Incidence and risk factors for hip fractures among U.S. Armed Forces active component women compared to men, 2018-2022.

Women, who comprise approximately 18% of the U.S. Armed Forces, suffer disproportionately higher rates of musculoskeletal injuries among active component service members. Using a retrospective study design, this study calculated incidence rates and rate ratios for acute hip fractures and hip stress fractures from January 1, 2018 through September 30, 2022 among female and male active component U.S. military members. Women who were younger than age 20 years, in recruit training, serving in the Army or Marine Corps, engaged in combat-related occupations, and with body mass indexes in the underweight or normal weight categories had the highest rates of both types of fractures. Women who had progressed beyond the recruit training phase had a higher female-to-male rate ratios of hip stress fractures than recruits. Despite an overall decline during the surveillance period, rates of acute hip fracture and hip stress fracture were higher among women than men. Changes in training and fitness policies may have contributed to the hip fracture rate declines among women. Continued efforts are needed to further reduce injuries among women.

Vitamin D deficiency trends, risk factors, and occupational risk in active component service members of the U.S. Armed Forces, 2018-2022.

Vitamin D contains 2 related fat-soluble substances, D3 and D2, that are essential for bone health and overall well-being. The burden of vitamin D deficiency within the active component of the armed forces is unknown. This study describes trends of vitamin D deficiency diagnoses in the active component of the U.S. Armed Forces. Risk factors for vitamin D, such as military occupation, were examined to see if preventive measures and targeted vitamin D screening would be beneficial, as the United States Preventive Task Force does not recommend universal screening for vitamin D, nor does TRICARE cover screening for asymptomatic individuals. The surveillance period covered January 1, 2018 through December 31, 2022. The data were derived from the Defense Medical Surveillance System (DMSS). Vitamin D deficiency was measured using ICD-9-CM and ICD-10-CM diagnoses recorded in inpatient and outpatient medical encounters. Incidence rate and average annual prevalence were calculated. A logistic regression was performed to obtain adjusted odds ratios. The rates of vitamin D deficiency diagnoses among active component service members (ACSMs) remained steady during the study period, with an incidence rate of 16.4 per 1,000 person-years and an average annual prevalence of 2.2%. Female service members, those of older age groups, and indoor workers demonstrated higher rates of vitamin D deficiency. Previously described demographic risk factors such as indoor work and history of obesity or malabsorption syndrome were also associated in this study with vitamin D deficiency in ACSMs, although older age groups in this study were not associated with vitamin D deficiency. Pilots and air crew had the lowest rates of vitamin D deficiency, while health care workers had the highest, when evaluating by occupation.

Malaria in the Australian military, 2008-2022.

Australian Defence Force (ADF) personnel train and operate in malarious regions that include neighboring countries with high burden and species with latent hepatic parasites.1 We summarized longitudinal malaria case data, following a prior 10-year period review to 2007.2 Malaria case entries within the ADF Malaria and Infectious Diseases Institute (ADFMIDI)-managed Central Malaria Register (CMR) were examined. Data from cases confirmed between January 1, 2008 through December 31, 2022 were analyzed. Sixty ADF members were diagnosed with malaria, including 1 with a mixed Plasmodium falciparum and P. vivax infection. Of 61 malaria infections, 69% (42 of 61) were P. vivax. P. vivax infection resulted in delayed initial case presentation (more than 4 weeks after exposure) in at least 36% (15 of 42) of cases, and 5 personnel experienced further relapse. Most P. vivax infections were acquired in the U.S. Indo-Pacific Command (INDOPACOM) and P. falciparum in the U.S. Africa Command (AFRICOM) regions. The ADF experienced ongoing reduced malaria case incidence following high rates in the early 2000s. Maintenance of prophylactic vigilance, both for eradicating dormant hypnozoites and preventing P. vivax relapse, remains important, however.

Lymphatic filariasis in soldiers exposed in INDOPACOM.

