Medical appraisal of Chinese military aircrew with abnormal results of coronary computed tomographic angiography.

BACKGROUND: Coronary artery diseases can cause myocardial ischemia and hypoxia, angina pectoris, myocardial infarction, arrhythmia, and even sudden death led to inflight incapacitation of aircrew. As the main cause of grounding due to illness, they severe threats to the health and fighting strength of military aircrew. Early warning in an early and accurate manner and early intervention of diseases possibly resulting in inflight incapacitation are key emphases of aeromedical support in clinic. AIM: To figure out the flight factors and clinical characteristics of military aircrew with abnormal results of coronary artery computed tomographic angiography (CTA), thereby rendering theoretical references for clinical aeromedical support of military flying personnel. METHODS: The clinical data of 15 flying personnel who received physical examinations in a military medical center from December 2020 to June 2023 and were diagnosed with coronary artery diseases by coronary artery CTA were collected and retrospectively analyzed, and a descriptive statistical analysis was conducted on their onset age, aircraft type and clinical data. RESULTS: The 15 military flying personnel diagnosed with coronary artery diseases by coronary artery CTA were composed of 9 pilots, 1 navigator and 5 air combat service workers. Multi-vessel disease was detected in 9 flying personnel, among which 8 (88.9%) were pilots. Flying personnel with multi-vessel disease had higher content of cholesterol, low-density lipoprotein cholesterol and apolipoprotein B than those with single-vessel disease. CONCLUSION: Coronary artery diseases are the major heart disease for the grounding of flying personnel due to illness, which can lead to inflight incapacitation. Coronary artery CTA is conducive to early detection and early intervention treatment of such diseases in clinic.

Cold operational readiness in the military: from science to practice.

Cold weather operations are logistically difficult to orchestrate and extremely challenging for soldiers. Decades of research and empirical evidence indicate that humans are extremely vulnerable to cold and that individual responses are highly variable. In this context, it may be necessary to develop personalised strategies to sustain soldiers' performance and ensure overall mission success in the cold. Systematic cold weather training is essential for soldiers to best prepare to operate during, and recover from, cold weather operations. The purpose of this review is to highlight key aspects of cold weather training, including (1) human responses to cold, (2) nutrition, (3) sleep and (4) protective equipment requirements. Bringing science to practice to improve training principles can facilitate soldiers performing safely and effectively in the cold. Cold weather training prepares soldiers for operations in cold, harsh environments. However, decreases in physical, psychological and thermoregulatory performance have been reported following such training, which influences operational ability and increases the overall risk of injuries. When optimising the planning of field training exercises or operational missions, it is important to understand the soldiers' physical and cognitive performance capacity, as well as their capacity to cope and recover during and after the exercise or mission. Even though the body is fully recovered in terms of body composition or hormonal concentrations, physical or cognitive performance can still be unrecovered. When overlooked, symptoms of overtraining and risk of injury may increase, decreasing operational readiness.

Tailoring Hospice Care to the Veteran Population.

United States Military Veterans are an increasingly elderly population, and more and more veterans are choosing hospice care at the end of life. These veterans, particularly if they served in combat, can bring unique management challenges and opportunities to a hospice team. This review highlights the physical and psychosocial traumas experienced by many veterans, and discusses how these issues can affect their hospice care. Traumatic injury-related issues such as chronic pain, neuropathic pain, insomnia, and chronic headaches can worsen for veterans at the end of life, and the psychological sequelae of these traumatic events such as Post-Traumatic Stress Disorder (PTSD), Chronic Anxiety, Substance Abuse, and increased risk of suicide can also be magnified during this time. This review details these and other commonly seen service-related comorbidities, and offers evidence-based recommendations regarding their diagnosis and treatment. In addition, it discusses what is important to veterans at the end of life, and provides suggestions on how hospice programs can individualize and optimize their care of this special population. Honoring their service and respecting their sacrifices are also important aspects of "Best Care" for veterans at the end of life, and this review provides suggestions on how to do so and includes a list of resources that can greatly assist hospice programs, veterans, and families in delivering the most respectful, comprehensive, and thoughtful care possible.

