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Studies

Welcome to the Military Health System Studies Inventory Tool (MSIT). Military Health System (MHS) data are used by Department of Defense, Veterans Administration, and academic health professionals and scientists to implement health care studies. These studies reflect the MHS interest to rigorously assess and improve our beneficiaries’ access to the high quality health care services they need. Additionally, these studies are frequently used to develop or improve MHS policy and often adopt useful, relevant comparisons to the national health care experience.

The MSIT allows easy review of recent studies that are either conducted or sponsored by the MHS, or accomplished using datasets developed or maintained by the Defense Health Agency for administrative, operational, or research purposes. The studies within this website represent important contributions of the MHS to the national health care dialogue and reflect our capacity to tackle the challenging issues needed to support evidence-informed health policy. Thank you for your interest in them.

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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.

Epidemiology of Clostridium difficile infection among active duty United States military personnel (1998-2010).

Study

Abstract

BACKGROUND: Clostridium difficile associated disease (CDAD) has risen in incidence and the experience in the US military has not been described. METHODS: We evaluated the U.S. military's database and identified CDAD cases and demographic characteristics among affected military personnel from 1998 to 2010. RESULTS: 2,423 cases were identified. CDAD incidence was 13.2 cases (95% CI: 12.7-13.7) per 100 K p-yr and increased over study years. CA-CDAD and HA-CDAD incidence was 5.5 (95% CI: 5.2, 5.9) per 100 K p-y and 1.3 (95% CI: 1.2, 1.4) per 1,000 hospitalizations respectively. Females comprised a larger proportion of CA-CDAD than HA-CDAD (25.5% vs. 19.3%; p < 0.001) cases as did Air Force service (29% vs. 23.4%; p < 0.01). On multivariate analysis female gender, Coast Guard or Air Force service, and a married status was associated with CA-CDAD whereas Male gender and Marine Corps service were associated with HA-CDAD cases. CONCLUSIONS: CDAD has increased among military personnel, with female cases more likely to be community associated. Gender, marital status and branch of service had the strongest association with CDAD subtype. Further work is needed to evaluate the epidemiologic factors that have led to these increased rates in otherwise low-risk populations and associated sequelae.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences/Armed Forces Health Surveillance Center
  • 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: Gutiérrez RL, Riddle MS, Porter CK. Epidemiology of Clostridium difficile infection among active duty United States military personnel (1998-2010). BMC Infect Dis. 2013 Dec 28;13:609.

Combining surveillance systems: effective merging of U.S. Veteran and military health data.

Study

Abstract

BACKGROUND: The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) had more than 18 million healthcare beneficiaries in 2011. Both Departments conduct individual surveillance for disease events and health threats. METHODS: We performed joint and separate analyses of VA and DoD outpatient visit data from October 2006 through September 2010 to demonstrate geographic and demographic coverage, timeliness of influenza epidemic awareness, and impact on spatial cluster detection achieved from a joint VA and DoD biosurveillance platform. RESULTS: Although VA coverage is greater, DoD visit volume is comparable or greater. Detection of outbreaks was better in DoD data for 58% and 75% of geographic areas surveyed for seasonal and pandemic influenza, respectively, and better in VA data for 34% and 15%. The VA system tended to alert earlier with a typical H3N2 seasonal influenza affecting older patients, and the DoD performed better during the H1N1 pandemic which affected younger patients more than normal influenza seasons. Retrospective analysis of known outbreaks demonstrated clustering evidence found in separate DoD and VA runs, which persisted with combined data sets. CONCLUSION: The analyses demonstrate two complementary surveillance systems with evident benefits for the national health picture. Relative timeliness of reporting could be improved in 92% of geographic areas with access to both systems, and more information provided in areas where only one type of facility exists. Combining DoD and VA data enhances geographic cluster detection capability without loss of sensitivity to events isolated in either population and has a manageable effect on customary alert rates.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Armed Forces Health Surveillance Center
  • 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: Pavlin JA, Burkom HS, Elbert Y, Lucero-Obusan C, Winston CA, Cox KL, Oda G, Lombardo JS, Holodniy M. Combining surveillance systems: effective merging of U.S. Veteran and military health data. PLoS One. 2013 Dec 26;8(12):e84077.

