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Diagnostic Utility of the Posttraumatic Stress Disorder (PTSD) Checklist for Identifying Full and Partial PTSD in Active-Duty Military.

Study

Abstract

The aim of this study was to determine optimally efficient cutoff scores on the Posttraumatic Stress Disorder Checklist (PCL) for identifying full posttraumatic stress disorder (PTSD) and partial PTSD (P-PTSD) in active-duty Marines and Sailors. Participants were 1,016 Marines and Sailors who were administered the PCL and Clinician-Administered PTSD Scale (CAPS) 3 months after returning from Operations Iraqi and Enduring Freedom. PCL cutoffs were tested against three CAPS-based classifications: full PTSD, stringent P-PTSD, and lenient P-PTSD. A PCL score of 39 was found to be optimally efficient for identifying full PTSD. Scores of 38 and 33 were found to be optimally efficient for identifying stringent and lenient P-PTSD, respectively. Findings suggest that the PCL cutoff that is optimally efficient for detecting PTSD in active-duty Marines and Sailors is substantially lower than the score of 50 commonly used by researchers. In addition, findings provide scores useful for identifying P-PTSD in returning service members.

  • 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: September 01, 2014
  • Citation: Dickstein BD, Weathers FW, Angkaw AC, Nievergelt CM, Yurgil K, Nash WP, et.al. . Diagnostic Utility of the Posttraumatic Stress Disorder (PTSD) Checklist for Identifying Full and Partial PTSD in Active-Duty Military. Assessment. 2014 Sep 1.

A Brief Description of the Operation of the DoD Serum Repository.

Study

Abstract

Beginning in 1985, the United States military has consistently maintained repositories of frozen human serum for force health protection reasons. The separate repositories created by the Army, Navy, and Air Force during the startup of their human immunodeficiency virus (HIV) screening programs were fully combined by 1996, along with the Defense Medical Surveillance System, to form the DoD Serum Repository (DoDSR). Currently comprised of 450,000 square feet of storage space at a constant -30 degrees Celsius, the DoDSR, operated by the Armed Forces Health Surveillance Center (AFHSC), receives approximately 2 million new serum specimens per year as a result of current HIV screening programs and pre- and post-deployment serum collection. Following initial testing for HIV when required, each specimen remains frozen until needed for clinical testing or a public health study, and its physical location is carefully tracked. Certain militarily-relevant research studies occur, though the serum from a specific individual is never allowed to be fully exhausted. AFHSC maintains careful control over the repository, utilizing a scientific review board to determine which requests for serum will be granted. As of 2012, only 0.42% of all of the frozen specimens in the DoDSR had been thawed for any type of use. The addition of new specimen processing capacity and significant changes to policy would be required if more of the specimens were to be used to answer relevant epidemiological, operational, or medical research questions.

  • 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: October 01, 2015
  • Citation: Perdue CL, Eick-Cost AA, Rubertone MV. A Brief Description of the Operation of the DoD Serum Repository. Mil Med. 2015 Oct;180(10 Suppl):10-2.

Incidence, Etiology and Risk Factors for Travelers' Diarrhea during a Hospital Ship-Based Military Humanitarian Mission: Continuing Promise 2011.

