Obesity Risk Among West Point Graduates Later in Life.

ABSTRACT: Szivak, TK, Thomas, MM, Pietrzak, RH, Nguyen, DR, Ryan, DM, and Mazure, CM. Obesity Risk Among West Point Graduates Later in Life. J Strength Cond Res 37(6): 1284-1291, 2023-The purpose of this investigation was to evaluate sex differences in health and fitness outcomes among United States Military Academy (USMA) graduates (class years 1980-2011). Subjects ( n = 701 men, 641 women, age: 45.7 ± 9.3 years) were surveyed as a part of a larger investigation on risk and resiliency factors among USMA graduates. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) short form and calculation of weekly metabolic equivalents (METs). Overweight and obesity status were assessed by body mass index (BMI). Significance for the study was set at p ≤ 0.05. Obesity rates for men (30.1%) were significantly higher than for women (16.6%). Men reported significantly higher ( p = 0.01) vigorous METs·wk -1 (1,214.6 ± 1,171.6) than women (1,046.8 ± 1,133.2) despite significantly higher ( p = 0.00) BMI values (28.75 ± 4.53 kg·m -2 ) than women (25.90 ± 5.48 kg·m -2 ). Women were 89% more likely to have ever been on a diet and reported higher (15.2%) Army Body Composition Program enrollment rates than men (6.3%). Obesity rates among men reflect trends seen in the broader military, Veteran, and U.S. adult populations, whereas obesity rates among women were lower. Men may be at a greater risk for obesity later in life despite higher self-reported physical activity; however, lean body mass and self-report bias should be considered. Because lifetime obesity may be influenced by factors other than physical activity, health initiatives should use a comprehensive approach early in the career of military officers.

Female Family Physicians Are More Racially Diverse Than Their Male Counterparts in Federal Sites.

Supporting a diverse family physician workforce is an integral component of achieving health equity. This study compared the racial/ethnic composition of Federal family physicians (Military, Veterans Administration/Department of Defense) to the entire cohort of family physicians and stratified by gender. Female family physicians serving at Federal sites were more diverse than the overall population of female family physicians and, also than their male Federal counterparts. This gendered trend among Federal physicians needs further exploration.

Free the Bun: Prevalence of Alopecia Among Active Duty Service Women, Fiscal Years 2010-2019.

INTRODUCTION: Active duty service women (ADSW) constitute 16% of the force. The prevalence of alopecia, a dermatologic condition characterized by hair loss, is understudied in regard to hairstyle regulations across the U.S. military services. Alopecia has several causes; one of which is due to tension on the scalp secondary to tight hairstyles. In the U.S., alopecia has a lifetime prevalence of 1.7-2.1%; no previous studies which evaluated this condition in service women were found. MATERIALS AND METHODS: We used the Military Health System Data Repository to perform a retrospective study to assess the prevalence of alopecia in ADSW from fiscal years (FYs) 2010 to 2019. Statistical analyses included descriptive statistics on patient demographics and trend analysis on the prevalence of alopecia over the 10-year study period. RESULTS: A total of 498,219 ADSW were identified over the 10-year study period, of which 2.40% had a diagnosis of alopecia. Overall, the prevalence of alopecia decreases over the 10-year period, with two observed periods of slight increase (FY 2013 to 2014 and FY 2018 to 2019) when comparing prevalence year-to-year. Of those diagnosed, the majority were young, Black, with a senior enlisted rank, and in the U.S. Army. CONCLUSION: The prevalence of alopecia in ADSW is slightly higher than that in civilian populations and is most likely underreported. It is more commonly diagnosed in Black women than would be expected based on ratios of this population in military service. Policy changes to ensure that traction alopecia is a qualifying medical condition for Veterans Affairs disability compensation, mechanisms are in place for more specific coding in the electronic medical record, and treatment options to be covered by TRICARE are recommended. All U.S. military services should consider updating and evaluating regulations to improve the health and quality of life of ADSW.

Frequency of Medical Claims for Diastasis Recti Abdominis Among U.S. Active Duty Service Women, 2016 to 2019.