Outpatient Rehabilitation Utilization Following Major Limb Loss in Adults Receiving Care in the Military Health System from 2001 to 2017.

OBJECTIVE: To investigate exposures associated with outpatient rehabilitation encounters among Military Health System (MHS) beneficiaries with major limb loss. DESIGN: Retrospective, cohort study. SETTING: American military treatment facilities and civilian healthcare facilities that accept TRICARE benefits. PARTICIPANTS: Adult MHS beneficiaries with major limb amputation(s) acquired between January 2001 and September 2017 (N=5,161). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): This exploratory analysis investigated associations between outpatient rehabilitation care and demographic and amputation characteristics in MHS beneficiaries with major limb loss. RESULTS: Of 5,161 military beneficiaries with major limb amputation(s), most were aged 55-64 (36%), male (73%), retirees/dependents (60%), with enlisted sponsor rank (88%), and single limb loss (89%). The active/reserve beneficiaries were younger, majority male, and more likely to be diagnosed with incident behavioral health conditions. Unadjusted negative binomial regression models revealed increased rates of outpatient rehabilitation encounters in ADSMs compared to retirees/dependents (rate ratio (RR): 10.02, 95% confidence interval (CI): 9.30, 10.80). The rate ratios for sex, sponsor rank, limb(s) lost, incident behavioral health condition, incident TBI, incident PTSD, and outpatient care setting were attenuated following stratification by beneficiary category. Enlisted ADSMs had increased rates of outpatient rehabilitation encounter days compared to officers, whereas retirees/dependents with enlisted sponsors had decreased rates compared to those with officer sponsors. ADSMs who accessed outpatient care in DC and PC settings demonstrated high rates of outpatient rehabilitation encounters compared to those who only sought care from PC settings (RR: 4.60, 95% CI: 2.95, 6.81). CONCLUSIONS: This study suggests that MHS beneficiaries with major limb loss utilize outpatient rehabilitation services differently, based on active/reserve duty or retiree/dependent status. This study is the first of its kind to quantify outpatient rehabilitation utilization for military beneficiaries with all cause major limb loss and may inform MHS policymakers on the rehabilitation needs for combat- and non-combat-related amputee populations.

Effectiveness of surfing on psychological health in military members: a systematic review.

INTRODUCTION: Surfing, a leisure activity known for its positive physical and mental health effects, has emerged as a potential therapeutic intervention. This study aims to systematically review the available evidence on the effects of surfing on mental health in active military personnel and veterans. METHODS: Studies were searched across four electronic databases (MEDLINE/PubMed, Web of Science, SportDiscus and Scopus) until May 2024. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database, Methodological Index for Non-Randomized Studies and the Quality Assessment Tool for Before-After Studies with No Control Group scales. RESULTS: A total of seven studies met the inclusion criteria and were included. Depression and anxiety symptoms (n=7), positive affect (n=5) and pain (n=3) were the main outcomes analysed. Overall, the studies reviewed generally reported beneficial effects of surfing on depression, anxiety and positive affect. However, none of the four studies that examined pain as an outcome observed any positive effects of surfing. CONCLUSION: There is evidence indicating that surfing may positively influence the management of anxiety, depression and overall positive affect among military personnel. Nonetheless, it cannot be definitively concluded that surfing provides superior benefits compared with other forms of exercise.

Physical fitness profile of military lifeguards.

Introduction: Throughout a lifeguard's career, regardless of age, the physical demands of performing a water rescue are likely to remain constant. Objectives: To establish a physical fitness profile by age group of a sample composed of professional beach lifeguards who regularly engage in physical activity. Methods: One hundred and seventy-two lifeguards were initially recruited for this study. Data from 99 male lifeguards were provided for analysis. Anthropometric measurements, lower limb strength, and handgrip measurements were taken at the initial visit. During a second visit, running tests were performed on sand. All testing procedures followed the same predefined sequence for all individuals. Results: One-way analysis of variance with post hoc Bonferroni or Kruskal-Wallis adjusted analysis was performed to assess differences between age groups depending on the exact variable. The significance level was set at p ≤ 0.05. There were statistically significant differences in all power and velocity performance parameters as well as body fat percentage with better results found in the younger age groups (20-29;30-39) compared to an older age group (40-49). However, there were no statistically significant differences between the groups for handgrip strength. Conclusions: The results of the present study indicate significant differences in physical fitness between different age groups. The authors suggest that the squat jump, countermovement jump, 20-meter linear sprint test, zigzag change-of-direction test, and running anaerobic sprint test assessment should be used as screening tools for fitness.