A case-control study of incident rheumatological conditions following acute gastroenteritis during military deployment.

Study

Abstract

OBJECTIVES: The aim of this study was to assess the risk of incident rheumatological diagnoses (RD) associated with self-reported diarrhoea and vomiting during a first-time deployment to Iraq or Afghanistan. Such an association would provide evidence that RD in this population may include individuals with reactive arthritis (ReA) from deployment-related infectious gastroenteritis. DESIGN: This case-control epidemiological study used univariate and multivariate logistic regression to compare the odds of self-reported diarrhoea/vomiting among deployed US military personnel with incident RD to the odds of diarrhoea/vomiting among a control population. SETTING: We analysed health records of personnel deployed to Iraq or Afghanistan, including responses on a postdeployment health assessment and medical follow-up postdeployment. PARTICIPANTS: Anonymous data were obtained from 891 US military personnel with at least 6 months of medical follow-up following a first-time deployment to Iraq or Afghanistan in 2008-2009. Cases were defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes; controls had an unrelated medical encounter and were representative of the study population. MAIN OUTCOME MEASURES: The primary measure was an association between incident RD and self-reported diarrhoea/vomiting during deployment. A secondary measure was the overall incidence of RD in this population. RESULTS: We identified 98 cases of new onset RD, with a total incidence of 161/100 000 persons. Of those, two participants had been diagnosed with Reiter's disease (i) (3.3/100 000 persons) and the remainder with non-specific arthritis/arthralgia (157.5/100 000 persons). The OR for acute diarrhoea was 2.67 (p=0.03) after adjusting for important covariates. CONCLUSIONS: Incident rheumatological conditions, even those classified as 'non-specific,' are significantly associated with prior severe diarrhoea in previously deployed military personnel, potentially indicating ReA and need for preventive measures to reduce diarrhoeagenic bacterial exposures in military personnel and other travellers to the developing regions.

  • Publication Status: Published
  • Sponsoring Organization: Navy
  • Sponsoring Office:
  • 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: Deyoung KH, Riddle MS, May L, Porter CK. A case-control study of incident rheumatological conditions following acute gastroenteritis during military deployment. BMJ Open. 2013 Dec 5;3(12):e003801.

The association of predeployment and deployment-related factors on dimensions of postdeployment wellness in U.S. military service members.

Study

Abstract

PURPOSE: To assess the effects of predeployment and deployment-related factors on dimensions of wellness following deployment. DESIGN: Prospective longitudinal study. The dependent variable was dimensions of wellness. Independent variables were measured in terms of modifiable, nonmodifiable, and military factors, such as sex, race/ethnicity, service branch, smoking status, and combat experience. SETTING: A large military cohort participating in the Millennium Cohort Study. SUBJECTS: Included 10,228 participants who deployed in support of the operations in Iraq and Afghanistan. MEASURES: Dimensions of wellness were measured by using standardized instruments assessing self-reported physical health, mental health, and stress. Covariates were measured by using self-reported and electronic data. ANALYSIS: Factors of postdeployment wellness were assessed by using ordinal logistic regression. RESULTS: Most participants (78.7%) were categorized as "moderately well" post deployment. Significant modifiable predeployment predictors of postdeployment wellness included normal/underweight body mass index (odds ratio [OR] = 1.72, p < .05). Military factors significantly associated with wellness included not experiencing combat (OR = .56, p < .05), member of Air Force (OR = 2.02, p < .05) or Navy/Coast Guard (OR = 1.47, p < .05), and combat specialist occupation (OR = 1.22, p < .05). CONCLUSION: Multiple modifiable factors associated with postdeployment wellness were identified, which may help inform medical and military leadership on potential strategies to ensure a well force. Those trained in combat roles were more likely to be well post deployment though this apparent benefit was not conferred onto those reporting combat experiences.