Study

Abstract

Travelers' diarrhea (TD) is the most common ailment affecting travelers, including deployed U.S. military. Continuing Promise 2011 was a 5-month humanitarian assistance/disaster response (HA/DR) military and non-governmental organization training mission aboard the hospital ship USNS Comfort, which deployed to Central and South America and the Caribbean between April and September 2011. Enhanced TD surveillance was undertaken during this mission for public health purposes. Passive surveillance (clinic visits), active surveillance (self-reported questionnaires), and stool samples were collected weekly from shipboard personnel. Descriptive statistics and multivariate-logistic regression methods were used to estimate disease burden and risk factor identification. Two polymerase chain reaction methods on frozen stool were used for microbiological identification. TD was the primary complaint for all clinic visits (20%) and the leading cause of lost duties days due to bed rest confinement (62%), though underreported, as the active self-reported incidence was 3.5 times higher than the passive clinic-reported incidence. Vomiting (p = 0.002), feeling lightheaded or weak (p = 0.005), and being a food handler (p = 0.017) were associated with increased odds of lost duty days. Thirty-eight percent of self-reported cases reported some amount of performance impact. Based on the epidemiological curve, country of exercise and liberty appeared to be temporally associated with increased risk. From the weekly self-reported questionnaire risk factor analysis, eating off ship in the prior week was strongly associated (adjusted odds ratio [OR] 2.4, p<0.001). Consumption of seafood increased risk (aOR 1.7, p = 0.03), though consumption of ice appeared protective (aOR 0.3, p = 0.01). Etiology was bacterial (48%), with enterotoxigenic Escherichia coli as the predominant pathogen (35%). Norovirus was identified as a sole pathogen in 12%, though found as a copathogen in an additional 6%. Despite employment of current and targeted preventive interventions, ship-board HA/DR missions may experience a significant risk for TD among deployed US military personnel and potentially impact mission success.

  • 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: May 01, 2016
  • Citation: Hameed JM, et. al., Incidence, Etiology and Risk Factors for Travelers' Diarrhea during a Hospital Ship-Based Military Humanitarian Mission: Continuing Promise 2011. PLoS One. 2016 May 12;11(5):e0154830.

Low back pain, active component, U.S. Armed Forces, 2010-2014.

Study

Abstract

Low back pain (LBP) is a common cause of disability, lost worker productivity, and healthcare costs in both military and civilian populations. During the 5-year surveillance period of this analysis, the LBP diagnoses of interest were associated with more than 6 million outpatient healthcare encounters and more than 25,000 hospitalizations among active component service members. Annual numbers of outpatient encounters for LBP diagnoses increased 34% during 2010-2014. Annual numbers of inpatient encounters decreased during the period. Incidence rates were lowest among the youngest service members and increased with advancing age. Of all service members ever given a LBP diagnosis during the surveillance period, 91% were diagnosed at least once with a condition in the broad category "nonspecific back pain." The most common specific diagnosis during the surveillance period was lumbago. The discussion covers the importance of LBP in the military, initiatives to lower the incidence of, and enhance the care of, LBP, and methodologic limitations to the analysis.

  • 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: November 01, 2015
  • Citation: AFHSC. Clark LL, Hu Z. Low back pain, active component, U.S. Armed Forces, 2010-2014. MSMR. 2015 Dec;22(12):8-11.

PREVALENCE AND CORRELATES OF SUICIDAL BEHAVIOR AMONG NEW SOLDIERS IN THE U.S. ARMY: RESULTS FROM THE ARMY STUDY TO ASSESS RISK AND RESILIENCE IN SERVICEMEMBERS (ARMY STARRS).

Study

Abstract

BACKGROUND: The prevalence of suicide among U.S. Army soldiers has risen dramatically in recent years. Prior studies suggest that most soldiers with suicidal behaviors (i.e., ideation, plans, and attempts) had first onsets prior to enlistment. However, those data are based on retrospective self-reports of soldiers later in their Army careers. Unbiased examination of this issue requires investigation of suicidality among new soldiers. METHOD: The New Soldier Study (NSS) of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) used fully structured self-administered measures to estimate preenlistment histories of suicide ideation, plans, and attempts among new soldiers reporting for Basic Combat Training in 2011-2012. Survival models examined sociodemographic correlates of each suicidal outcome. RESULTS: Lifetime prevalence estimates of preenlistment suicide ideation, plans, and attempts were 14.1, 2.3, and 1.9%, respectively. Most reported onsets of suicide plans and attempts (73.3-81.5%) occurred within the first year after onset of ideation. Odds of these lifetime suicidal behaviors among new soldiers were positively, but weakly associated with being female, unmarried, religion other than Protestant or Catholic, and a race/ethnicity other than non-Hispanic White, non-Hispanic Black, or Hispanic. CONCLUSIONS: Lifetime prevalence estimates of suicidal behaviors among new soldiers are consistent with retrospective reports of preenlistment prevalence obtained from soldiers later in their Army careers. Given that prior suicidal behaviors are among the strongest predictors of later suicides, consideration should be given to developing methods of obtaining valid reports of preenlistment suicidality from new soldiers to facilitate targeting of preventive interventions.

