Abstinence outcomes among women in reproductive health centers administered clinician or electronic brief interventions.

Treatment of substance use in women seeking reproductive healthcare is crucial for the health of both women and their offspring. Although abstinence from all substance use during pregnancy is optimal, it is difficult to achieve. This secondary analysis reports abstinence outcomes from a randomized clinical trial of screening, brief intervention, and referral to treatment (SBIRT) for substance use among women seeking reproductive healthcare services. Women who screened positive for substance use were randomly assigned to either clinician-administered SBIRT, an electronically-administered brief intervention (e-SBIRT), or an enhanced usual care condition. At a 6-month follow-up assessment, compared to enhanced usual care, the clinician-administered SBIRT increased 1-month point prevalence of abstinence from the primary substance by 7.7%, and e-SBIRT increased abstinence by 12.8%. Both brief interventions were more useful than enhanced usual care and could increase substance use abstinence rates among women in reproductive healthcare clinics. The electronic brief intervention is particularly attractive given that it appears as efficacious as, but requires fewer resources than, clinician-delivered brief interventions.

Impact of Smoking and Smoking Cessation Medications in Aviators.

PURPOSE OF REVIEW: To (1) compare the effects of cigarette smoking, nicotine withdrawal, and smoking cessation medications in US civilian and military aviators and (2) review the regulations in place regarding the use of smoking cessation medications for US aviators. RECENT FINDINGS: Cigarette smoking and associated cessation attempts are associated with multiple hazards in flight to aviators including effects from nicotine intoxication, nicotine withdrawal, carbon monoxide intoxication, and side effects related to smoking cessation medications. Current civilian and military regulations place significant restrictions on the use of smoking cessation medications to aviators; however, recent research suggests that the hazards associated with these medications might be lower than the risk-associated unassisted nicotine withdrawal. An evidence-based approach to smoking cessation may require changing restrictions against smoking cessation medication use in US civilian and military aviators. Use and cessation of smokeless tobacco and e-cigarettes require additional attention and research in this population.

Burnout in Army health care providers.

Research performed on soldiers in the military far exceeds that of research performed on military health care providers. The focus of this study was to explore the prevalence of burnout among the health care providers of the 101 st Airborne Division in relation to deployments. A cross-sectional survey was electronically dispersed to 158 health care professionals including combat medics, physician assistants, and physicians. Over one-third of these professionals completed the online anonymous survey successfully. Results revealed that the majority of those surveyed were, in fact, burnt out. The study showed no correlation between burnout and deployment, though it did demonstrate correlation to the number of leave days accrued. More in-depth research and analysis is needed to further explain this correlation of health care providers in the military, the amount of leave days they have accrued, and burnout. Further research is also needed to see if this high level of burnout is present among military providers of other services, in different locations, and between different professions.

Telebehavioral health in Afghanistan.

Providing behavioral health care to numerous beneficiaries spread over a large and dangerous area is a unique and challenging responsibility faced by the U.S. Army in the deployed environment. We describe the use of telebehavioral health as one tool available to behavioral health officers in Afghanistan to reach remote service members when face-to-face encounters are not possible or practical. Finally, challenges to the current telebehavioral system established during Operation Enduring Freedom are discussed, with recommendations made for implementation in future deployed settings.

Evolution of the combat and operational stress control detachment.

Medical units designed to provide combat and operational stress control services have evolved since World War II into the current Combat and Operational Stress Control (COSC) detachments. Yet the structure of these COSC detachments differ greatly between what is authorized in the table of organization and equipment (TO&E) and what is doctrinally described in the current field manual guiding combat and operational stress control operations. We therefore explore the evolution of the COSC detachment, compare the organizations found in current doctrine with that currently authorized on the TO&E, and conclude with a proposed structure of a modern COSC detachment that is functionally modular with more clear chains of command.

Modeling manipulation in medical education.

As residents and medical students progress through their medical training, they are presented with multiple instances in which they feel they must manipulate the healthcare system and deceive others in order to efficiently treat their patients. This, however, creates a culture of manipulation resulting in untoward effects on trainees' ethical and professional development. Yet manipulation need not be a skill necessary to practice medicine, and steps should be taken by both individuals and institutions to combat the view that the way medicine must be practiced "in the real world" is somehow different from what one's affective moral sense implores.

Hippocampal atrophy in persons with age-associated memory impairment: volumetry within a common space.

OBJECTIVE: The objective of this study is to demonstrate the assessment of hippocampal atrophy within a standard brain atlas for persons with age-associated memory impairment (AAMI) compared with cognitively intact elderly. METHODS: High-resolution three-dimensional (3D) brain magnetic resonance imaging (MRI) was performed on 20 nondemented persons: 10 had AAMI and 10 were normal elderly. Scans were aligned to a common atlas template to control for errors due to variable brain size and orientation as well as facilitating communication of results across centers. Manual outlining every 1 mm with volumes determined for both the hippocampal head and body was accomplished after coronal resampling perpendicular to the long axis of the hippocampus. RESULTS: Subject groups were similar in age, sex ratios, and educational achievement. The AAMI group had significantly lower volumes for the right hippocampus and hippocampal head (p =.02) compared with controls. CONCLUSION: A growing body of work suggests the right hippocampal head as an early site of atrophy in early memory impairment. Subtle atrophic changes are detectable within a common atlas template allowing imaging assessment across centers.