Introdução: Ao longo da vida profissional de um guarda-vidas, independentemente da idade, as exigências físicas impostas durante um salvamento provavelmente se manterão constantes. Objetivos: Estabelecer um perfil de aptidão física de uma amostra composta por guarda-vidas profissionais praticantes de atividade física regular. Métodos: Cento e setenta e dois salva-vidas foram inicialmente recrutados para este estudo. Dados de 99 indivíduos foram utilizados para análise. Medidas antropométricas foram obtidas durante a primeira visita, assim como a análise da potência de membros inferiores e da força de preensão manual. Testes de velocidade e mudança de direção foram realizados em uma segunda visita. A testagem seguiu a mesma ordem predefinida para todos os indivíduos. Resultados: Uma análise de variância com post-hoc de Bonferroni ou o teste de Kruskal-Wallis com comparações por pares ajustada foi utilizado para comparação entre grupos, a depender da variável. O nível de significância adotado foi de ≤ 0,05. Foram observadas diferenças estatisticamente significativas entre as faixas etárias para todos os testes de potência e velocidade, bem como no percentual de gordura corporal, com melhores resultados encontrados nas faixas etárias mais jovens (20-29 e 30-39 anos quando comparados ao grupo 40-49). No entanto, não houve diferença estatisticamente significativa entre os grupos em relação à força de preensão manual. Conclusões: Os resultados indicam diferenças estatisticamente significativas na aptidão física de guarda-vidas entre as diferentes faixas etárias. É sugerido que o salto vertical, sem e com contramovimento, o teste de 20 metros, o teste de corrida anaeróbica e o teste em zigue-zague sejam implementados como ferramenta para triagem da aptidão física.

Age-Related Variation in Ecological Resources Among Veterans Seeking Treatment Related to Military Sexual Trauma.

Approximately 16% of Veterans experience military sexual trauma (MST), defined as sexual assault or harassment experienced during military service. Veterans across life stages may possess differing resources and face unique stressors that impact their ability to engage in mental health treatment or require additional liaison to services. The present study sought to characterize age-related differences in the socioecological contexts of Veterans seeking mental health treatment following MST in the domains of economic sufficiency, housing, spiritual coping, supportive relationships, and interpersonal violence. From 2009 to 2019, Veterans (N = 640) seeking mental health services following exposure to MST attended evaluation and treatment planning sessions at a Midwestern Veterans Health Administration posttraumatic stress disorder specialty clinic. Veterans completed semistructured interviews that included surveys and diagnostic screenings to assess psychosocial needs and resources. ANOVA and ordinal regressions were used to evaluate potential disparities in socioecological resources by age. No age-related differences in economic sufficiency and stable housing emerged, though most Veterans (57%) endorsed financial difficulties. Veterans who endorsed spiritual beliefs were significantly older than those who did not. Veterans who reported having a support system were significantly younger than Veterans who denied having a support system. Less than half (46%) of Veteran reported having peer relationships. Veterans who endorsed frequent interaction with their peers were significantly older than those who did not. Veterans who reported past-year exposure to interpersonal violence were significantly younger. Greater clarity about age-related differences in the socioecological contexts of Veterans can support clinicians in providing responsive mental health treatment and connecting Veterans to additional Veterans Health Administration resources following MST.

Trauma, resilience and significant relationships: Sex differences in protective factors for military mental health.