Some military organizations in the U.S. Indo-Pacific Command (INDOPACOM) give returning soldiers presumptive treatment for filariasis. As there have been few clinical cases in recent decades, the historical basis for this chemotherapy was reviewed. During the Second World War, U.S. Marines stationed on Polynesian islands such as Tonga, Samoa, and Fiji experienced clinical lymphatic filariasis. Although thousands of both U.S. and Australian soldiers served in New Guinea, few, if any, cases of lymphatic filariasis were ascribed to Melanesia. While the French Army reported dozens of cases of filariasis among its service members during the 1950s Vietnam conflict, the U.S. military experienced only a few cases among the nearly 2 million service members who served in Vietnam in the 1960s. Australian soldiers deployed to Timor Leste in the 21st century showed rare seroconversions to filaria but no clinical disease. Following mass drug administration to eliminate lymphatic filaria in the INDOPACOM region, exposure in deployed soldiers rarely occurs and preventive chemotherapy should cease.

Canadian Veterans' Experiences of Living with Chronic Pain: A Descriptive Qualitative Study.

Background: An estimated 30% of veterans live with chronic pain, compared to 20% of Canadians in the general population. Veterans face health care challenges upon release from the military, increasing difficulties in obtaining chronic pain care. Aims: We explored experiences of Canadian Armed Forces veterans living with chronic pain, their transition from military to civilian care, perceived barriers and facilitators to chronic pain care, and impacts of their pain on the domains of well-being. Methods: We conducted a qualitative descriptive study using semistructured interviews. We used a deductive/inductive approach to derive themes and concepts from interview transcripts. Results: Thirty-five veterans living with chronic pain participated. Participants reported that pain affected their lives in numerous ways, including negatively impacting relationships and limiting activities of daily living and leisure. They identified barriers to care, including lack of access to family doctors or health care services, reluctance to ask for help, and challenges in obtaining coverage for services from Veterans Affairs Canada. Facilitators included support from other veterans and online resources. Chronic pain had bidirectional effects on domains of well-being. Conclusions: Experiences of pain varied among Canadian veterans, and military culture played a role in perceptions and management of pain. Barriers and facilitators to chronic pain care were highlighted from their time in the military into their transition to civilian care. Participants described the impact of chronic pain on their overall well-being. Determining whether these findings are relevant to a larger population of Canadian veterans will be important for future research and knowledge translation to improve chronic pain care for Canadian veterans.

Contexte : On estime que 30 % des anciens combattants souffrent de douleur chronique, contre 20 % des Canadiens dans la population générale Les vétérans sont confrontés à des défis en matière de soins de santé lorsqu'ils quittent l'armée, ce qui augmente les difficultés pour obtenir des soins pour la douleur chronique.Objectifs : Nous avons exploré les expériences des vétérans des Forces armées canadiennes vivant avec une douleur chronique, leur transition des soins militaires aux soins civils, les obstacles et les facilitateurs perçus en matière de soins pour la douleur chronique, ainsi que les effets de cette douleur sur les différents aspects de leur bien-être.Méthodes : Nous avons réalisé une étude qualitative descriptive en utilisant des entretiens semi-structurés. Une approche à la fois déductive et inductive a été utilisée pour extraire des thèmes et des concepts à partir des transcriptions des entretiens.Résultats : Trente-cinq anciens combattants souffrant de douleur chronique ont participé à l'étude. Les participants ont déclaré que la douleur affectait leur vie de nombreuses façons, notamment en ayant un impact négatif sur leurs relations en limitant les activités de la vie quotidienne ainsi que les loisirs. Ils ont recensé des obstacles aux soins, notamment le manque d'accès à des médecins de famille ou aux services de soins de santé, la réticence à demander de l'aide, et les difficultés à obtenir une couverture pour les services d'Anciens Combattants Canada. Les facilitateurs comprennent le soutien d'autres anciens combattants et les ressources en ligne. La douleur chronique a eu des effets bidirectionnels sur différents aspects de leur bien-être.Conclusions : Les expériences de la douleur varient parmi les anciens combattants canadiens, et la culture militaire joue un rôle dans les perceptions et la prise en charge de la douleur. Les obstacles aux soins pour la douleur chronique, ainsi que les facilitateurs, ont été mis en évidence depuis leur temps dans l'armée jusqu'à leur transition vers les soins civils. Les participants ont décrit l'effet de la douleur chronique sur leur bien-être général. Il sera important de déterminer si ces résultats sont pertinents pour une population plus large d'anciens combattants canadiens dans le cadre de recherches futures et de l'application des connaissances, afin d'améliorer les soins pour la douleur chronique chez les anciens combattants canadiens.

