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1.
Mil Med ; 187(1-2): 9-11, 2022 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-34990511

RESUMO

In response to the COVID pandemic, Uniformed Services University (USU) suspended clerkships. As the nation's military medical school, USU had to keep students safe while still preparing them to be military physicians. In this commentary, we, a group of USU students, explore what this experience taught us about military medicine.


Assuntos
COVID-19 , Educação Médica , Medicina Militar , Militares , Estudantes de Medicina , Humanos , Medicina Militar/educação , SARS-CoV-2 , Faculdades de Medicina
2.
Reprod Health ; 19(1): 6, 2022 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-35022043

RESUMO

BACKGROUND: Male partner's approval is a key determinant of contraceptive use for women living in Sub-Saharan Africa and improving men's support and couple communication is a cornerstone of family planning programs. However, approval is often only measured through the women's perception of their partner's opinion. METHODS: This study conducted in Kinshasa compares contraceptive approval variables from matched male and female partners (n = 252 couples) to establish the frequency of (in)accurate perceptions by the woman, then test their association with modern contraceptive use. Additional regressions estimate individual and couple variables associated with (in)correct perceptions. RESULTS: Results confirm women are poorly aware of their partner's opinion but indicate that perceived approval or disapproval by the woman is a much stronger determinant of modern contraceptive use than her partner's actual opinion. Higher educational achievement from the woman is the strongest driver of misunderstanding her partner's approval. CONCLUSIONS: Women's perceptions of partner's approval are much stronger determinant of contraceptive use than the latter's actual opinion, and stereotyping men's opinion of family planning is a common error of appreciation. However, findings also suggest these misunderstandings might serve women's capacity to negotiate contraceptive use.


Research indicates that women living in Sub-Saharan Africa may not use contraceptive methods if their partner disapproves. However, there are methodological gaps in how this relation has been measured so far. For example, women are often the only ones asked whether their partner approves of contraception and surveys rarely assess how women know of their partner's disapproval and how strongly it has been communicated to them, nor do they ask said partner for his actual opinion on the matter.In this study we address some of those questions by interviewing men and women from married couples separately and comparing their opinion of family planning use. The research uses a population-based survey conducted among couples living in military camps in the capital city of the Democratic Republic Congo, Kinshasa.The results show that women overall are poorly aware of their partner's actual opinion, but act based on those perceptions, nonetheless. In particular, women whose husband disapproves of family planning but (falsely) perceive his approval have some of the highest odds in our cohort for contraceptive use. Conversely, women in a "false negative" scenario (husband approves but they perceive disapproval) are less likely to use modern contraception. Additional analysis indicates that this latter scenario is more common among women who are more educated than their partner, possibly because they are stereotyping his family planning desires. The findings and the discussion also raise the possibility that women may however benefit from ignoring their partners' true wishes in order to fulfill their own contraceptive choice.


Assuntos
Anticoncepcionais , Militares , Anticoncepção , Comportamento Contraceptivo , República Democrática do Congo , Serviços de Planejamento Familiar , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Cônjuges
3.
BMC Health Serv Res ; 22(1): 74, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-35031051

RESUMO

BACKGROUND: Families with complex needs face significant challenges accessing and navigating health and social services. For veteran families, these challenges are exacerbated by interactions between military and civilian systems of care, and the density of the veterans' non-profit sector. This qualitative study was designed to gather rich, detailed information on complex needs in veteran families; and explore service providers' and families' experiences of accessing and navigating the veterans' support system. METHODS: The study comprised participant background questionnaires (n = 34), focus groups with frontline service providers (n = 18), and one-on-one interviews with veteran families (n = 16) in Australia. The semi-structured focus groups and interviews were designed to gather rich, detailed information on four study topics: (i) health and wellbeing needs in veteran families; (ii) service-access barriers and facilitators; (iii) unmet needs and gaps in service provision; and (iv) practical solutions for improving service delivery. The study recruited participants who could best address the focus on veteran families with complex needs. The questionnaire data was used to describe relevant characteristics of the participant sample. The focus groups and interviews were audio-recorded, transcribed, and a reflexive thematic analysis was conducted to identify patterns of shared meaning in the qualitative data. RESULTS: Both service providers and families found the veterans' support system difficult to access and navigate. System fragmentation was perceived to impede care coordination, and delay access to holistic care for veteran families with complex needs. The medico-legal aspects of compensation and rehabilitation processes were perceived to harm veteran identity, and undermine health and wellbeing outcomes. Recovery-oriented practice was viewed as a way to promote veteran independence and self-management. Participants expressed a strong preference for family-centred care that was informed by an understanding of military lifestyle and culture. CONCLUSION: The health and wellbeing needs of veteran families intensify during the transition from full-time military service to civilian environments, and service- or reintegration-related difficulties may emerge (or persist) for a significant period of time thereafter. Veteran families with complex needs are unduly burdened by care coordination demands. There is a pressing need for high-quality implementation studies that evaluate initiatives for integrating fragmented systems of care.