  • Publication Status: Published
  • Sponsoring Organization: Navy
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: November 01, 2013
  • Citation: Bagnell ME, LeardMann CA, McMaster HS, Boyko EJ, et. al. The association of predeployment and deployment-related factors on dimensions of postdeployment wellness in U.S. military service members. Am J Health Promot. 2013 Nov-Dec;28(2):e56-66.

Delayed presentations of popliteal artery entrapment syndrome in a middle-aged military population.

Study

Abstract

Popliteal artery entrapment syndrome (PAES) is a rare but significant cause of disability usually diagnosed in young, healthy adults. Advancements in diagnostic imaging modalities have prompted a current report of our recent experience with PAES in a middle-aged military population at the Walter Reed National Military Medical Center. The addition of computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) permit accurate and facile diagnosis of this complex syndrome.

  • 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: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: November 01, 2013
  • Citation: Radowsky J, Patel B, Fox CJ. Delayed presentations of popliteal artery entrapment syndrome in a middle-aged military population. Ann Vasc Surg. 2013 Nov;27(8):1184.e1-6.

Syncope among U.S. Air Force basic military trainees, August 2012-July 2013.

Study

Abstract

Syncope is a common event with many possible etiologies, ranging from benign to severe. Syncopal episodes of any origin, however, may result in traumatic injury due to postural collapse. Based on the prevalence of internal and external stressors during training, basic military trainees may be at increased risk for syncope. Between 1 August 2012 and 31 July 2013, there were 112 unique individuals who experienced syncopal or pre-syncopal events among basic military trainees at Joint Base San Antonio-Lackland, Texas, the only basic training site in the U.S. Air Force. The overall rate was 19.6 cases per 1,000 person-years (18.4 and 36.1 per 1,000 person-years in males and females, respectively). Based upon the findings of electronic chart review of the 112 cases, a majority of events occurred either during or immediately after exercise (n=38) or during a blood draw, immunization, or laceration repair (n=22). The most common etiologies were judged to be neurocardiogenic (n=54) and orthostatic hypotension (n=40), and two cases were attributed to cardiovascular disease. These findings support current preventive measures, including anemia screening during medical in-processing, an emphasis on hydration throughout training, and a padded floor in the trainee vaccination bay.

  • 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: November 01, 2013
  • Citation: Webber BJ, Cropper TL, Federinko SP. Syncope among U.S. Air Force basic military trainees, August 2012-July 2013. MSMR. 2013 Nov;20(11):2-4.

Deployment-related injury and posttraumatic stress disorder in US military personnel.

Study

Abstract

BACKGROUND: The current military conflicts in Iraq and Afghanistan have resulted in the most US casualties since the Vietnam War. Previous research on the association between deployment-related injury and posttraumatic stress disorder (PTSD) has yielded mixed results. OBJECTIVES: To examine the effect of battle injury (BI) relative to non-battle injury (NBI) on the manifestation of PTSD symptoms in military personnel and to assess the demographic, injury-specific, and pre-injury factors associated with PTSD following a BI. PATIENTS AND METHODS: A total of 3403 personnel with deployment-related injury (1777 BI and 1626 NBI) were identified from the Expeditionary Medical Encounter Database. Records were electronically matched to Post-Deployment Health Assessment (PDHA) data completed 1-6 months post-injury. The PTSD screening outcome was identified using a four-item screening tool on the PDHA. RESULTS: Compared to those with NBI, personnel with BI had more severe injuries, reported higher levels of combat exposure, and had higher rates of positive PTSD screen. After adjusting for covariates, personnel with BI were twice as likely to screen positive for PTSD compared to those with NBI (odds ratio [OR], 2.10; 95% confidence interval [CI], 1.60-2.75). In multivariable analysis among battle-injured personnel only, moderate and serious-severe injury (OR, 1.49; 95% CI, 1.12-2.00 and OR, 1.64; 95% CI, 1.01-2.68, respectively), previous mental health diagnosis within 1 year of deployment (OR, 2.69; 95% CI, 1.50-4.81), and previous BI (OR, 1.96; 95% CI, 1.22-3.16) predicted a positive PTSD screen. CONCLUSIONS: Military personnel with BI have increased odds of positive PTSD screen following combat deployment compared to those with NBI. Post-deployment health questionnaires may benefit from questions that specifically address whether service members experienced an injury during combat.

