) and enlisted women (OR 2.71, 95% CI 1.99-3.69) had higher odds of reporting unintended pregnancy compared to their counterparts, as did women in the Navy (OR 1.51, 95% CI 1.19-1.91) and Marine Corps (OR 2.38, 95% CI 1.92-2.95) compared to women in the Air Force. Unintended pregnancy rates did not differ between women who were deployed in the previous 12months and nondeployed women. Additionally, 10% of women who were deployed for 11-12months in 2011 reported an unintended pregnancy in the previous year, suggesting that their pregnancies occurred during deployment.
CONCLUSION:
Unintended pregnancy is higher in the military, including during deployment, compared to the general U.S. population (52/1000 women). All branches need to address the issue in a comprehensive manner including evidence-based provision of contraception and education among servicemembers.
IMPLICATIONS:
Unintended pregnancy is high in the military, including during deployment; further efforts to improve evidence-based provision of contraception and education are needed.
- Publication Status: Published
- Sponsoring Organization: Undetermined
- Sponsoring Office:
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: December 01, 2015
-
Citation: Grindlay K, Grossman D. Unintended pregnancy among active-duty women in the United States military, 2011. Contraception. 2015 Dec;92(6):589-95.
Study
Abstract
INTRODUCTION:
Accurate prognosis assessment after non-small-cell lung cancer (NSCLC) diagnosis is an essential step for making effective clinical decisions. This study is aimed to develop a prediction model with routinely available variables to assess prognosis in patients with NSCLC in the U.S. Military Health System.
METHODS:
We used the linked database from the Department of Defense's Central Cancer Registry and the Military Health System Data Repository. The data set was randomly and equally split into a training set to guide model development and a testing set to validate the model prediction. Stepwise Cox regression was used to identify predictors of survival. Model performance was assessed by calculating area under the receiver operating curves and construction of calibration plots. A simple risk scoring system was developed to aid quick risk score calculation and risk estimation for NSCLC clinical management.
RESULTS:
The study subjects were 5054 patients diagnosed with NSCLC between 1998 and 2007. Age, sex, tobacco use, tumor stage, histology, surgery, chemotherapy, peripheral vascular disease, cerebrovascular disease, and diabetes mellitus were identified as significant predictors of survival. Calibration showed high agreement between predicted and observed event rates. The area under the receiver operating curves reached 0.841, 0.849, 0.848, and 0.838 during 1, 2, 3, and 5 years, respectively.
CONCLUSIONS:
This is the first NSCLC prognosis model for quick risk assessment within the Military Health System. After external validation, the model can be translated into clinical use both as a web-based tool and through mobile applications easily accessible to physicians, patients, and researchers.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Walter Reed National Military Medical Center/Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: December 01, 2015
-
Citation: Lin J, Carter CA, McGlynn KA, Zahm SH, Nations JA, Anderson WF, Shriver CD, Zhu K. A Prognostic Model to Predict Mortality among Non-Small-Cell Lung Cancer Patients in the U.S. Military Health System. J Thorac Oncol. 2015 Dec;10(12):1694-702.
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