Assuntos
Militares , Veteranos , Grupos Focais , Humanos , Pesquisa Qualitativa , Serviço Social
4.
BMC Psychiatry ; 22(1): 41, 2022 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-35038985

RESUMO

BACKGROUND: Trauma-focused psychotherapies for combat-related posttraumatic stress disorder (PTSD) in military veterans are efficacious, but there are many barriers to receiving treatment. The objective of this study was to determine if cognitive processing therapy (CPT) for PTSD among active duty military personnel and veterans would result in increased acceptability, fewer dropouts, and better outcomes when delivered In-Home or by Telehealth as compared to In-Office treatment. METHODS: The trial used an equipoise-stratified randomization design in which participants (N = 120) could decline none or any 1 arm of the study and were then randomized equally to 1 of the remaining arms. Therapists delivered CPT in 12 sessions lasting 60-min each. Self-reported PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5) served as the primary outcome. RESULTS: Over half of the participants (57%) declined 1 treatment arm. Telehealth was the most acceptable and least often refused delivery format (17%), followed by In-Office (29%), and In-Home (54%); these differences were significant (p = 0.0008). Significant reductions in PTSD symptoms occurred with all treatment formats (p < .0001). Improvement on the PCL-5 was about twice as large in the In-Home (d = 2.1) and Telehealth (d = 2.0) formats than In-Office (d = 1.3); those differences were statistically large and significant (d = 0.8, 0.7 and p = 0.009, 0.014, respectively). There were no significant differences between In-Home and Telehealth outcomes (p = 0.77, d = -.08). Dropout from treatment was numerically lowest when therapy was delivered In-Home (25%) compared to Telehealth (34%) and In-Office (43%), but these differences were not statistically significant. CONCLUSIONS: CPT delivered by telehealth is an efficient and effective treatment modality for PTSD, especially considering in-person restrictions resulting from COVID-19. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT02290847 (Registered 13/08/2014; First Posted Date 14/11/2014).


Assuntos
COVID-19 , Terapia Cognitivo-Comportamental , Militares , Transtornos de Estresse Pós-Traumáticos , Telemedicina , Veteranos , Humanos , SARS-CoV-2 , Transtornos de Estresse Pós-Traumáticos/terapia , Resultado do Tratamento
5.
BMC Musculoskelet Disord ; 23(1): 33, 2022 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-34986825

RESUMO

BACKGROUND: Biomechanical risk factors have been identified as the main predisposing factor of chronic low back pain (CLBP), especially in Army personnel. The Job Requirements and Physical Demands (JRPD) questionnaire has been developed to assess the biomechanical exposures related to CLBP. Examining the biomechanical risk factors could prevent CLBP. This study aimed to translate and cross-culturally adapt the JRPD into Persian and assess its psychometric properties among Iranian male Army personnel with CLBP. METHODS: In this cross-sectional study, the content validation of the JRPD was assessed after translating to Persian. The Persian JRPD was administered to 198 male Army personnel with CLBP, with an interval of 7 days, to assess test-retest reliability, including Cronbach's α, intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimal detectable change at 95% confidence interval (MDC95%). Scores of the Persian JRPD were correlated with the scores of visual analog scale (VAS), Borg's category-ratio (CR10) scale, general health questionnaire-28 (GHQ-28), and physical functioning (PF1 and PF2) subscale of the 12-item short-form health survey (SF-12) to assess convergent validity using Spearman correlation for a priori hypotheses. RESULTS: The Persian JRPD had good content validity evidenced by the higher content validity index (> 0.70). The questionnaire had a significant positive negligible to weak correlation with the VAS (rho = 0.27; p < 0.001), Borg's CR10 scale (rho = 0.19; p = 0.009), and the total score of GHQ-28 and its domains (rho ≤0.34; p < 0.05); and significant negative weak correlation with PF2 (rho = - 0.27; p < 0.001) and significant negative moderate correlation with PF1 (rho = - 0.35; p < 0.001), thus confirming the priori hypotheses (89%, 8/9). The internal consistency and ICC (α = 0.91; ICC = 0.80) were highly adequate, with SEM and MDC95% of 7.91 and 21.3 respectively. CONCLUSIONS: The JRPD was successfully adapted into Persian and had adequate psychometric properties in terms of content and convergent validity, internal consistency, and test-retest reliability. The questionnaire is found useable to assess the CLBP-related biomechanical exposures in Iranian male Army personnel.


