Health measurement instruments and their applicability to military veterans: a systematic review.

INTRODUCTION: Accurate measurement of health status is essential to assess veterans' needs and the effects of interventions directed at improving veterans' well-being. We conducted a systematic review to identify instruments that measure subjective health status, considering four components (ie, physical, mental, social or spiritual well-being). METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we searched CINAHL, MEDLINE, Embase, PsycINFO, Web of Science, JSTOR, ERIC, Social Sciences Abstracts and ProQuest in June 2021 for studies reporting on the development or evaluation of instruments measuring subjective health among outpatient populations. We assessed risk of bias with the Consensus-based Standards for the Selection of Health Measurement Instruments tool and engaged three veteran partners to independently assess the clarity and applicability of identified instruments. RESULTS: Of 5863 abstracts screened, we identified 45 eligible articles that reported health-related instruments in the following categories: general health (n=19), mental health (n=7), physical health (n=8), social health (n=3) and spiritual health (n=8). We found evidence for adequate internal consistency for 39 instruments (87%) and good test-retest reliability for 24 (53%) instruments. Of these, our veteran partners identified five instruments for the measurement of subjective health (Military to Civilian Questionnaire (M2C-Q), Veterans RAND 36-Item Health Survey (VR-36), Short Form 36, Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF) and Sleep Health Scale) as clear and very applicable to veterans. Of the two instruments developed and validated among veterans, the 16-item M2C-Q considered most components of health (mental, social and spiritual). Of the three instruments not validated among veterans, only the 26-item WHOQOL-BREF considered all four components of health. CONCLUSION: We identified 45 health measurement instruments of which, among those reporting adequate psychometric properties and endorsed by our veteran partners, 2 instruments showed the most promise for measurement of subjective health. The M2C-Q, which requires augmentation to capture physical health (eg, the physical component score of the VR-36), and the WHOQOL-BREF, which requires validation among veterans.

Preparing a deployed role 3 medical treatment facility for COVID-19 in Afghanistan.

The Craig Joint Theater Hospital at Bagram Airfield is the coalition role 3 facility for the North Atlantic Treaty Organization-led Operation RESOLUTE SUPPORT in northern Afghanistan. The onset of the global COVID-19 pandemic in early 2020 presented the challenges of limiting viral transmission, disease force protection, specific protection of healthcare workers and management of patients with COVID-19, all while continuing to provide high-quality care for battlefield trauma. The estimated COVID-19 threat led to the introduction of enhanced force protection measures across the Combined Joint Operations Area-Afghanistan. Surveillance testing of high-risk groups at coalition locations was established. Non-essential movements were restricted and quarantine periods instigated. Protection of healthcare workers and patients was improved with enhanced personal protective equipment as well as structural, procedural and personnel changes across the role 3 facility in order to limit viral exposure and transmission. This occurred in a resource-limited environment without degrading overall clinical capability.