  • 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: November 01, 2014
  • Citation: Ursano RJ, et. al.,Prevalence and Correlates of Suicidal Behavior Among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Service Members (ARMY STARRS). Depress Anxiety. 2014 Oct

Women in Combat: Framing the Issues of Health and Health Research for America's Servicewomen.

Study

Abstract

BACKGROUND: Although women have served in the U.S. military officially since 1901, the medical needs of women in combat have historically been poorly understood. Recent expansion of the opportunities females may now play in combat roles has created an urgent need for a review of how Department of Defense supports females as they transition into these new roles, as well as current science related to key aspects of the health of female warriors. There is currently no systematic institutional structure in place to regularly and methodically examine gaps in policy, research, and treatment for issues related to women in combat. METHOD: This article serves as a brief overview and introduction to some of the critical topics related to the health of women in combat roles, to include women's health issues research and treatment efforts, physiological differences between sexes, and leadership and unit factors. CONCLUSION: The Department of Defense should continue to explore and address policy, research, and practice related to the complex ongoing needs of military females in combat roles, and ensures sufficient staffing, resources and support from senior military leaders.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: January 01, 2015
  • Citation: Moosey M. Communicating Difficult and Taboo Information: A How-To Guide for Commanders. Mil Med. 2016 Jan;181(1 Suppl):40-3.

Women and exertional heat illness: identification of gender specific risk factors.

Study

Abstract

OBJECTIVE: With the expanding role of women into previously closed combat military occupational specialties, women will likely be exposed more to challenging and extreme conditions. Physical work or exercise in extreme environments could increase the risk for exertional heat illness (EHI) and exertional heat stroke (EHS), the most severe type of EHI. Although men have higher rates of EHS than women, women have slightly higher rates of other EHI. Women may respond differently to exertion in the heat than men, as they typically have higher percentage of body fat (BF%) and lower aerobic power. Further, published pilot-data using the Israeli heat tolerance test (HTT) indicate that women are more likely to be classified as heat intolerant than men. The objectives of the present study were to (1) compare male and female classification patterns of heat tolerance, and (2) identify EHI risk factors that might account for the relationship between heat tolerance classification and sex. METHODS: Fifty-five male and 20 female participants were recruited from military and university communities to participate in a standardized HTT. Subjects underwent measures to calculate anthropometric variables (BF%, body surface area, and waist circumference), a maximal oxygen uptake test to assess aerobic power (VO₂max), and a standardized HTT, which consisted of treadmill walking at 5 km/h at a 2% grade for 120 minutes at 40°C and 40% relative humidity. Heat intolerance was defined as attaining a maximum heart rate (HR) greater than 150 bpm or a core body temperature (Tc) more than 38.5°C. Separate hierarchical regressions were conducted using categorical (heat tolerant/intolerant) and continuous (physiological strain index, maximum HR, Tc) HTT outcomes. Risk factors were identified with and without controlling for sex. RESULTS: Women were 3.7 (95% CI, 1.21-11.24) times more likely to be heat intolerant than men (χ²=6.85, P<.01). Compared to men, women had significantly higher BF% and lower body surface area, waist circumference, and VO₂max. All heat intolerant participants had lower VO₂max and higher BF% than those who were classified as heat tolerant. When VO₂max and BF% were entered into regression equations to predict HTT outcomes, sex became nonsignificant; VO₂max predicted maximum HR and physiological strain index after controlling for sex. CONCLUSION: The present study found that differences between men and women in heat tolerance classification are largely explained by VO₂max. The higher rates of heat intolerance among women likely correlate with higher EHI risk, and underscore the need to understand the physiological and thermoregulatory differences between men and women. As lower aerobic power is a major risk factor for EHI, maximizing the aerobic power of women will be critical to force health protection and readiness as they integrate into combat military occupational specialties.

