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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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Assessing functional impairment in a working military population: the Walter Reed functional impairment scale.

Study

Abstract

Measurement of functional impairment is a priority for the military and other professional work groups routinely exposed to stressful traumatic events as part of their occupation. Standard measures of impairment used in general or chronically ill populations contain many items not suitable for these populations, and include mental health symptoms items that are not true measures of functioning. We created a new, 14-item scale-the Walter Reed Functional Impairment Scale-to assess functioning in 4 domains (physical, occupational, social, and personal). We asked 3,380 soldiers how much difficulty they currently have in each of the 4 domains on a 5-point scale. Behaviorally based psychosocial and occupational performance measures and general health questions were used to validate the scale. The utility of the scale was assessed against clinical measures of psychopathology and physical health (depression, posttraumatic stress disorder [PTSD], general health, generalized physical symptoms). We utilized Cronbach's alpha, item response theory, and the score test for trend to establish consistency of items and the validity of the scale. The scale exhibited excellent reliability (Cronbach's α= 0.92) and validity. The individual items and quartiles of sum scores were strongly correlated with negative occupational and social performance, and the utility of the scale was demonstrated by strong correlations with depression, PTSD, and high levels of generalized physical symptoms. This scale exhibits excellent psychometric properties in this sample of U.S. soldiers and, pending future research, is likely to have utility for other healthy occupational groups.

  • Publication Status: Published
  • Sponsoring Organization: Army
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Army
  • Release Date/Publication: August 01, 2014
  • Citation: Herrell RK, Edens EN, Riviere LA, Thomas JL, Bliese PD, Hoge CW. Assessing functional impairment in a working military population: the Walter Reed functional impairment scale. Psychol Serv. 2014 Aug;11(3):254-64.

Gender differences in the expression of PTSD symptoms among active duty military personnel.

Study

Abstract

This study examined gender differences in posttraumatic stress disorder (PTSD) symptoms and symptom factors in the total U.S. active duty force. Data were drawn from the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel including 17,939 men and 6751 women from all services. The results indicated that women expressed more distress than men across almost all the symptoms on the PTSD Checklist except for hypervigilance. Women also scored significantly higher on all four factors examined: Re-experiencing, Avoidance, Emotionally Numb, Hyperarousal. More women than men were distressed by combat experiences that involved some type of violence, such as being wounded, witnessing or engaging in acts of cruelty, engaging in hand-to-hand combat, and, to a lesser extent, handling dead bodies. Men who had been sexually abused had a greater number of symptoms and were consistently more distressed than women on individual symptoms and symptom factors.

  • Publication Status: Published
  • Sponsoring Organization: Undetermined
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: December 01, 2014
  • Citation: Hourani L, Williams J, Bray R, Kandel D. Gender differences in the expression of PTSD symptoms among active duty military personnel. J Anxiety Disord. 2014 Dec 5;29C:101-108.

Sexual Assault and Sexual Harassment in the U.S. Military Top-Line Estimates for Active-Duty Service Members from the 2014 RAND Military Workplace Study