BACKGROUND: Military service is historically a male-dominated occupation, as such, the majority of research examining the development of mental disorder in Australian Defence Force members has had primarily male samples. While there have been mixed findings internationally regarding sex differences in rates of mental disorder and subthreshold symptoms among military personnel, across studies, the evidence tends to suggest that female military members are at least as likely as males to experience subthreshold mental health symptoms and have similar or higher rates of posttraumatic stress disorder despite the differences in roles during service. What is less understood is the impact of sex differences in symptom emergence over time and in predictors of clinical disorder. METHOD: The sample included a longitudinal cohort of Australian Defence Force members (N = 8497) surveyed at Time 1 (2010) and followed up at Time 2 (2015) on measures of anger, self-perceived resilience, trauma exposure, deployment exposure, suicidality, help-seeking, relationship satisfaction and mental health disorder symptoms. Outcomes included Subthreshold Disorder (above the optimal screening cut-off on the 10-item Kessler distress scale or posttraumatic stress disorder checklist) and Probable Disorder (above the epidemiological cut-off on the 10-item Kessler distress scale or posttraumatic stress disorder checklist). RESULTS: Results found that while lifetime trauma exposure remained the strongest predictor of later probable disorder emergence among both males and females, for females specifically, self-reported resilience was also a significant protective factor. In contrast, being in a significant relationship at Time 1 was a protective factor against the development of subthreshold disorder in males. CONCLUSION: For the first time, sex differences in mental health symptom emergence over time have been explored in a large Australian cohort of military members. The capacity to adapt and bounce back after adversity emerged as a proactive factor against poor mental health for females in the military and could be addressed as part of routine skills training. Social support from significant relationship was particularly important for males' mental health, suggesting that maintaining positive relationships and supporting military spouses and partners are critical for males' mental health.

Post-traumatic stress disorder among military personnel admitted at the Northwest Command Level Three Military Hospital, Bahir Dar, Ethiopia, 2022: an institution-based cross-sectional study.

Background: Post-traumatic stress disorder (PTSD) is one of the most common mental health problems that military personnel encounter. It could be lifelong and affect every aspect of military personnel, including their mental and physical health, family and social interactions, and their work. However, in Ethiopia, the magnitude and its associated factors have not been well investigated. Objective: This study aimed to determine the prevalence of PTSD and its associated factors among military personnel, who were admitted at the Northwest Command Level Three Military Hospital, Bahir Dar, Northwest, Ethiopia, 2022. Methods: An institution-based cross-sectional study was conducted from 21 June to 21 July 2022, at the Northwest Command Level Three Military Hospital. A computer-generated simple random sampling technique was used to select a total of 627 participants. The 17-item Military Version Checklist was utilized to measure PTSD. The Patient Health Questionnaire, Brief Resilience Coping, and Critical War Zone Experience scale were utilized to measure depression, resilience, and combat exposure, respectively. Descriptive, bivariate, and multivariate binary logistic regressions with odds ratios and a 95% confidence interval were used. The level of significance of the association was determined at a p-value < 0.05. Results: A total of 612 respondents participated, with a response rate of 97.6%. The prevalence of PTSD in this study was 21.9% (95% CI: 18.6, 25.2). In multivariable regression, female sex [adjusted odds ratio (AOR) = 2.3, 95% CI; 1.3, 3.87], combat personnel (AOR = 2.75, 95% CI; 1.44, 6.36), handling dead bodies (AOR = 2.5, 95% CI,1.24, 5.02), having 4-5 deployments (AOR = 2.94, 95% CI, 1.63, 5.32), having ≥6 deployments (AOR = 3.4, 95% CI, 1.95, 6.17), low resilience coping (AOR = 2.02, 95% CI; 1.16, 3.53), poor social support (AOR = 2.46, 95% CI, 1.39, 4.35), very high combat exposures (AOR = 4.8, 95% CI, 2.03, 11.93), and depression (AOR = 2.8, 95% CI, 1.68, 4.67) were significantly associated with PTSD. Conclusion: PTSD is markedly prevalent among the Ethiopian military population, with key risk factors identified as being female, poor social support, low resilience coping skills, handling dead bodies, multiple deployments (four or more), high combat experiences, and depression. Healthcare professionals must prioritize the early diagnosis and intervention of PTSD in vulnerable groups of military personnel.