Absolute and relative morbidity burdens attributable to various illnesses and injuries among non-service member beneficiaries of the Military Health System, 2023.

The Military Health System (MHS) is a global, integrated health delivery system tasked with ensuring the medical readiness of the U.S. Armed Forces while fulfilling the individual health care needs of eligible military personnel and their dependents. The MHS network comprises military hospitals and clinics that ensure the medical readiness of the force, which are complemented by programs that enable beneficiary care in the private sector through the TRICARE insurance program. Mental health disorders accounted for the largest proportions of the morbidity and health care burdens that affected the pediatric and younger adult beneficiary age groups of nonservice member beneficiaries of the Military Health System in 2023. Among adults aged 45-64 years and adults aged 65 years and older, musculoskeletal diseases accounted for the most morbidity and health care burdens. With almost all health care for Medicare-eligible beneficiaries aged 65 years and older at private sector medical facilities, over 91% of health care encounters among non-service member beneficiaries (TRICARE-eligible and Medicare-eligible) occurred at non-military medical facilities.

Blood far forward: A cross-sectional analysis of prehospital transfusion practices in the Canadian Armed Forces.

BACKGROUND: Canadian Armed Forces (CAF) operate in environments that challenge patient care, especially trauma. Military personnel often find themselves in remote settings without conventional healthcare facilities. Treating traumatic injuries, particularly hemorrhagic shock, often necessitates prehospital blood transfusion. This study aims to present an overview of the current CAF prehospital transfusion practices. Furthermore, the study compared current and developing protocols against expert-recommended guidelines. METHODS: A cross-sectional survey design was employed to describe and compare CAF prehospital blood transfusion practices and protocols against expert recommendations. Topics included protocols, equipment, and procedures. An online survey targeted medical leadership and providers within CAF, with data collected from August 15 to December 15, 2023. Results were summarized descriptively. This study received approval from the Unity Health Toronto Research Ethics Board (REB 23-087). RESULTS: Units and teams with prehospital blood transfusion capabilities were contacted, achieving a 100 % response rate. Within CAF, Canadian Special Operations Forces Command (CANSOFCOM), Mobile Surgical Resuscitation Team (MSRT), and Canadian Medical Emergency Response Team (CMERT) possess these capabilities, established between 2013 and 2018. These programs are crucial for military operations. CAF has access to standard blood components, cold Leuko-Reduced Whole Blood (LrWB), and factor concentrates from Canadian Blood Services (CBS), available for both domestic and international missions given adequate planning and favorable conditions. Key findings indicate high adherence to recommended practices, some variability in the transfusion process, and potential benefits of standardizing prehospital transfusion practices. CONCLUSIONS: This study provided insights into CAF's implementation of prehospital transfusion practices, highlighting high adherence to national expert recommendations and the importance of structured protocols in military prehospital trauma management. IMPLICATIONS OF KEY FINDINGS: CAF's approach and adoption of prehospital transfusion protocols lay a strong foundation for managing trauma patients in remote settings and for expanding prehospital transfusion capabilities across CFHS deployed assets. Further research is needed to advance military trauma care by adapting prehospital blood transfusion to dynamic tactical landscapes and evolving technologies.

Sleep disturbances and psychological well-being among military medical doctors of the Swiss Armed Forces: study protocol, rationale and development of a cross-sectional and longitudinal interventional study.