  • Publication Status: Published
  • Sponsoring Organization: Navy
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: November 01, 2013
  • Citation: Macgregor AJ, Tang JJ, Dougherty AL, Galarneau MR. Deployment-related injury and posttraumatic stress disorder in US military personnel. Injury. 2013 Nov;44(11):1458-64.

Surveillance snapshot: Bacterial meningitis among beneficiaries of the military health system, 1998-2013.

Study

Abstract

From 1998 to 2013 (partial year), 3,782 beneficiaries of the Military Health System (MHS) were diagnosed as cases of bacterial meningitis. Cases were ascertained from diagnoses recorded in special electronic reports of meningococcal meningitis (a Reportable Medical Event in the MHS) or in records of inpatient hospital stays in which bacterial meningitis was documented in the primary or secondary diagnostic position. Among the three types of benefi ciary groups, the proportions of meningitis cases by bacterial type varied. In active and Reserve/Guard component service members, meningococcal meningitis was the most commonly documented specifi ed type of bacterial meningitis. Among all other benefi ciaries (e.g., spouses, children, retirees, etc.) streptococcal meningitis was the most commonly specifi ed type of bacterial meningitis. Meningococcal meningitis was diagnosed among 91 active component service members, 14 Reserve/Guard service members, and 251 other benefi ciaries (Figure 2). Th e overall rate in active component service members was 0.41 per 100,000 person-years. The incidence rate was relatively stable from 1998 to 2008, and then varied greatly from 2009 through 2013. In 2009 and 2011, there were no cases of meningococcal meningitis in active component service members. During the entire surveillance period, there were documented an additional 266 cases of meningococcal disease that were not recorded as meningitis. These included meningococcemia (n=150), carditis (n=13), and other specified and unspecifi ed meningococcal infections (n=103). These cases affected 38 active component members, 6 Reserve and Guard members, and 222 other benefi ciaries.

  • 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, 2013
  • Citation: AFHSC. Surveillance snapshot: Bacterial meningitis among beneficiaries of the military health system, 1998-2013. MSMR. 2013 Nov;20(11):15.

Obesity and the US military family.

Study

Abstract

OBJECTIVE: This review discusses the current knowledge and future directions regarding obesity within the US military family (i.e., active-duty servicemembers, as well as military spouses, children, retirees, and veterans). The increasing rates of overweight and obesity within the US military adversely impact military readiness, limit recruitment, and place a significant financial burden on the Department of Defense. DESIGN AND METHODS: The following topics are reviewed: 1) The prevalence of and the financial, physical, and psychological costs associated with overweight in military communities; 2) military weight regulations, and challenges faced by the military family related to overweight and disordered eating; 3) the continued need for rigorous program evaluations and new intervention development. RESULTS: Overweight and its associated sequelae impact the entire military family. Military families share many similarities with their civilian counterparts, but they face unique challenges (e.g., stress related to deployments and relocations). Although the military has weight management resources, there is an urgent need for rigorous program evaluation and the development of enhanced obesity prevention programs across the lifespan of the military family-several of which are proposed herein. CONCLUSIONS: Interdisciplinary and collaborative research efforts and team-based interventions will continue to inform understanding of obesity treatment and prevention within military and civilian populations.