Study

Abstract

In early 2014, the Department of Defense (DoD) Sexual Assault Prevention and Response Office (SAPRO) asked the RAND National Defense Research Institute (NDRI) to conduct an independent assessment of sexual assault, sexual harassment, and gender discrimination in the military — an assessment last conducted in 2012 by the department itself with the Workplace and Gender Relations Survey of Active Duty Personnel (WGRA). This report provides initial top-line estimates from the resulting study, the RAND Military Workplace Study (RMWS), which included a survey of 560,000 U.S. service members fielded in August and September of 2014. Compared to the prior DoD studies, the RMWS takes a new approach to counting individuals in the military who experienced sexual assault, sexual harassment, or gender discrimination. Our measurement of sexual assault aligns closely with the definitions and criteria in the Uniform Code of Military Justice (UCMJ) for Article 120 crimes. The survey measures of sexual harassment and gender discrimination, which together we refer to as sex-based military equal opportunity (MEO) violations, use criteria drawn directly from DoD Directive 1350.2. Compared with past surveys that were designed to measure a climate of sexual misconduct associated with illegal behavior, the approach used in the RMWS offers greater precision in estimating the number of crimes and MEO violations that have occurred. However, recognizing that DoD is also interested in trends in sexual assault, sexual harassment, and gender discrimination, RAND fielded a portion of the 2014 surveys using the same questions as previous DoD surveys on this topic. Key Findings RAND Researchers Estimate That, as of Early Fall of 2014, Approximately 20,000 of the U.S. Military's 1.3 Million Active-Duty Members Experienced One or More Sexual Assaults in the Past Year This figure includes assaults by other service members, civilians, spouses or others. It represents 4.9 percent of active-duty women and 1 percent of active-duty men. An Estimated 26 Percent of Active-Duty Women and 7 Percent of Active-Duty Men Experienced Sexual Harassment or Gender Discrimination in the Past Year Close to one third of women in the Navy and Marines experienced one of these violations in the past year. The majority of these violations involve experiences consistent with a sexually hostile work environment; however, significant numbers of women also indicate having experienced gender discrimination. We estimate that in the Army, almost 1 in 12 men experienced such a violation in the past year; in the Navy, it was nearly 1 in 10. For men, the largest source of problems stem from sexually hostile work environments, not gender discrimination or sexual quid pro quo. The Study Found Significant Differences in Rates of Sexual Assaults and Sex-Based MEO Violations by Branch of Service Fewer Air Force men and women experienced these events than their counterparts in the other services. In forthcoming reports, RAND will investigate if some of these service differences are attributable to differences in member demographics (e.g., age and education levels), cultures, or policies across services. Trend Data Suggest That Rates of Unwanted Sexual Contact and Sexual Harassment for Active-Duty Women Have Declined from 2012; Rates for Both Men and Women Are Lower Than in 2006, But About the Same as in 2010 We estimate that the percentage of active-duty women who experienced unwanted sexual contact as measured by the WGRA methods declined from 6.1 percent in 2012 to 4.3 percent in 2014; the same percentages for men did not see a statistically significant change (1.2 percent in 2012 compared with 0.9 percent in 2014). Similarly, estimates for the percentage of women who experienced sexual harassment in the past year declined significantly from 23.2 percent in 2012 to 20.2 percent in 2014; for men, the percentage in 2014 (3.5 percent) was not significantly lower than in 2012 (4.1 percen

  • Publication Status: Published
  • Sponsoring Organization: DoD agency, office, or organization other than the Army, Navy, Air Force, or Defense Health Agency
  • Sponsoring Office: National Development and Research Institutes, Inc.
  • Congressionally Mandated: No
  • Funding Source: Federally Funded Research and Development Center
  • Release Date/Publication: December 01, 2014
  • Citation: Rand Corporation, National Defense Research Institute

Stress in Service Members.

Study

Abstract

Military service differs from civilian jobs in the stressors that service members experience, including frequent deployments (eg, to an area of combat operations), obedience, regimentation, subordination of self to the group, integrity, and flexibility. The military culture emphasizes teamwork and peer support. In some cases, service members cannot adapt to military life, become overwhelmed by stress, or cannot overcome a traumatic experience. Clinicians should conduct a thorough evaluation guided by an understanding of the military culture. Every effort should be made to identify the stress and the maladaptive response and provide early clinical interventions to prevent progression.

  • 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: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: December 01, 2014
  • Citation: Lande RG. Stress in Service Members. Psychiatr Clin North Am. 2014 Dec;37(4):547-560. doi: 10.1016/j.psc.2014.08.007.