Assuntos
Dor Lombar , Militares , Comparação Transcultural , Estudos Transversais , Humanos , Irã (Geográfico)/epidemiologia , Dor Lombar/diagnóstico , Dor Lombar/epidemiologia , Masculino , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
6.
Appl Ergon ; 98: 103580, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34598077

RESUMO

With the rapid rise in unmanned aerial vehicles (UAVs) for military and civil first-person applications like infrastructure inspection, there is an increased need for skilled UAV operators. However, research on effective training of UAV pilots has not kept pace with the demand. How much autonomy should be onboard, how much training, and how much control humans should have are still points of debate. To help fill this gap, this paper examines how different training programs and levels of control autonomy affect training outcomes for people operating a UAV in inspection tasks with high onboard autonomy. Results revealed a cost-benefit trade space in that those top performers with both lower-level teleoperation and higher-level supervisory control training could achieve the best performance, but with higher variability, as compare to those who received just supervisory control training. Another important finding was that those trainees who were overconfident were more likely to spend too much time micro-controlling the UAV, and also 15 times more likely to crash. Given that commercial UAV licensing is expected to significantly increase in the next few years, these results suggest more work is needed to determine how to mitigate overconfidence bias both through training and design.


Assuntos
Aeronaves , Militares , Humanos
7.
Appl Ergon ; 98: 103602, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34662749

RESUMO

Most female soldiers report that in-service body armour systems are too large. We investigated whether a smaller prototype body armour system could improve thoracolumbar range of motion (ROM) and reduce interference when female soldiers performed dynamic postures. 97 female soldiers completed three ROM tasks and seven dynamic postures wearing no armour, an in-service body armour system, and a smaller prototype system. Feedback on comfort of the prototype system was also obtained. Thoracolumbar ROM and dynamic posture completion were both hindered by using body armour, although the participants' performances were significantly less impeded when they wore the smaller prototype system compared to the in-service system. A smaller body armour system that is better matched to the anthropometric dimensions of female soldiers appears to improve overall fit and function. An increased range of body armour sizes and female-specific designs should be systematically explored to further enhance fit and function of body armour.


Assuntos
Militares , Antropometria , Feminino , Humanos , Roupa de Proteção , Amplitude de Movimento Articular
8.
Environ Res ; 203: 111824, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34364859

RESUMO

BACKGROUND: Over ten years after the Deepwater Horizon (DWH) oil spill, our understanding of long term respiratory health risks associated with oil spill response exposures is limited. We conducted a prospective analysis in a cohort of U.S. Coast Guard personnel with universal military healthcare. METHODS: For all active duty cohort members (N = 45,193) in the DWH Oil Spill Coast Guard Cohort Study we obtained medical encounter data from October 01, 2007 to September 30, 2015 (i.e., ~2.5 years pre-spill; ~5.5 years post-spill). We used Cox Proportional Hazards regressions to calculate adjusted hazard ratios (aHR), comparing risks for incident respiratory conditions/symptoms (2010-2015) for: responders vs. non-responders; responders reporting crude oil exposure, any inhalation of crude oil vapors, and being in the vicinity of burning crude oil versus responders without those exposures. We also evaluated self-reported crude oil and oil dispersant exposures, combined. Within-responder comparisons were adjusted for age, sex, and smoking. RESULTS: While elevated aHRs for responder/non-responder comparisons were generally weak, within-responder comparisons showed stronger risks with exposure to crude oil. Notably, for responders reporting exposure to crude oil via inhalation, there were elevated risks for allsinusitis (aHR = 1.48; 95%CI, 1.06-2.06), unspecified chronic sinusitis (aHR = 1.55; 95%CI, 1.08-2.22), chronic obstructive pulmonary disease (COPD) and other allied conditions (aHR = 1.43; 95%CI, 1.00-2.06), and dyspnea and respiratory abnormalities (aHR = 1.29; 95%CI, 1.00-1.67); there was a suggestion of elevated risk for diseases classified as asthma and reactive airway diseases (aHR = 1.18; 95%CI, 0.98-1.41), including the specific condition, asthma (aHR = 1.35; 95%CI, 0.80-2.27), the symptom, shortness of breath (aHR = 1.50; 95%CI, 0.89-2.54), and the overall classification of chronic respiratory conditions (aHR = 1.18; 95%CI, 0.98-1.43). Exposure to both crude oil and dispersant was positively associated with elevated risk for shortness of breath (HR = 2.24; 95%CI, 1.09-4.64). CONCLUSIONS: Among active duty Coast Guard personnel, oil spill clean-up exposures were associated with moderately increased risk for longer term respiratory conditions.