Canine vector-borne infections of working dogs of the Sri Lanka Air Force, and free roaming, and privately owned dogs.

Canine vector-borne infections (CVBIs) are a global health problem. The military working dogs of Sri Lanka die at an early age, and CVBIs have been a leading speculated cause. We examined CVBIs in the working dogs of the Sri Lanka air force (SLAF) and free-roaming dogs (FRDs) and privately owned dogs (PODs) country-wide. Giemsa-stained smears were prepared and conventional PCR-positive DNA was subjected to sequencing and phylogeny. Of the 668 dogs sampled, 212 (31.7%) had one or more CVBIs. The prevalence of infections among the FRDs (40.0%) was significantly higher than SLAF working dogs (30.0%; χ2 = 10.5216; p = 0.0012) and PODs (26.2%; χ2 = 5.3414, p = 0.0208) but not between SLAF dogs and PODs (χ2 = 1.7655, p = 0.1838). Many infected dogs were asymptomatic (57.4%), which was higher among the FRDs. Seven infectious agents were identified: Babesia gibsoni, B. canis, Ehrlichia canis, Anaplasma platys, Leishmania sp., Hepatozoon canis, and filaria worms. The most common infection was B. gibsoni (13.8%), followed by E. canis (9.9%). Three tick species: Rhipicephalus linneai, Rhipicephalus haemaphysaloides and Haemophysalis bispinosa were found infesting the dogs. The SLAF dogs were thoroughly quarantined upon arrival, but the infection prevalence was similar to PODs.

Combat Medic-Performed Auscultation Versus Thoracic Ultrasound Image Interpretation for Pneumothorax Detection: Look or Listen?

Background Pneumothorax (PTX) is a potentially life-threatening condition encountered by U.S. Army combat medics on the battlefield. PTX, when left untreated, can progress to tension PTX, a leading cause of preventable death on the battlefield which can be difficult to diagnose based on physical exam alone due to variable physical exam findings. Prior literature shows medics can accurately use point-of-care ultrasound (POCUS) to diagnose PTX in cadaver and porcine models; however, no studies have directly compared the diagnostic accuracy of ultrasound (US) and physical exams performed by this population. We sought to compare medic diagnostic accuracy of a simulated PTX using these two diagnostic modalities. Methodology We conducted a prospective, observational study in which medics from the Flight Paramedic Program at Joint Base San Antonio-Sam Houston, TX received a standardized 30-minute training on physical exam and US diagnosis of PTX, followed by a 20-minute hands-on US familiarization session. Participants were then randomly selected into cohorts to evaluate 12 high-fidelity manikin lung fields and 12 thoracic US video clips for the presence of PTX in a simulated combat environment. Cohorts evaluated the same manikins and thoracic US video clips but in opposing sequences. Our primary outcome compared the sensitivity and specificity of PTX identification via thoracic US image interpretation and physical exam. Results In total, 21 medics evaluated 252 hemithoraces and interpreted 252 thoracic US images. We found a statistically significant difference favoring medics' sensitivity with US image interpretation over physical exam to detect PTX (85.7% vs. 72.4%, p = 0.004). There was no statistically significant difference in specificity between these modalities (81.9% vs. 69.4%, p = 0.139). Conclusions After brief training, medics demonstrated greater sensitivity to detect PTX using thoracic US image interpretation compared to physical exam in a simulated combat environment. Further studies involving medics' ultrasound image acquisition capability in human patients in austere combat environments are warranted.

Strengthening the military stoic tradition: enhancing resilience in military service members and public safety personnel through functional disconnection and reconnection.