  • 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: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: April 01, 2015
  • Citation: Kazman JB, Purvis DL, Heled Y, Lisman P, Atias D, Van Arsdale S, Deuster PA. Women and exertional heat illness: identification of gender specific risk factors. US Army Med Dep J. 2015 Apr-Jun:58-66.

Willingness to receive a hypothetical avian influenza vaccine among US military personnel in mid-deployment.

Study

Abstract

Though no avian influenza vaccine currently exists, development efforts have increased. Given recent reports of suboptimal vaccination rates among US military personnel, we sought to assess factors associated with a willingness to receive a hypothetical avian influenza vaccine. A self-administered questionnaire was completed by US military personnel during mid-deployment to Iraq, Afghanistan, and surrounding regions. Respondents were predominately male (86.2%), Army (72.1%), and enlisted (86.3%) with a mean age of 29.6 y. The majority (77.1%) agreed to receive an avian influenza vaccine if available. Exploratory factor analysis (EFA) identified two factors, vaccine importance and disease risk, that best described the individual perceptions and both were associated with an increased willingness to receive the hypothetical vaccine (OR: 8.2 and 1.6, respectively). Importantly, after controlling for these factors differences in the willingness to receive this hypothetical vaccine were observed across gender and branch of service. These results indicated that targeted education on vaccine safety and efficacy as well as disease risk may modify vaccination patterns in this 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: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
  • Release Date/Publication: December 01, 2013
  • Citation: Porter CK, Fitamaurice G, Tribble DR, Armstrong AW, Mostafa M, Riddle MS. Willingness to receive a hypothetical avian influenza vaccine among US military personnel in mid-deployment. Hum Vaccin Immunother. 2013 Dec;9(12):2613-7.

When, If Ever, Should Military Physicians Violate a Military Order to Give Medical Obligations Higher Priority?

Study

Abstract

Military care providers may face ethical conflicts when they must treat their own and enemy soldiers during combat and their resources are limited. Legally under the Geneva Convention, they are instructed to treat enemy soldiers equally, but in practice, providers still have some discretion. This article discusses this discretion and ethical frameworks and uncertainties that bear on these decisions. A case is presented in which this conflict arose. How the provider resolved this is reported.

  • 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: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: November 01, 2015
  • Citation: Howe EG. When, If Ever, Should Military Physicians Violate a Military Order to Give Medical Obligations Higher Priority? Mil Med. 2015 Nov;180(11):1118-9. ;180(11):1121-3.

Variation in rates of autoimmune thyroid disease by race/ethnicity in US military personnel.

Study

Abstract

The relationship between Graves disease and race/ethnicity is undefined. Based on thyroid antibody prevalence, the rates of Hashimoto thyroiditis may be highest in whites and lowest in blacks. Using a large and comprehensive data set of medical diagnoses for all US active duty service personnel, we calculated age-standardized incidence rates for Graves disease and Hashimoto thyroiditis by race/ethnicity. Compared with whites, the IRR for Graves disease was significantly elevated in black women (IRR, 1.92; 95% CI, 1.56-2.37) and men (IRR, 2.53; 95% CI, 2.01-3.18) and Asian/Pacific Islander women (IRR, 1.78; 95% CI, 1.20-2.66) and men (IRR, 3.36; 95% CI, 2.57-4.40) (Figure). In contrast, Hashimoto thyroiditis incidence was highest in whites and lowest in black women (IRR, 0.33; 95% CI, 0.21-0.51) and men (IRR, 0.22; 95% CI, 0.11-0.47) and Asian/Pacific Islander women (IRR, 0.31; 95% CI, 0.17-0.56) and men (IRR, 0.23; 95% CI, 0.07-0.72). The differences in incidence by race/ethnicity may be due to different environmental exposures, genetics, or a combination of both. Our results are not easily attributable to the strongest known environmental risk factor, cigarette smoking.