Assuntos
Militares , Poluição por Petróleo , Petróleo , Estudos de Coortes , Seguimentos , Golfo do México , Humanos , Incidência , Poluição por Petróleo/efeitos adversos
9.
Addict Behav ; 126: 107200, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34906882

RESUMO

International evidence indicates that currently serving and former military personnel may be at heightened vulnerability to problem gambling. The aim of the present study was to undertake the first survey of gambling experience and potential problems among serving United Kingdom Royal Air Force (RAF) personnel. Our objectives were to survey the frequency of gambling problems, types of gambling activities, examine mental health, alcohol use, and COVID-19-related associations with gambling, and identify potential risk factors for problem gambling among RAF personnel. A cross-sectional online survey was distributed to all serving RAF personnel in January 2021 and the final dataset consisted of n = 2119 responses. The Problem Gambling Severity Index (PGSI) identified gambling severity, the Patient Health Questionnaire (PHQ-9) assessed depression, the Generalized Anxiety Disorder assessment (GAD-7) measured anxiety, and alcohol use was assessed with the Alcohol Use Disorders Identification Test (AUDIT). Questions relating to COVID-19 asked whether the pandemic had impacted one's gambling, mental health, and alcohol use. Findings indicated that 12.5% of personnel reported gambling problems, which included 8.0% with PGSI scores indicating low-risk gambling (1-2), 2.9% with moderate-risk gambling scores (3-4), and 1.6% with scores indicating problem gambling (≥8). Most personnel had no symptoms of depression or anxiety, and most experienced lower risk drinking levels. The likelihood of any gambling problem (PGSI ≥ 1) in RAF personnel was associated with age (18-24 years old), male gender, and Non-Commissioned ranks. Most participants reported a deterioration in their mental health due to COVID-19 and increased risky gambling. These findings indicate that gambling problems and associated harms are significant concerns for serving RAF personnel.


Assuntos
Alcoolismo , COVID-19 , Jogo de Azar , Militares , Adolescente , Adulto , Estudos Transversais , Jogo de Azar/epidemiologia , Humanos , Masculino , SARS-CoV-2 , Reino Unido/epidemiologia , Adulto Jovem
10.
J Sci Med Sport ; 25(1): 89-94, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34507882

RESUMO

OBJECTIVES: To determine the physiological effects of multiple stressors including energy deficit during a 62-day Ranger course in a hot-humid environment. DESIGN: Prospective cohort design. METHODS: Food intake data were collected daily and energy expenditure at each of the three phases of the course was estimated by the doubly-labeled water method. Anthropometry, hydration status, stress and metabolic hormones, handgrip strength and lower explosive power were measured at the start and at the end of each phase. RESULTS: Seventeen male participants (age: 24.5 ±â€¯3.2 years, height: 173.9 ±â€¯5.1 cm, body mass: 69.3 ±â€¯3.2 kg, BMI: 22.9 ±â€¯0.9 kg/m2, percent body fat: 14 ±â€¯5%) completed the study. Mean total daily energy expenditure was 4756 kcal/day and mean daily energy intake was 3882 kcal/day. An 18% energy deficit resulted in an average body mass loss of 4.6 kg, comprising mostly fat mass. Participants with higher baseline adiposity (>15% body fat) lost more fat mass and gained (rather than lost) muscle mass compared to those with lower baseline adiposity. Handgrip strength declined only at the end of Phase I, while lower body explosive power declined progressively throughout the course. Lean mass in arms and legs was correlated with initial grip strength and lower body explosive power, but only at the start of the course. CONCLUSIONS: Physiologically demanding Ranger training in an equatorial environment is at least as metabolically demanding and stressful as other similar high-risk training courses, as demonstrated by the stress and metabolic endocrine responses, changes in body composition, and reduction in explosive power. Moreover, the smaller body size of Asian soldiers may confer an energetic advantage over larger sized Western counterparts.