Sexual Assault and Sexual Harassment in the U.S. Military Top-Line Estimates for Active-Duty Coast Guard Members from the 2014 RAND Military Workplace Study

Study

Abstract

In early 2014, the Department of Defense (DoD) Sexual Assault Prevention and Response Office (SAPRO) asked the RAND National Defense Research Institute (NDRI) to conduct an independent assessment of sexual assault, sexual harassment, and gender discrimination in the military — an assessment last conducted in 2012 by the department itself with the Workplace and Gender Relations Survey of Active Duty Personnel (WGRA). Separately, the Coast Guard requested that we expand the 2014 study to include an assessment of its active and reserve force. This report provides initial top-line active-duty Coast Guard estimates from the resulting RAND Military Workplace Study, which invited close to 560,000 service members to participate in a survey fielded in August and September of 2014. The RMWS takes an approach to counting individuals in the military who experienced sexual assault, sexual harassment, or gender discrimination that measures the incidence of specific crimes and violations. Our measurement of sexual assault aligns closely with the definitions and criteria in the Uniform Code of Military Justice (UCMJ) for Article 120 crimes. The survey measures of sexual harassment and gender discrimination, which together we refer to as sex-based military equal opportunity (MEO) violations, use criteria drawn from DoD Directive 1350.2. Compared with past surveys that were designed to measure a climate of sexual misconduct associated with illegal behavior, the approach used in the RMWS offers greater precision in estimating the number of crimes and MEO violations that have occurred. Key Findings RAND Researchers Estimate That, as of Early Fall of 2014, Approximately 270 of the U.S. Coast Guard's 39,000 Active-Duty Members Experienced One or More Sexual Assaults in the Past Year This figure includes assaults by other service members, civilians, spouses or others. It represents 3.0 percent of active-duty women and 0.3 percent of active-duty men. Nearly a Quarter of Active-Duty Women Experienced Sexual Harassment or Gender Discrimination in the Past Year The majority of these sex-based military equal opportunity (MEO) violations involve experiences consistent with a sexually hostile work environment or gender discrimination. Our estimate of the prevalence of sex-based MEO violations against active-duty Coast Guard men is substantially lower, though still affecting about 1 in 22 men. These violations usually involve hostile work environments. The Study Found That A Smaller Proportion of Coast Guard Members Experienced Sexual Assaults Than Found Among Their Counterparts in the Other U.S. Military Services In forthcoming reports, RAND will investigate if some of these service differences are attributable to differences in member demographics (e.g., age and education levels), cultures, or policies across services. Men in the Coast Guard experienced lower rates of sex-based MEO violations than men in the other services.

  • Publication Status: Published
  • Sponsoring Organization: DoD agency, office, or organization other than the Army, Navy, Air Force, or Defense Health Agency
  • Sponsoring Office: National Development and Research Institutes, Inc.
  • Congressionally Mandated: No
  • Funding Source: Federally Funded Research and Development Center
  • Release Date/Publication: December 01, 2014
  • Citation: Rand Corporation, National Defense Research Institute

Chronic multisymptom illness: a comparison of iraq and afghanistan deployers with veterans of the 1991 gulf war.

Study

Abstract

Symptoms and illnesses reported by veterans of the 1991 Gulf War era are a cause of potential concern for those military members who have deployed to the Gulf region in support of more recent contingency operations in Iraq and Afghanistan. In the present study, we quantified self-reported symptoms from participants in the Millennium Cohort Study, a prospective study representing all US service branches, including both active duty and Reserve/National Guard components (2001-2008). Self-reported symptoms were uniquely compared with those in a cohort of subjects from the 1991 Gulf War to gain context for the present report. Symptoms were then aggregated to identify cases of chronic multisymptom illness (CMI) based on the case definition from the Centers for Disease Control and Prevention. The prevalence of self-reported CMI symptoms was compared with that collected in 1997-1999 from a study population of US Seabees from the 1991 Gulf War, as well as from deployed and nondeployed subgroups. Although overall symptom reporting was much less in the Millennium Cohort than in the 1991 Gulf War cohort, a higher prevalence of reported CMI was noted among deployed compared with nondeployed contemporary cohort members. An increased understanding of coping skills and resilience and development of well-designed screening instruments, along with appropriate clinical and psychological follow-up for returning veterans, might help to focus resources on early identification of potential long-term chronic disease manifestations.