  • 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, 2013
  • Citation: Tanofsky-Kraff M, Sbrocco T, Theim KR, Cohen LA, Mackey ER, Stice E, Henderson JL, McCreight SJ, Bryant EJ, Stephens MB. Obesity and the US military family. Obesity (Silver Spring). 2013 Nov;21(11):2205-20.

Development and Initial Validation of Military Deployment-Related TBI Quality-of-Life Item Banks.

Study

Abstract

OBJECTIVE: To investigate unique factors that affect health-related quality of life (QOL) in individuals with military deployment-related traumatic brain injury (MDR-TBI) and to develop appropriate assessment tools, consistent with the TBI-QOL/PROMIS/Neuro-QOL systems. PARTICIPANTS: Three focus groups from each of the 4 Veterans Administration (VA) Polytrauma Rehabilitation Centers, consisting of 20 veterans with mild to severe MDR-TBI, and 36 VA providers were involved in early stage of new item banks development. The item banks were field tested in a sample (N = 485) of veterans enrolled in VA and diagnosed with an MDR-TBI. DESIGN: Focus groups and survey. OUTCOME MEASURES: Developed item banks and short forms for Guilt, Posttraumatic Stress Disorder/Trauma, and Military-Related Loss. RESULTS: Three new item banks representing unique domains of MDR-TBI health outcomes were created: 15 new Posttraumatic Stress Disorder items plus 16 SCI-QOL legacy Trauma items, 37 new Military-Related Loss items plus 18 TBI-QOL legacy Grief/Loss items, and 33 new Guilt items. Exploratory and confirmatory factor analyses plus bifactor analysis of the items supported sufficient unidimensionality of the new item pools. Convergent and discriminant analyses results, as well as known group comparisons, provided initial support for the validity and clinical utility of the new item response theory-calibrated item banks and their short forms. CONCLUSION: This work provides a unique opportunity to identify issues specific to individuals with MDR-TBI and ensure that they are captured in QOL assessment, thus extending the existing TBI-QOL measurement system.

  • 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
  • Citation: Toyinbo PA, Vanderploeg RD, Donnell AJ, Mutolo SA, Cook KF, Kisala PA, Tulsky DS. Development and Initial Validation of Military Deployment-Related TBI Quality-of-Life Item Banks. J Head Trauma Rehabil. 2016 Jan-Feb;31(1):52-61.

Alcohol Use Among Active Duty Women: Analysis AUDIT Scores From the 2011 Health-Related Behavior Survey of Active Duty Military Personnel.

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
  • 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.

Predicting non-familial major physical violent crime perpetration in the US Army from administrative data.

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
  • 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.

Update: Malaria, U.S. Armed Forces, 2015.

Study

Abstract

U.S. service members are at risk of acquiring malaria infection when they are located in endemic areas because of long-term duty assignments, participation in shorter-term contingency operations, or personal travel. The number of malaria cases among U.S. military service members in 2015 (n=30) was the lowest annual count in at least 20 years and follows 3 previous years of greatly reduced incidence. The relatively low numbers of cases during 2012-2015 mainly reflect decreases in cases acquired in Afghanistan as the number of troops who served in Afghanistan sharply diminished in those years. About 43% of the 2015 cases were caused by Plasmodium falciparum (n=13) and 13% by Plasmodium vivax (n=4); about one-third of cases (37%) were reported as "unspecified" malaria. Malaria was diagnosed at or reported from 21 different medical facilities in the U.S., Afghanistan, Germany, and Korea. Providers of health care to military members should be knowledgeable regarding, and vigilant for, clinical presentations of malaria outside of endemic areas.

  • 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
  • Citation: Armed Forces Health Surveillance Branch. Update: Malaria, U.S. Armed Forces, 2015. MSMR. 2016 Jan;23(1):2-6.

Reproductive Health of Active Duty Women in Medically Austere Environments

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
  • Citation: Krulewitch CJ. Reproductive Health of Active Duty Women in Medically Austere Environments. Mil Med. 2016 Jan;181(1 Suppl):63-9.
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