Assuntos
Militares , Adulto , Composição Corporal , Ingestão de Energia , Metabolismo Energético , Força da Mão , Humanos , Masculino , Metaboloma , Desempenho Físico Funcional , Estudos Prospectivos , Adulto Jovem
11.
Med J (Ft Sam Houst Tex) ; (Per 22-01/02/03): 3-10, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34940962

RESUMO

OBJECTIVES: Introduction: Medical readiness is an integral component of total readiness and a prime indicator of an individual's overall fitness to deploy. Promoting medical readiness is the prime directive for military medical departments; however, there are few studies evaluating specific factors of care delivery that will improve medical readiness. In this study, we evaluated one of the common patient perceptions that access to routine and specialty care will have a positive effect on military medical readiness. Surprisingly, there appeared to be a reverse relationship between a patient's perception of access to care and the correlation to their medical readiness. MATERIALS AND METHODS: This study uses the Joint Outpatient Experience Survey data of Army active duty soldiers (December 2017 through May 2018) to investigate the relationship between access to care and medical readiness. Medical readiness scores were examined a month before and a month after a medical encounter. Medical Readiness Categories (MRC) were collected from the Army Medical Operational Data System Mainframe. Respondents of the survey were matched to MRC data. Comparisons were made using chi-square tests and Wilcoxon rank-sum non-parametric tests to determine whether there were differences in readiness and patient experience ratings before and after the encounter. Logistic regressions were also conducted to predict the odds of non-readiness based on the type of health care visit. RESULTS: Soldiers who were medically non-ready were more likely to be above age 35 years or have specialty care encounters. Results indicated those meeting all medical readiness requirements or having minor medical issues that could be resolved quickly, generally rated access to care slightly lower compared to those who were medically non-ready. Musculoskeletal Injuries (MSKIs) are the leading cause of medical non-readiness. As a result, this study explored access to care for MSKIs. Although there were no statistical differences in access ratings for those with MSKIs compared to those without MSKIs, there were statistically significant differences in self-reported health. Individuals with MSKIs tended to report poorer health status. Those with specialty care visits had 1.79 times significantly greater odds (p is less than .05) of being non-medically ready compared to those with primary care. For visits related to MSKI (e.g., physical medicine, orthopedic, or chiropractic etc.), those with an orthopedic or occupational therapy visit had 1.25 and 1.59 significantly greater odds (p is less than .05) of being considered not medically ready compared to all other MSKI related visits before the encounter. However, after the encounter, those with orthopedic care had significantly higher odds of improved readiness. CONCLUSIONS: Findings from this study help contextualize who is considered medically non-ready as well as differences in access to care experiences for this group. The lowest scoring areas for improving access to care include ease of making appointment, time between scheduling an appointment and the visit, and being seen past the scheduled time. Given that musculoskeletal injuries tend to require long term specialized treatments such as physical and occupational therapy, findings from the logistic regressions suggest that access and adherence to such treatments, particularly for orthopedic care, are helpful in improving medical readiness.


