Heat exhaustion and heat stroke among active component members of the U.S. Armed Forces, 2019-2023.

The most serious types of heat illnesses, heat exhaustion and heat stroke, are occupational hazards associated with many of the military's training and operational environments. These illnesses can typically be prevented by appropriate situational awareness, risk management strategies, along with effective countermeasures. In 2023, the crude incidence of heat stroke and heat exhaustion were 31.7 and 172.7 cases per 100,000 person-years, respectively. The rates of incident heat stroke declined during the 2019 to 2023 surveillance period, but rates of incident heat exhaustion increased over the same period. In 2023, higher rates of heat stroke were observed among male service members compared to their female counterparts, and female service members experienced higher rates of heat exhaustion compared to male personnel. Heat illness rates were also higher among those younger than age 20, Marine Corps and Army service members, non-Hispanic Black service members, and recruits. Leaders, training cadres, and supporting medical and safety personnel must inform their subordinate and supported service members of heat illness risks, preventive measures, early signs and symptoms of illness, and appropriate interventions.

Feasible Removal of Facial Hemangiomas Under Local Anesthesia in Young Children.

BACKGROUND: Facial Hemangiomas are often recommended to be removed exclusively in the operating room under general anesthesia, especially for children under the age of 4. Assumed parental and patient anxiety and possible blood loss pushes surgeons away from attempting excision under local anesthesia. METHODS: A review was conducted to assess the outcomes of children who underwent excision of facial hemangiomas under local anesthesia alone by 1 plastic surgeon with a minimum of 3 months follow-up. Complications and hemangioma recurrence were recorded. A survey was given 3 to 6 months after treatment to assess parental satisfaction, anxiety, and thought process about anesthesia. RESULTS: Eighteen children (9 males and 9 females) underwent in-office excision between 2020 and 2021. The mean age of this cohort was 12 months ( ranging 2-52 m). The average facial hemangioma size was 2.088 cm (ranging 1.0-3.2 cm). Ten patients experienced complete resolution (56%) at 12-month follow-up. There were no hospitalizations or cases of significant (>10 mL) blood loss, infection, dehiscence, hematoma, or scar hypertrophy. The average level of parental anxiety before the procedure was 3.3/10, and 1.6/10 after the procedure. Total 13/14 parents gave 4/4 ratings for satisfaction with the quality of care, team responsiveness, pain management, and management of expectations. CONCLUSIONS: Facial hemangioma removal under local anesthesia alone is a safe and feasible alternative treatment method for patients younger than 4 years of age.

Financial costs to the U.S. Army for suicides by newly enlisted Soldiers.

OBJECTIVE: To estimate the financial burden to the U.S. Army of suicide by enlisted Soldiers during their first year of service. METHODS: This analysis included new Army enlisted Soldiers who started initial entry training from October 2012 through September 2016 and subsequently died by suicide within their first year of service. Outpatient and inpatient direct medical, direct nonmedical, recruiting, and training costs to the Army were calculated. RESULTS: During the 48-month observational study period, 29 Soldiers died by suicide within their respective first year of service. The described financial costs accrued by the Army as a result of these deaths were $152,271-with an average of $6,091 per healthcare utilizer. Recruiting and training costs were $1,115,860 for all suicide cases. CONCLUSION: Average direct cost per healthcare utilizer increased during a Soldier's first year of service. This may be associated with the transition through different phases of training and to the first operational duty station. PUBLIC HEALTH IMPLICATIONS: Results obtained through this cost-of-illness analysis may serve as baseline metrics to inform future cost-effectiveness studies.

A Cross-Sectional Examination of the Association Between Social Media Use and Sleep Among a Sample of U.S. Army Soldiers.

INTRODUCTION: In the United States (U.S.), approximately 35% of adults sleep less than 7 hours per night. The relationship between social media use and insufficient sleep has not thoroughly been examined among adults. The purpose of this study was to determine if social media use is associated with insufficient sleep among a sample of U.S. Army Soldiers. METHODS: This study surveyed 9,052 U.S. Soldiers in 2018 via a self-administered online questionnaire. Using multivariable logistic regression, we examined the association between social media use (<38 hours vs. ≥38 hours per week) and insufficient sleep, controlling for demographic and behavioral covariates. RESULTS: Overall, 54.9% of Soldiers reported insufficient sleep. There was no significant relationship between excessive social media use and insufficient sleep in the multivariable logistic regression (OR: 1.03; CI: 0.87-1.23). The covariates of sex, race/ethnicity, rank, hazardous alcohol consumption, anxiety, and depression were significantly associated with insufficient sleep. Soldiers who reported symptoms of anxiety were more than twice as likely (OR: 2.11; CI: 1.65-2.70) to report insufficient sleep than Soldiers without signs of anxiety. Additionally, Soldiers who reported depressive symptoms were 85% (OR: 1.85; CI: 1.44-2.37) more likely to experience insufficient sleep than Soldiers without signs of depression. CONCLUSION: Sufficient sleep is essential to ensuring mission readiness and preventing accidental morbidity and mortality among Soldiers. The findings of this analysis do not suggest a link between extended social media use and insufficient sleep. However, though previously uninvestigated, Soldiers reporting symptoms of anxiety and depression were more likely to experience insufficient sleep compared to unafflicted Soldiers. Therefore developing a culture that encourages Soldiers to seek necessary behavioral health screening and care could be a key primary strategy to promote adequate sleep.

Screw Placement Accuracy and Outcomes Following O-Arm-Navigated Atlantoaxial Fusion: A Feasibility Study.

Study Design Case series of seven patients. Objective C2 stabilization can be challenging due to the complex anatomy of the upper cervical vertebrae. We describe seven cases of C1-C2 fusion using intraoperative navigation to aid in the screw placement at the atlantoaxial (C1-C2) junction. Methods Between 2011 and 2014, seven patients underwent posterior atlantoaxial fusion using intraoperative frameless stereotactic O-arm Surgical Imaging and StealthStation Surgical Navigation System (Medtronic, Inc., Minneapolis, Minnesota, United States). Outcome measures included screw accuracy, neurologic status, radiation dosing, and surgical complications. Results Four patients had fusion at C1-C2 only, and in the remaining three, fixation extended down to C3 due to anatomical considerations for screw placement recognized on intraoperative imaging. Out of 30 screws placed, all demonstrated minimal divergence from desired placement in either C1 lateral mass, C2 pedicle, or C3 lateral mass. No neurovascular compromise was seen following the use of intraoperative guided screw placement. The average radiation dosing due to intraoperative imaging was 39.0 mGy. All patients were followed for a minimum of 12 months. All patients went on to solid fusion. Conclusion C1-C2 fusion using computed tomography-guided navigation is a safe and effective way to treat atlantoaxial instability. Intraoperative neuronavigation allows for high accuracy of screw placement, limits complications by sparing injury to the critical structures in the upper cervical spine, and can help surgeons make intraoperative decisions regarding complex pathology.