This paper addresses operational stress injuries (OSIs) among military service members (SM) and public safety personnel (PSP) resulting from prolonged exposure to potentially psychologically traumatic events (PPTEs). While psychotherapeutic interventions for post-traumatic stress injuries (PTSIs) are well established, there is a significant gap in evidence-based mental health training programs addressing proactive mitigation of negative outcomes from PPTEs. Building on the Functional Disconnection/Functional Reconnection (FD/FR) model, we introduce FD/FR 2, emphasizing early identification and management of psychological risks. FD/FR 2 discusses the practice of emotional suppression, or "pseudo-stoicism," and its potential negative impact on mental health. By integrating authentic Stoic principles, FD/FR 2 offers practical exercises to enhance resilience and well-being, addressing a critical need in current training approaches for military SM and PSP.

Ethical use of big data for healthy communities and a strong nation: unique challenges for the Military Health System.

Recent advances in artificial intelligence (AI) created powerful tools for research, particularly for extracting meaningful insights from extremely large data sets. These developments increase research benefits of big data and risks posed to individual privacy, forcing a re-examination of ethics in research which is of particular importance to the Military Health System. To advance discussion of research ethics in this context, the Forum on Health and National Security: Ethical Use of Big Data for Healthy Communities and a Strong Nation was held in December 2018. The workshop was designed to identify ethical questions relevant to population and health research studies using difficult to access, health-related data in the Department of Defense (DoD). Discussions explored researchers' ethical obligations to research subjects, particularly in the areas of privacy, trust, and consent, as well as potential methods to improve researchers' ability to collect, access, and share data while protecting privacy and potential risks to national security. These include creating risk management frameworks and data governance policies, improving education and workplace training, and increasing community involvement in research design and practice. While the workshop was conducted in 2018, the discussion of data ethics is still relevant today. The research agenda of the nation is best served by building ethics into the research ecosystem. There are substantial challenges to fully realizing this goal including commitments of time and funding to address the ethical complexities, train others to understand them, and create appropriate ethical frameworks before research begins.

Traumatic brain injury rehabilitation for warfighters with post-traumatic stress.

BACKGROUND: While there is extensive empirical support and clinical guidance for the treatment of mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) individually, less is known about treating the comorbid presentation of both conditions. OBJECTIVE: The purpose of this review article is to provide information on the mental health treatment needs of service members (SMs) engaged in traumatic brain injury (TBI) rehabilitation. It also aims to offer a framework for an integrated treatment approach to address the cognitive and psychological health needs of warfighters. METHODS: We review the prevalence and outcomes associated with comorbid TBI and PTSD and present relevant access to care considerations. Additionally, we identify an integrated approach to TBI treatment which takes psychological trauma into consideration. We introduce a trauma-informed care (TIC) model with specified diagnostic and treatment considerations for the service member and veteran (SM/V) communities. TIC is a strengths-based framework that raises the system-wide awareness of treatment facilities to the impact of psychological trauma on behavioral health. RESULTS: A comprehensive diagnostic approach is recommended with considerations for symptom etiology. Clinical considerations derived from available guidelines are identified to meet critical treatment needs for SM/Vs presenting for TBI treatment with a remote history of mTBI and psychological trauma or known PTSD. Clinical practice guidelines are used to inform an integrated TBI treatment model and maximize rehabilitation efforts for warfighters. CONCLUSION: Given the prevalence of comorbid TBI and PTSD among SM/Vs and its impact on outcomes, this review presents the integration of appropriate diagnostics and treatment practices, including the incorporation of CPGs into TBI rehabilitation.

Characteristics of mpox cases diagnosed in Military Health System beneficiaries, May 2022-April 2024

In May 2022, cases of mpox emerged beyond its historically endemic parts of Central and West Africa, primarily affecting men who have sex with men (MSM), and spreading via sexual networks. During this global outbreak the novel clinical and epidemiological characteristics of mpox disease were thoroughly documented in civilian populations but comparable data have not been reported for Military Health System (MHS) populations including beneficiaries. MHS cases were identified through a variety of data sources, including the Disease Reporting System internet (DRSi) and a customized query of ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) encounter codes. Contemporaneous chart reviews of patients' electronic health records in the Armed Forces Health Longitudinal Technology Application (AHLTA) and MHS GENESIS were performed to characterize cases. A total of 146 confirmed and probable MHS cases were identified from May 2022 through April 2024. Most cases occurred among MSM, with the majority developing classic prodromal symptoms and some experiencing anogenital and urinary symptoms.