  • Publication Status: Published
  • Sponsoring Organization: Undetermined
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Government, academic, or industry source other than Federal Government
  • Release Date/Publication: April 01, 2014
  • Citation: McLeod DS, Caturegli P, Cooper DS, Matos PG, Hutfless S. Variation in rates of autoimmune thyroid disease by race/ethnicity in US military personnel. JAMA. 2014 Apr 16;311(15):1563-5.

Vaccine-associated reduction in symptom severity among patients with influenza A/H3N2 disease.

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.

VA Vascular Injury Study (VAVIS): VA-DoD extremity injury outcomes collaboration.

Study

Abstract

BACKGROUND: Limb injuries comprise 50-60% of U.S. Service member's casualties of wars in Afghanistan and Iraq. Combat-related vascular injuries are present in 12% of this cohort, a rate 5 times higher than in prior wars. Improvements in medical and surgical trauma care, including initial in-theatre limb salvage approaches (IILS) have resulted in improved survival and fewer amputations, however, the long-term outcomes such as morbidity, functional decline, and risk for late amputation of salvaged limbs using current process of care have not been studied. The long-term care of these injured warfighters poses a significant challenge to the Department of Defense (DoD) and Department of Veterans Affairs (VA). METHODS/DESIGN: The VA Vascular Injury Study (VAVIS): VA-DoD Extremity Injury Outcomes Collaborative, funded by the VA, Health Services Research and Development Service, is a longitudinal cohort study of Veterans with vascular extremity injuries. Enrollment will begin April, 2015 and continue for 3 years. Individuals with a validated extremity vascular injury in the Department of Defense Trauma Registry will be contacted and will complete a set of validated demographic, social, behavioral, and functional status measures during interview and online/ mailed survey. Primary outcome measures will: 1) Compare injury, demographic and geospatial characteristics of patients with IILS and identify late vascular surgery related limb complications and health care utilization in Veterans receiving VA vs. non-VA care, 2) Characterize the preventive services received by individuals with vascular repair and related outcomes, and 3) Describe patient-reported functional outcomes in Veterans with traumatic vascular limb injuries. DISCUSSION: This study will provide key information about the current process of care for Active Duty Service members and Veterans with polytrauma/vascular injuries at risk for persistent morbidity and late amputation. The results of this study will be the first step for clinicians in VA and military settings to generate evidence-based treatment and care approaches to these injuries. It will identify areas where rehabilitation medicine and vascular specialty care or telehealth options are needed to allow for better planning, resource utilization, and improved DoD-to-VA care transitions.

  • 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: Government, academic, or industry source other than Federal Government
  • Release Date/Publication: February 01, 2015
  • Citation: Shireman PK, Rasmussen TE, Jaramillo CA, Pugh MJ. VA Vascular Injury Study (VAVIS): VA-DoD extremity injury outcomes collaboration. BMC Surg. 2015 Feb 3;15:13. doi: 10.1186/1471-2482-15-13.

Utilization of telemedicine in the U.S. military in a deployed setting.

Study

Abstract

BACKGROUND: A retrospective evaluation of the Department of Defense teledermatology consultation program from 2004 to 2012 was performed, focusing on clinical application and outcome measures such as consult volume, response time, and medical evacuation status. METHODS: A retrospective review of the teledermatology program between 2004 and 2012 was evaluated based on defined outcome measures. In addition, 658 teledermatology cases were reviewed to assess how the program was utilized by health care providers from 2011 to 2012. RESULTS: As high as 98% of the teledermatology consults were answered within 24 hours, and 23% of consults within 1 hour. The most common final diagnoses included eczematous dermatitis, contact dermatitis, and evaluation for nonmelanoma skin cancer. The most common medications recommended included topical corticosteroids, oral antibiotics, antihistamines, and emollients. Biopsy was most commonly recommended for further evaluation. Following teleconsultation, 46 dermatologic evacuations were "avoided" as the patient was not evacuated based on the consultants' recommendation. Consultants' recommendations to the referring provider "facilitated" 41 evacuations. CONCLUSION: Telemedicine in the U.S. military has provided valuable dermatology support to providers in remote locations by delivering appropriate and timely consultation for military service members and coalition partners. In addition to avoiding unnecessary medical evacuations, the program facilitated appropriate evacuations that may otherwise have been delayed.