  • Publication Status: Published
  • Sponsoring Organization: Undetermined
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: December 01, 2014
  • Citation: Smith TC, Powell TM, Jacobson IG, Smith B, Hooper TI, Boyko EJ, Gackstetter GD. Chronic multisymptom illness: a comparison of iraq and afghanistan deployers with veterans of the 1991 gulf war. Am J Epidemiol. 2014 Dec 15;180(12):1176-87.

Complementary and alternative medicine among veterans and military personnel: a synthesis of population surveys.

Study

Abstract

BACKGROUND: Recent reports reinforce the widespread interest in complementary and alternative medicine (CAM), not only among military personnel with combat-related disorders, but also among providers who are pressed to respond to patient demand for these therapies. However, an understanding of utilization of CAM therapies in this population is lacking. OBJECTIVE: The goals of this study are to synthesize the content of self-report population surveys with information on use of CAM in military and veteran populations, assess gaps in knowledge, and suggest ways to address current limitations. RESEARCH DESIGN: The research team conducted a literature review of population surveys to identify CAM definitions, whether military status was queried, the medical and psychological conditions queried, and each specific CAM question. Utilization estimates specific to military/veterans were summarized and limitations to knowledge was classified. RESULTS: Seven surveys of CAM utilization were conducted with military/veteran groups. In addition, 7 household surveys queried military status, although there was no military/veteran subgroup analysis. Definition of CAM varied widely limiting cross-survey analysis. Among active duty and Reserve military, CAM use ranged between 37% and 46%. Survey estimates do not specify CAM use that is associated with a medical or behavioral health condition. CONCLUSIONS: Comparisons between surveys are hampered due to variation in methodologies. Too little is known about reasons for using CAM and conditions for which it is used. Additional information could be drawn from current surveys with additional subgroup analysis, and future surveys of CAM should include military status variable. PMID: 25397828 [PubMed - in process]

  • Publication Status: Published
  • Sponsoring Organization: DoD agency, office, or organization other than the Army, Navy, Air Force, or Defense Health Agency
  • 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, 2014
  • Citation: Davis MT, Mulvaney-Day N, Larson MJ, Hoover R, Mauch D. Complementary and alternative medicine among veterans and military personnel: a synthesis of population surveys. Med Care. 2014 Dec;52 Suppl 5:S83-90.

Prevalence, health care utilization, and costs of fibromyalgia, irritable bowel, and chronic fatigue syndromes in the military health system, 2006-2010.

Study

Abstract

OBJECTIVE: We compared prevalence, health care utilization, and costs over time for nonelderly adults diagnosed with fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS) in relation to timing of federal approvals for FMS drugs. DATA SOURCE: We used military health care claims from October 2006 to September 2010. STUDY DESIGN/ANALYSIS: Retrospective, multiple-year comparisons were conducted using trend analyses, and time series regression-based generalized linear models. RESULTS: Over 5 years, FMS prevalence rates increased from 0.307% to 0.522%, whereas IBS and CFS prevalence rates remained stable. The largest increase in FMS prevalence occurred between 2007 and 2008. Health care utilization was higher for FMS cases compared to IBS and CFS cases. Over 5 years, the total cost for FMS-related care increased $163.2 million, whereas IBS costs increased $14.9 million and CFS cost increased $3.7 million. Between 2006 and 2010, total pharmacy cost for FMS cases increased from $55 million ($3,641/person) to $96.3 million ($3,557/person). CONCLUSION: Although cause and effect cannot be established, the advent of federally approved drugs for FMS in concert with pharmaceutical industry marketing of these drugs coincide with the observed changes in prevalence, health care utilization, and costs of FMS relative to IBS and CFS.