Incidence of alopecia and hair loss among female active component service members, 2010-2022.

This study aimed to determine the incidence of hair loss among U.S. active component service women, describe the types of hair loss, and summarize potential racial and ethnic disparities of hair loss among service women over the last 12 years. Estimates of traction alopecia among service members have been difficult, as there are no specific diagnosis codes for traction alopecia in the International Classification of Diseases, 9th and 10th revisions (ICD-9/ICD-10). A prior study on the prevalence of alopecia among female active component service women between 2010 and 2019 reported that 2.7% had traction alopecia diagnoses. That estimate may not be accurate, as the previous study used the ICD-9 code 704.01 (alopecia areata) and ICD-10 code Q84.0 (congenital alopecia), which are not fully representative of traction alopecia cases in administrative health records. This study used ICD-9/ICD-10 diagnostic codes 704.0 (ICD-9), L63, L64, L65, and L66 (ICD-10) to define cases of alopecia. The study population included female active component service members in the U.S. Army, Navy, Air Force, and Marine Corps between January 1, 2010 and December 31, 2022. The overall incidence rate of alopecia was 804.4 per 100,000 person-years. Non-Hispanic Black and Hispanic female active component service members had the highest incidence rates among all races and ethnicities, at 1,138.7 and 1,013.6 per 100,000 person-years, respectively. Non-Hispanic Black female active component service members were more than twice as likely to be diagnosed with alopecia compared to non-Hispanic White female active component service members.

Use of telemedicine for trauma care since the Russian invasion of Ukraine: A qualitative assessment.

INTRODUCTION: Ukraine's health and trauma system has been detrimentally impacted since the start of the Russian invasion in February 2022. Use of telemedicine became critical to providing timely medical care. As such, the aim of this study was to describe telemedicine's use in the health and trauma system of Ukraine following the full-scale invasion. METHODS: We conducted qualitative key informant interviews with military and civilian health care workers using an expanded version of the Global Trauma System Evaluation Tool which had components focusing on telemedicine use. Thematic content analysis was used to derive key telemedicine themes from interviews. RESULTS: We conducted 36 key informant interviews. Most respondents described using telemedicine through informal means of communication such as messaging apps to meet patient care needs. Concerns and challenges with use of telemedicine included weapons targeting, internet connections and safety of communications from Russian hackers. A unified system for telemedicine would greatly improve use in country both during and post conflict. DISCUSSION: Telemedicine use has rapidly increased in Ukraine during the current conflict particularly in the scope of providing trauma care when numerous specialties are needed. Development of a unified, secure telemedicine system with mechanisms for integrating multinational medical support would aid in providing swift medical care to persons injured in the conflict or unable to access a specialty provider in their proximity.

Factors influencing postdeployment reintegration adjustment for U.S. service members and their spouses by spouse gender.

Research on spouses' adjustment after military deployment has focused primarily on female spouses of male service members; little is known about how adjustment differs by gender. We used Walsh's family resilience framework to examine communication, belief system, organizational factors, and other stressors, likely associated with postdeployment adjustment. Using Millennium Cohort Family Study data, logistic regressions assessed risk and protective factors on spouses' and service members' time to adjust, exploring whether spouse gender moderated their associations. Findings indicated that the association of (1) spouses' perceptions of their own mental functioning with spouses' and service members' adjustment and (2) spouses' mental readiness for deployment with service members' adjustment both differed by spouse gender, with associations attenuated for male spouses and their service member partners. Other factors associated with family adjustment included the spouse's satisfaction with communication, the extent to which the service member shared deployment experiences, the extent to which the spouse was bothered by deployment experiences, the spouse's participation in postdeployment transition programs, the spouse's informal support during deployment, and length of deployment. Results indicated shared and gender-specific risk and protective factors associated with spouse and service member adjustment, demonstrating the importance of tailored military family support programs addressing the needs of different populations of military spouses.