Assuntos
Militares , Doenças Musculoesqueléticas , Adulto , Exercício Físico , Acesso aos Serviços de Saúde , Humanos , Avaliação de Resultados da Assistência ao Paciente
12.
Med J (Ft Sam Houst Tex) ; (Per 22-01/02/03): 17-22, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34940964

RESUMO

OBJECTIVE: Examine incidence rates of Type 2 Diabetes Mellitus (T2DM) in a military population over a tenyear period and whether demographic characteristics differ within the same population. METHODS: Diagnostic data and demographic variables from 23,821 active duty service members between 2006 and 2015 were analyzed from the Defense Medical Epidemiological Database. RESULTS: The incidence rates of new onset cases ranged from .22 (per 1,000 service members) in 2015 to a high of 1.46 (per 1,000 service members) in 2006 for T2DM without complications and .00 (per 1,000 service members) in 2007 to a high of .29 (per 1,000 service members) in 2015 for T2DM with complications. The one-sample chi-square test showed the observed, and expected frequencies differed significantly for all demographic variables tested. CONCLUSIONS: Although there was a significant increase in the diagnosis of T2DM with complications in 2015, the overall downtrend is similar to that of the general US population. Older age and higher rank were more likely to be associated with the diagnosis of T2DM with and without complications, again suggestive of similar trends with the general US population. Continued efforts towards early diagnosis and treatment of these service members are needed to address this problem regarding military readiness.


Assuntos
Diabetes Mellitus Tipo 2 , Militares , Idoso , Distribuição de Qui-Quadrado , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Incidência , Estudos Retrospectivos
13.
Med J (Ft Sam Houst Tex) ; (Per 22-01/02/03): 50-55, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34940968

RESUMO

OBJECTIVE: We document a military patient presenting with a diffuse set of symptoms suggestive of chronic Lyme disease (CLD) and the subsequent empiric treatment and health complications arising therein. The lay medical community, spurred by the internet, has ascribed these diffuse symptoms to various illnesses including CLD without confirmatory serological evidence of any underlying disease. With a growing community of patient advocates, CLD has become an illness with broad and highly generalized list of clinical symptoms and an absence of agreed-upon confirmatory laboratory tests. Further complicating matters, diagnostic criteria and treatment protocols differ between the Infectious Diseases Society of America and the International Lyme and Associated Diseases Society guidelines. Clinicians also face serious challenges in diagnosing and treating patients who present with generalized symptoms and close to 50 diagnostic tests for Lyme disease available in North America. Further complicating the picture for military patients seeking medical confirmation of a disease and resolution of their symptoms, medical fitness boards use putative diagnoses as prima faciae evidence in disability. Here a military patient with a long list of complaints that defy any clear or easy diagnosis and treatment is discussed. However, these symptoms taken together with selectively summed notes in the medical record in the absence of convincing and clear laboratory confirmation are suggestive of CLD and its complications, but no resolution was ultimately reached. With the presumptive determination of a medical disability due to CLD by the medical board, the medical dismissal of this service member from active duty occurred.


Assuntos
Doença de Lyme , Militares , Síndrome Pós-Lyme , Humanos , Doença de Lyme/diagnóstico , Doença de Lyme/tratamento farmacológico , América do Norte
14.
Med J (Ft Sam Houst Tex) ; (Per 22-01/02/03): 64-65, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34940970

RESUMO

Physical therapists (PT) have an integral role in supporting readiness of the Army warfighter. With an increased demand for active duty PTs and the transition to Defense Health Agency (DHA), more direct commission PTs and new graduates as first lieutenants will see themselves positioned in brigade combat teams (BCT). Traditionally, this role is given to a captain due to experience. Additionally, working in a forward deployed or rotational environment brings its own challenges encountered very seldom while in garrison. For example, military treatment facility (MTF) support for outlying clinics ensures continued ease of access to care for musculoskeletal conditions. Whereas in rotational environments, battalions are spread out across large geographic regions, thereby limiting continuity of care. As a brigade (BDE) PT, finding solutions is imperative to overcome these challenges, minimize the negative consequences of limited access, and find ways to address musculoskeletal (MSK) conditions requiring care.


Assuntos
Medicina , Militares , Doenças Musculoesqueléticas , Fisioterapeutas , Humanos , Doenças Musculoesqueléticas/terapia , Modalidades de Fisioterapia
15.
Med J (Ft Sam Houst Tex) ; (Per 22-01/02/03): 82-84, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34940973

RESUMO

Isolated atrophy of the pectoralis major muscle (PMM) secondary to traumatic lesion of the medial pectoral nerve is a known entity in the field of neuromuscular electrodiagnostics. Recent literature has begun describing a Pectoral Gap Phenomenon in which this atrophy occurs bilaterally as an overuse injury, leading to a marked concavity in the central chest wall musculature. While there is limited information in science journals on this topic, social media posts on weight lifting discuss the topic frequently. We report a case in which a soldier's body armor crushed the lateral medial and pectoral nerves against the anterior chest wall causing permanent upper body weakness. To optimize military medical readiness, awareness of this disorder and the pathophysiology causing it should spread so as to mitigate this potential for significant disability.