  • 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: September 01, 2014
  • Citation: Jeffery DD, Bulathsinhala L, Kroc M, Dorris J. Prevalence, health care utilization, and costs of fibromyalgia, irritable bowel, and chronic fatigue syndromes in the military health system, 2006-2010. Mil Med. 2014 Sep;179(9):1021-9.

Day of injury cognitive performance on the Military Acute Concussion Evaluation (MACE) by U.S. military service members in OEF/OIF.

Study

Abstract

OBJECTIVES: The study investigated the clinical validity of the cognitive screening component of the Military Acute Concussion Evaluation (MACE) for the evaluation of acute mild traumatic brain injury (mTBI) in a military operational setting. METHODS: This was a retrospective data study involving analysis of MACE data on Operation Enduring Freedom/Operation Iraqi Freedom deployed service members with mTBI. In total, 179 cases were included in analyses based on ICD-9 diagnostic codes and characteristics of mTBI, and availability of MACE data on day of injury. MACE data from the mTBI group was compared to a military sample without mTBI administered the MACE as part of a normative data project. RESULTS: On day of injury, the mTBI group performed worse than controls on the MACE cognitive test (d = 0.90), with significant impairments in all cognitive domains assessed. MACE cognitive score was strongly associated with established indicators of acute injury severity. Lower MACE cognitive performance on day of injury was predictive of lengthier postinjury recovery time and time until return to duty after mTBI. CONCLUSIONS: Findings from the current study support the use of the MACE as a valid screening tool to assess for cognitive dysfunction in military service members during the acute phase after mTBI.

  • 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: McCrea M, Guskiewicz K, Doncevic S, Helmick K, Kennedy J, Boyd C, et.al., . Day of injury cognitive performance on the Military Acute Concussion Evaluation (MACE) by U.S. military service members in OEF/OIF. Mil Med. 2014 Sep;179(9):990-7.

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.

Providing care to military personnel and their families: how we can all contribute.

Study

Abstract

Providing medical care to members of the military and their families remains a societal duty carried out not only by military physicians but also, and in large part, by civilian providers. As many military families are geographically dispersed, it is probable that all physicians at some point in their training or careers will care for this unique patient population. Understanding the military culture can help physicians provide the best care possible to our military families, and inclusion of military cultural competency curricula in all medical schools is a first step in advancing this understanding. The authors review the knowledge, skills, and attitudes that all health professionals should acquire to be able to care for those who serve and offer recommendations for developing these among all students and trainees.

  • 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: September 01, 2014
  • Citation: Gleeson TD, Hemmer PA. Providing care to military personnel and their families: how we can all contribute. Acad Med. 2014 Sep;89(9):1201-3.

Embedded fragments from U.S. military personnel--chemical analysis and potential health implications.