Background: Compared to civilians and non-medical personnel, military medical doctors are at increased risk for sleep disturbances and impaired psychological well-being. Despite their responsibility and workload, no research has examined sleep disturbances and psychological well-being among the medical doctors (MDs) of the Swiss Armed Forces (SAF). Thus, the aims of the proposed study are (1) to conduct a cross-sectional study (labeled 'Survey-Study 1') of sleep disturbances and psychological well-being among MDs of the SAF; (2) to identify MDs who report sleep disturbances (insomnia severity index >8), along with low psychological well-being such as symptoms of depression, anxiety and stress, but also emotion regulation, concentration, social life, strengths and difficulties, and mental toughness both in the private/professional and military context and (3) to offer those MDs with sleep disturbances an evidence-based and standardized online interventional group program of cognitive behavioral therapy for insomnia (eCBTi) over a time lapse of 6 weeks (labeled 'Intervention-Study 2'). Method: All MDs serving in the SAF (N = 480) will be contacted via the SAF-secured communication system to participate in a cross-sectional survey of sleep disturbances and psychological well-being ('Survey-Study 1'). Those who consent will be provided a link to a secure online survey that assesses sleep disturbances and psychological well-being (depression, anxiety, stress, coping), including current working conditions, job-related quality of life, mental toughness, social context, family/couple functioning, substance use, and physical activity patterns. Baseline data will be screened to identify those MDs who report sleep disturbances (insomnia severity index >8); they will be re-contacted, consented, and randomly assigned either to the eCBTi or the active control condition (ACC) ('Intervention-Study 2'). Individuals in the intervention condition will participate in an online standardized and evidence-based group intervention program of cognitive behavioral therapy for insomnia (eCBTi; once the week for six consecutive weeks; 60-70 min duration/session). Participants in the ACC will participate in an online group counseling (once the week for six consecutive weeks; 60-70 min duration/session), though, the ACC is not intended as a bona fide psychotherapeutic intervention. At the beginning of the intervention (baseline), at week 3, and at week 6 (post-intervention) participants complete a series of self-rating questionnaires as for the Survey-Study 1, though with additional questionnaires covering sleep-related cognitions, experiential avoidance, and dimensions of self-awareness. Expected outcomes: Survey-Study 1: We expect to describe the prevalence rates of, and the associations between sleep disturbances (insomnia (sleep quality); sleep onset latency (SOL); awakenings after sleep onset (WASO)) and psychological well-being among MDs of the SAF; we further expect to identify specific dimensions of psychological well-being, which might be rather associated or non-associated with sleep disturbances.Intervention-Study 2: We expect several significant condition-by-time-interactions. Such that participants in the eCBTi will report significantly greater improvement in sleep disturbances, symptoms of depression, anxiety, stress reduction both at work and at home (family related stress), and an improvement in the overall quality of life as compared to the ACC over the period of the study. Conclusion: The study offers the opportunity to understand the prevalence of sleep disturbances, including factors of psychological well-being among MDs of the SAF. Further, based on the results of the Intervention-Study 2, and if supported, eCBTi may be a promising method to address sleep disturbances and psychological well-being among the specific context of MDs in the SAF.

Morbidity burdens attributable to various illnesses and injuries among deployed active and reserve component service members of the U.S. Armed Forces, 2023.

This report updates previous analyses of health care burden distributions among active and reserve component service members of the U.S. Armed Forces in deployed settings. Musculoskeletal disorders in combination with administrative and other health services (ICD-10 "Z" codes) accounted for more than half of all medical encounters in 2023 among service members deployed to the U.S. Central Command (CENTCOM) and Africa Command (AFRICOM). Three common injury conditions occurred among male and female service members deployed to U.S. CENTCOM and U.S. AFRICOM: other back problems, arm and shoulder injuries, and knee injuries.

Medical evacuations out of U.S. Central and Africa commands among the active and reserve components of the U.S. Armed Forces, 2023

This report summarizes the nature, numbers, and trends of conditions for which military members were medically evacuated from the U.S. Central Command (CENTCOM) or Africa Central Command (AFRICOM) operations during 2023, with historical comparisons to the previous 4 years. Mental health disorders and injuries were the most common diagnostic categories in 2023 among service members medically evacuated from U.S. Central Command (CENTCOM) and U.S. Africa Command (AFRICOM). In 2023, 724 service members were medically evacuated from CENTCOM and 225 were evacuated from AFRICOM, with hospitalization required for 197 (27.2%) and 50 (22.2%), respectively. Most service members who were medically evacuated from CENTCOM or AFRICOM were returned to full duty status following their post-evacuation hospitalizations or outpatient evaluations. In 2023, evacuations for both battle and non-battle injuries from U.S. CENTCOM increased, following a period of decline. The number of service members medically evacuated in 2023 from AFRICOM remained unchanged from the previous year.