Assuntos
Plexo Braquial , Militares , Nervos Torácicos , Parede Torácica , Humanos , Músculos Peitorais
16.
PLoS One ; 16(12): e0261634, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34936679

RESUMO

Military identity and a sense of social connectedness may help explain differences in contemporary veteran wellbeing following transition from military to civilian life. However, it is unclear how these constructs interrelate. The current study quantitatively explored the role of social connectedness in the relationship between military identity and subjective wellbeing among contemporary ex-serving Australian Defence Force veterans. To facilitate analyses, data from 358 veterans were used to first explore the suitability of the factor structure of the Warrior Identity Scale. Subsequently, the potential moderating and mediating effects of social connectedness in the relationship between military identity and wellbeing were explored via path analysis. Confirmatory factor analysis of the Warrior Identity Scale revealed support for the multidimensional construct of military identity, and a revised six-factor measurement model was found suitable for further path analysis. Consistent with past research, social connectedness positively related to quality of life and negatively related to psychological distress. There was no support for a moderation effect of social connectedness. However, results indicated military identity indirectly influenced wellbeing and distress via differential relationships with social connectedness. Specifically, private and public regard for the military and not feeling like an outsider positively related to social connectedness. In contrast, interdependence with other veterans, viewing the military as family, and the centrality of military identity negatively related to social connectedness. The results suggest nurturing the protective aspects of military identity and addressing inhibitory aspects of military identity may support a sense of social connectedness and wellbeing among ex-serving veterans.


Assuntos
Veteranos , Adulto , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Militares , Qualidade de Vida , Identificação Social , Rede Social
17.
Chiropr Man Therap ; 29(1): 52, 2021 12 30.
Artigo em Inglês | MEDLINE | ID: mdl-34969400

RESUMO

PURPOSE: Low back pain (LBP) is prevalent in military personnel. We aimed to systematically review the literature regarding risk factors for first-time LBP during military service among active duty military personnel. METHODS: We searched six electronic databases (inception-April 2020) for randomised controlled trials, cohort studies, and case-control studies published in English in peer-reviewed journals. Eligible studies were independently critically appraised by paired reviewers and a descriptive synthesis was conducted. RESULTS: We screened 1981 records, reviewed 118 full-text articles, and synthesised data from eight acceptable quality cohort studies. Studies assessed physical (n = 4), sociodemographic (n = 2), and/or occupational factors (n = 5) associated with LBP. Two studies reported prior LBP was associated with a greater than twofold increased risk of LBP compared to those without prior LBP. Other factors consistently associated with LBP included previous musculoskeletal injury (n = 2), less time spent on physical training (n = 2), female sex (n = 2), and lower rank (n = 2). Factors associated with LBP from single studies included marital status, lower education level, blast injury, job duties, and service type. We found inconsistent associations for performance on physical fitness tests, age, and occupation type. Psychological risk factors were not assessed in any included studies. CONCLUSION: In active duty personnel, prior history of LBP, previous musculoskeletal injury, less time in physical training, female sex, and lower rank were consistent risk factors for LBP. This information is relevant for researchers, active duty military personnel, and other decision makers. Future studies should explore causal relationships for LBP in this population. PROSPERO registration number: CRD42018084549.


Assuntos
Dor Lombar , Militares , Estudos de Coortes , Exercício Físico , Feminino , Humanos , Dor Lombar/epidemiologia , Dor Lombar/etiologia , Fatores de Risco
18.
Dis Markers ; 2021: 7686374, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34956420