Study

Abstract

BACKGROUND: The majority of modern war wounds are characterized by high-energy blast injuries containing a wide range of retained foreign materials of a metallic or composite nature. Health effects of retained fragments range from local or systemic toxicities to foreign body reactions or malignancies, and dependent on the chemical composition and corrosiveness of the fragments in vivo. Information obtained by chemical analysis of excised fragments can be used to guide clinical decisions regarding the need for fragment removal, to develop therapeutic interventions, and to better anticipate future medical problems from retained fragment related injuries. In response to this need, a new U.S Department of Defense (DoD) directive has been issued requiring characterization of all removed fragments to provide a database of fragment types occurring in combat injuries. OBJECTIVES: The objective of this study is to determine the chemical composition of retained embedded fragments removed from injured military personnel, and to relate results to histological findings in tissue adjacent to fragment material. METHODS: We describe an approach for the chemical analysis and characterization of retained fragments and adjacent tissues, and include case examples describing fragments containing depleted uranium (DU), tungsten (W), lead (Pb), and non-metal foreign bodies composed of natural and composite materials. Fragments obtained from four patients with penetrating blast wounds to the limbs were studied employing a wide range of chemical and microscopy techniques. Available adjacent tissues from three of the cases were histologically, microscopically, and chemically examined. The physical and compositional properties of the removed foreign material surfaces were examined with energy dispersive x-ray fluorescence spectrometry (EDXRF), scanning electron microscopy (SEM), laser ablation inductively-coupled plasma mass-spectrometry (LA-ICP-MS), and confocal laser Raman microspectroscopy (CLRM). Quantitative chemical analysis of both fragments and available tissues was conducted employing ICP-MS. RESULTS: Over 800 fragments have been characterized and included as part of the Joint Pathology Center Embedded Fragment Registry. Most fragments were obtained from penetrating wounds sustained to the extremities, particularly soft tissue injuries. The majority of the fragments were primarily composed of a single metal such as iron, copper, or aluminum with traces of antimony, titanium, uranium, and lead. One case demonstrated tungsten in both the fragment and the connected tissue, together with lead. Capsular tissue and fragments from a case from the 1991 Kuwait conflict showed evidence of uranium that was further characterized by uranium isotopic ratios analysis to contain depleted uranium. CONCLUSIONS: The present study provides a systematic approach for obtaining a full chemical characterization of retained embedded fragments. Given the vast number of combat casualties with retained fragments, it is expected that fragment analysis will have significant implications for the optimal short and long-term care of wounded service members.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Joint Pathology 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: January 01, 2014
  • Citation: Centeno JA, Rogers DA, van der Voet GB, Fornero E, Zhang L et. al. Embedded fragments from U.S. military personnel--chemical analysis and potential health implications. Int J Environ Res Public Health. 2014 Jan 23;11(2):1261-78.

Race/ethnicity and HAART initiation in a military HIV infected cohort.

Study

Abstract

BACKGROUND: Prior studies have suggested that HAART initiation may vary by race/ethnicity. Utilizing the U.S. military healthcare system, which minimizes confounding from healthcare access, we analyzed whether timing of HAART initiation and the appropriate initiation of primary prophylaxis among those at high risk for pneumocystis pneumonia (PCP) varies by race/ethnicity. METHODS: Participants in the U.S. Military HIV Natural History Study from 1998-2009 who had not initiated HAART before 1998 and who, based on DHHS guidelines, had a definite indication for HAART (CD4 <200, AIDS event or severe symptoms; Group A), an indication to consider HAART (including CD4 <350; Group B) or electively started HAART (CD4 >350; Group C) were analyzed for factors associated with HAART initiation. In a secondary analysis, participants were also evaluated for factors associated with starting primary PCP prophylaxis within four months of a CD4 count <200 cells/mm3. Multiple logistic regression was used to compare those who started vs. delayed therapy; comparisons were expressed as odds ratios (OR). RESULTS: 1262 participants were evaluated in the analysis of HAART initiation (A = 208, B = 637, C = 479 [62 participants were evaluated in both Groups A and B]; 94% male, 46% African American, 40% Caucasian). Race/ethnicity was not associated with HAART initiation in Groups A or B. In Group C, African American race/ethnicity was associated with lower odds of initiating HAART (OR 0.49, p = 0.04). Race and ethnicity were also not associated with the initiation of primary PCP prophylaxis among the 408 participants who were at risk. CONCLUSIONS: No disparities in the initiation of HAART or primary PCP prophylaxis according to race/ethnicity were seen among those with an indication for therapy. Among those electively initiating HAART at the highest CD4 cell counts, African American race/ethnicity was associated with decreased odds of starting. This suggests that free healthcare can potentially overcome some of the observed disparities in HIV care, but that unmeasured factors may contribute to differences in elective care decisions.

  • 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: January 01, 2014
  • Citation: Johnson EN, Roediger MP, Landrum ML, Crum-Cianflone NF, Weintrob AC, Ganesan A, et. al. Race/ethnicity and HAART initiation in a military HIV infected cohort. AIDS Res Ther. 2014 Jan 24;11(1):10.

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.

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.
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