  • Publication Status: Published
  • Sponsoring Organization: Army
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Army
  • Release Date/Publication: November 01, 2014
  • Citation: Hwang JS, Lappan CM, Sperling LC, Meyerle JH. Utilization of telemedicine in the U.S. military in a deployed setting. Mil Med. 2014 Nov;179(11):1347-53.

Using base rates of low scores to interpret the ANAM4 TBI-MIL battery following mild traumatic brain injury.

Study

Abstract

Base rates of low ANAM4 TBI-MIL scores were calculated in a convenience sample of 733 healthy male active duty soldiers using available military reference values for the following cutoffs: ≤2nd percentile (2 SDs), ≤5th percentile, <10th percentile, and <16th percentile (1 SD). Rates of low scores were also calculated in 56 active duty male soldiers who sustained an mTBI an average of 23 days (SD = 36.1) prior. 22.0% of the healthy sample and 51.8% of the mTBI sample had two or more scores below 1 SD (i.e., 16th percentile). 18.8% of the healthy sample and 44.6% of the mTBI sample had one or more scores ≤5th percentile. Rates of low scores in the healthy sample were influenced by cutoffs and race/ethnicity. Importantly, some healthy soldiers obtain at least one low score on ANAM4. These base rate analyses can improve the methodology for interpreting ANAM4 performance in clinical practice and research.

  • 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: February 01, 2015
  • Citation: Ivins BJ, Lange RT, Cole WR, Kane R, Schwab KA, Iverson GL. Using base rates of low scores to interpret the ANAM4 TBI-MIL battery following mild traumatic brain injury. Arch Clin Neuropsychol. 2015 Feb;30(1):26-38.

Use and Abuse of Prescribed Opioids, Central Nervous System Depressants, and Stimulants Among U.S. Active Duty Military Personnel in FY 2010

Study

Abstract

OBJECTIVES: This study establishes rates of use/abuse of Schedule II-IV prescription medications in U.S. active duty military personnel, and characterizes correlates of such use/abuse. METHODS: All active duty personnel serving for 12 months during fiscal year 2010 were included. Data were obtained from medical and pharmacy claims and drug screening results. Logistic regression models were used to examine predictors of drug use, along with bivariate analyses to compare abuse of prescribed and illegal drugs. RESULTS: Nearly one-third of active duty service members received at least one prescription for opioids, central nervous system depressants, or stimulants, with 26.4% having received at least one prescription for opioids. About 0.7%, 1.4%, and 0.6% of the total force received >90-day prescriptions for opioids, central nervous system depressants, or stimulants, respectively. Battlefield injury, receipt of psychotropic medications, and substance abuse adverse events were predictive of >90-day supply of opioids. About 0.7% of the total force had documented known drug abuse for prescribed drugs compared to 0.4% for illegal drug abuse. CONCLUSIONS: We recommend systematic monitoring of prescriptions for controlled substances which may carry serious consequences, evaluation of the impact of controlled substances on military readiness, and examination of the rationale for prescribing controlled drugs.

  • 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: Undetermined
  • Release Date/Publication: October 01, 2014
  • Citation: Jeffery DD, May L, Luckey B, Balison BM, Klette KL. Use and Abuse of Prescribed Opioids, Central Nervous System Depressants, and Stimulants Among U.S. Active Duty Military Personnel in FY 2010. Mil Med. 2014 Oct;179(10):1141-8
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