RESUMO

Objective: S-Adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH) are indicators of global transmethylation and may play an important role as markers of severity of COVID-19. Methods: The levels of plasma SAM and SAH were determined in patients admitted with COVID-19 (n = 56, mean age = 61). Lung injury was identified by computed tomography (CT) in accordance with the CT0-4 classification. Results: SAM was found to be a potential marker of lung damage risk in COVID-19 patients (SAM > 80 nM; CT3,4 vs. CT 0-2: relative ratio (RR) was 3.0; p = 0.0029). SAM/SAH > 6.0 was also found to be a marker of lung injury (CT2-4 vs. CT0,1: RR = 3.47, p = 0.0004). There was a negative association between SAM and glutathione level (ρ = -0.343, p = 0.011). Interleukin-6 (IL-6) levels were associated with SAM (ρ = 0.44, p = 0.01) and SAH (ρ = 0.534, p = 0.001) levels. Conclusions: A high SAM level and high methylation index are associated with the risk of lung injury in patients with COVID-19. The association of SAM with IL-6 and glutathione indicates an important role of transmethylation in the development of cytokine imbalance and oxidative stress in patients with COVID-19.


Assuntos
COVID-19/complicações , Lesão Pulmonar/sangue , S-Adenosil-Homocisteína/sangue , S-Adenosilmetionina/sangue , SARS-CoV-2 , Adulto , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/epidemiologia , Biomarcadores , COVID-19/epidemiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Glutationa/sangue , Humanos , Hipertensão/epidemiologia , Interleucina-6/sangue , Lesão Pulmonar/diagnóstico por imagem , Lesão Pulmonar/etiologia , Masculino , Metilação , Pessoa de Meia-Idade , Militares , Risco , Tomografia Computadorizada por Raios X , Adulto Jovem
19.
J Spec Oper Med ; 21(4): 22-24, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34969122

RESUMO

Processionary caterpillars are well-described threats to human and animal health. They are found throughout Central Asia, Northern Africa, and Southern Europe. However, US military personnel may not be familiar with the threat that these organisms pose in Australia. The larval form of the bag-shelter moth (Ochrogaster lunifer) is a processionary caterpillar that has been found throughout inland and coastal Australia. These organisms are habitually associated with Acacia and Eucalyptus trees and they tend to form long chains known as "processions" as they travel between nesting and pupating sites. They are covered with numerous hairs that can detach, become airborne, and cause potentially life-threatening inflammatory reactions and ocular trauma in susceptible personnel. They can also cause severe inflammatory reactions in military working animals. It is important that military and preventive medical personnel become aware of the presence of processionary caterpillars in Australia, and that they can identify aerial or ground-based nests so that these dangerous organisms can be avoided by both humans and animals. Early identification is important so that prompt medical treatment can be rendered in the event of an accidental exposure.


Assuntos
Militares , Mariposas , Animais , Austrália , Humanos , Larva
20.
J Spec Oper Med ; 21(4): 30-35, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34969124

RESUMO

BACKGROUND: Servicemembers are required to operate at high levels despite experiencing common injuries such as chronic low back pain. Continuing high levels of activity while compensating for pain may increase the risk of musculoskeletal injuries. As such, the purpose of this project was to determine if servicemembers with chronic low back pain have reduced lower extremity performance, and if they use alternate strategies to complete a functional performance task as compared to healthy servicemembers. METHODS: Of a total of 46 male United States Marine Corps Forces Special Operations Command (MARSOC) personnel, 23 individuals who suffered from chronic low back pain (age = 28.6 ± 4.4 years, weight = 84.2 ± 6.8 kg) and 23 healthy controls (age = 27.9 ± 3.8 years, weight = 83.8 ± 7.7 kg) completed a stop jump task. In this task, three-dimensional biomechanics were measured, and lower extremity and trunk strength were assessed. RESULTS: The low back pain group exhibited higher vertical ground reaction force impulse on the dominant limb (0.26% body weight [BW]/s), compared to the nondominant limb (0.25% BW/s, p = .036). The control group demonstrated relationships between jump height and strength in both limbs (dominant: r = 0.436, p = .043; nondominant: r = 0.571, p = .006), whereas the low back pain group demonstrated relationships between jump height and dominant limb knee work (r = 0.470, p = .027) and ankle work (r = 0.447, p = .037). CONCLUSIONS: This study demonstrates that active-duty MARSOC personnel with a history of low back pain reach similar levels of jump height during a counter movement jump, as compared to those without a history of low back pain. However, the asymmetries displayed by the low back pain group suggest an alternate strategy to reaching similar jump heights as compared to healthy individuals.


Assuntos
Dor Lombar , Militares , Adulto , Fenômenos Biomecânicos , Humanos , Articulação do Joelho , Masculino , Autorrelato , Adulto Jovem
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