Sexually transmitted infections among active component members of the U.S. Armed Forces, 2015-2023.

This report summarizes incidence rates and trends of sexually transmitted infections (STIs) from 2015 through 2023 among active component service members of the U.S. Armed Forces. The data compiled for this report are derived from the medical surveillance of chlamydia, gonorrhea, and syphilis as nationally notifiable diseases. Case data for 2 additional STIs, human papilloma virus (HPV) and genital herpes simplex virus (HSV), are also presented. The crude total case rates of chlamydia and gonorrhea initially rose by an average of 6.7% and 9.8% per year, respectively, until 2019. From 2020 onwards, rates steadily declined. By 2023, chlamydia rates had dropped by approximately 39%, while gonorrhea rates had fallen by more than 40% for female, and 19% for male, service members. Initially syphilis increased, on average, 10% annually from 2015 to 2019, then declined in 2020, but resumed its upward trend through 2023, nearly doubling the 2015 rate in 2023. The total crude annual incidence rates of genital HPV and HSV exhibited downward trends in general over the surveillance period, decreasing by 30.7% and 24.7%, respectively. Age- and gender-adjusted case rates for chlamydia, gonorrhea, and syphilis remain elevated within the U.S. Armed Forces compared to the general U.S. population, which may be due to factors that include mandatory STI screening, more complete reporting, incomplete adjustment for age distribution, and inequitable comparisons between the military active duty and general U.S. populations. Social restrictions enacted during the COVID-19 pandemic may have contributed to declines in true case rates and screening coverage.

Canadian Armed Forces Veterans' Perspectives on the Effects of Exposure to Children in Armed Conflict During Military Service: Protocol for a Qualitative Study.

BACKGROUND: The mental health of military personnel has garnered increased attention over the last few decades; however, the impacts of perpetuating, observing, or failing to prevent acts that transgress deeply held moral standards, referred to as moral injuries, are less understood, particularly in relation to encounters with children during deployment. This paper describes a multiphased research protocol that centers around the lived experiences of Canadian Armed Forces (CAF) Veterans to understand how encounters with children during military deployments impact the well-being and mental health of military personnel. OBJECTIVE: This study has four objectives: (1) highlight the lived experiences of CAF Veterans who encountered children during military deployments; (2) improve understanding of the nature of experiences that military personnel faced that related to observing or engaging with children during military service; (3) improve understanding of the mental health impacts of encountering children during military service; and (4) use participatory action research (PAR) to develop recommendations for improving preparation, training, and support for military personnel deployed to contexts where encounters with children are likely. METHODS: The research project has 2 main phases where phase 1 includes qualitative interviews with CAF Veterans who encountered children during military deployments and phase 2 uses PAR to actively engage Canadian Veterans with lived experiences of encountering children during military deployments, as well as health professionals and researchers to identify recommendations to better address the mental health effects of these encounters. RESULTS: As of January 26, 2024, a total of 55 participants and research partners have participated in the 2 phases of the research project. A total of 16 CAF Veterans participated in phase 1 (qualitative interviews), and 39 CAF Veterans, health professionals, and researchers participated in phase 2 (PAR). The results for phase 1 have been finalized and are accepted for publication. Data collection and analysis are ongoing for phase 2. CONCLUSIONS: Prioritizing and valuing the experiences of CAF Veterans has deepened our understanding of the intricate nature and impacts of potentially morally injurious events involving children during military deployments. Together with health professionals and researchers, the PAR approach empowers CAF Veterans to articulate important recommendations for developing and improving training and mental health support. This support is crucial not only during the deployment cycle but also throughout the military career, helping lessen the effects of moral injury among military personnel. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57146.

Post-traumatic stress disorder and associated factors among inpatients at Eastern Command Referral Hospital in Dire Dawa, Eastern Ethiopia.

Background: Post-traumatic stress disorder (PTSD) is characterized by heightened stress and anxiety after experiencing a traumatic event. While numerous studies have been conducted to investigate the magnitude and factors associated with PTSD, there is limited evidence available on specific study populations of military personnel. Objective: The study aimed to determine the magnitude of post-traumatic stress disorder and associated factors among military personnel admitted to the Eastern Command Referral Hospital in Eastern Ethiopia from May 1 to 30, 2023. Methods and materials: A cross-sectional study was carried out at an institution. Face-to-face interviews were conducted to collect data using the post-traumatic stress disorder military version checklist for the Diagnostic and Statistical Manual, Fifth Edition. Data were entered and analyzed using EpiData version 3.1 and STATA version 14. Descriptive statistics were employed to summarize the information. To investigate factors linked with outcome variables, bivariate and multivariate logistic regression analyses were conducted. The results were presented using odds ratios with 95% confidence intervals, with statistical significance given at a p-value of 0.05. Results: This study found that approximately 23.6% (95% CI = 19.9-27.8) of admitted military members fulfilled the diagnostic criteria for PTSD. Participants' history of mental illness [adjusted odds ratio (AOR) = 5.73, 95% CI = 2.66-12.31], family history of mental illness (AOR = 10.38, 95% CI = 5.36-20.10), current chewing of khat (AOR = 2.21, 95% CI = 1.13-4.32), physical trauma (AOR = 2.03, 95% CI = 1.00-4.13), moderate social support (AOR = 0.27, 95% CI = 0.1-4.53), strong social support (AOR = 0.09, 95% CI = 0.02-0.35), and severe depression (AOR = 2.06, 95% CI = 1.74-5.71) were factors significantly associated with post-traumatic stress disorder. Conclusions: The magnitude of post-traumatic stress disorder is high among military personnel. Factors such as participants' history of mental illness, family history of mental illness, depression, lack of social support, current use of khat, and physical trauma are significantly associated with PTSD. It is crucial to identify and intervene early in individuals with these risk factors to address PTSD effectively.

U.S. Army mortality surveillance in active duty soldiers, 2014-2019.

Mortality surveillance is an important activity for capturing information on a population's health. This retrospective surveillance analysis utilizes administrative data sources to describe active duty U.S. Army soldiers who died from 2014 to 2019, and calculate mortality rates, assess trends by category of death, and identify leading causes of death within subpopulations. During the surveillance period, 2,530 soldier deaths were reported. The highest crude mortality rates observed during the 6-year surveillance period were for deaths by suicide, followed by accidental (i.e., unintentional injury) deaths. The crude mortality rates for natural deaths decreased significantly over the 6-year period, by an average of 6% annually. The leading causes of death were suicide by gunshot wound, motor vehicle accidents, suicide by hanging, neoplasms, and cardiovascular events. Significant differences were observed in the leading causes of death in relation to demographic characteristics, which has important implications for the development of focused educational campaigns to improve health behaviors and safe driving habits. Current public health programs to prevent suicide should be evaluated, with new approaches for firearm safety considered.

Malaria among members of the U.S. Armed Forces, 2023.

MSMR publishes annual updates on the incidence of malaria among U.S. service members. Malaria infection remains a potential health threat to U.S. service members located in or near endemic areas due to duty assignment, participation in contingency operations, or personal travel. In 2023, a total of 39 active and reserve component service members were diagnosed with or reported to have malaria, an 8.3% increase from the 36 cases identified in 2022. Over half of the malaria cases in 2023 were caused by Plasmodium falciparum (53.8%; n=21) followed by unspecified types of malaria (35.9%; n=14) and P vivax and other Plasmodia (5.1%; n=2 each ). Malaria cases were diagnosed or reported from 22 different medical facilities: 18 in the U.S., 2 in Germany, 1 in Africa, 1 in South Korea. Of the 33 cases with known locations of diagnoses, 6 (18.2%) were reported from or diagnosed outside the U.S.