Background: Diastasis recti abdominis (DRA) is a condition in pregnant and postpartum women. Proposed risk factors include age, sex, multiparity, cesarean delivery, diabetes, gestational weight gain, and high birth weight. This study aims to estimate the prevalence of DRA using medical claims data among U.S. active duty service women (ADSW) and determine associated risk factors. Materials and Methods: We conducted a cross-sectional study of ADSW aged 18 years and older in the U.S. Army, Air Force, Navy, and Marine Corps during fiscal years (FYs) 2016 to 2019. Utilizing claims data, we identified ADSW with a diagnosis of DRA during the study period. Risk factors, including age, race, socioeconomic status, branch of service, military occupation, delivery type, and parity, were evaluated through descriptive statistics, chi-square tests, and logistic regression analysis. Results: A total of 340,748 ADSW were identified during FYs 2016 to 2019, of whom 2,768 (0.81%) had a medical claim for DRA. Of those with deliveries during the study period, 1.41% were multiparous and 84.53% had a cesarean delivery. Increased risk of DRA was found in ages 30 to 39 years, Black women, ranks representing a higher socioeconomic status, and women with overweight and obese body mass indices. Conclusions: Although the prevalence of DRA, defined as a medical claim for DRA, in the study population is low, subpopulations may be disproportionately affected by the condition. Further research could potentially detail the impact of DRA on the functional impairment and operational readiness of ADSW in the U.S. military and any possible means of prevention.

Psychological Resilience in West Point Graduates: Results From a Nationally Representative Study.

Background: The purpose of this study was to examine factors associated with psychological resilience in a nationally representative sample of West Point graduates. Aims: The aims of this study were to (a) employ a dimensional approach to operationalizing psychological resilience in a trauma-exposed population that had been highly trained and educated in persisting in the face of stress, was previously unstudied, and in which we could examine correlates of resilience, (b) identify key psychosocial factors, character traits, health variables, military experiences, and coping strategies as potential correlates of psychological resilience; and (c) examine whether reported gender moderated any of these associations in this population. Methods: A nationally representative sample of 1342 West Point graduates after gender integration from classes 1980 to 2011 were surveyed. Psychological resilience was operationalized using a discrepancy-based approach in which a measure of composite psychological distress (current posttraumatic stress disorder, generalized anxiety and depression symptoms) was regressed on measures of cumulative trauma burden. A multivariable linear regression model was then employed to identify factors that were independently associated with psychological resilience scores. Results: Purpose in life (29.8% of relative variance explained [RVE]), fewer perceived negative experiences in the military (20.6% RVE), social support (9.6% RVE), and grit (9.5% RVE) were the strongest correlates of psychological resilience scores for both women and men. Time in service was positively associated with resilience in women only. Conclusion: This study identifies key correlates of psychological resilience in West Point graduates, individuals who are highly trained to persevere in the face of stress and then were trauma-exposed. Most of these factors are modifiable and can be targeted in stress prevention and treatment interventions, especially for high-stress professions such as the military, frontline health care providers, and first responders.

Career Satisfaction of Military Medical Officers.

INTRODUCTION: Having a mentor is associated with higher job satisfaction among U.S. physicians. The objective of this study was to assess satisfaction among military medical officers and to assess if mentorship and job satisfaction are associated with intention to continue military service. MATERIALS AND METHODS: This is a cross-sectional study using voluntary, anonymous data from 2018 Uniformed Services Academy of Family Physicians Annual Meeting registered attendees who completed an online Omnibus Survey. Outcome measures: satisfaction with work hours and workload; voice in organizational decision-making; amount of teaching, research, and other administrative tasks; being and having a mentor; and likelihood of remaining in the military beyond current service obligation. Statistical analysis: descriptive statistics, chi-square, and logistic regression. RESULTS: There was a 66% response rate (310/568) among registered attendees. Respondents reported being satisfied with work hours-workload (53.3%), voice in organizational decision-making (47.4%), and amount of teaching-research-other administrative tasks (55.7%). About 64.6% of respondents reported being a mentor, and 80.7% reported having a mentor. About 53.4% reported being likely/very likely to continue military service beyond their current service obligation. Adjustment for demographic and occupational factors, with significance defined as P ≤ 0.05, revealed that higher percent time in clinical care was negatively associated with satisfaction with voice in organizational decision-making; being a mentor and working in an academic practice setting were positively associated with satisfaction in amount of time with teaching, research, and administrative tasks; and having a mentor was the only factor associated with being likely/very likely to continue military service beyond current service obligation (odd ratio 3.9, 95% confidence interval 1.2-12.1). CONCLUSIONS: Having a mentor was the only factor associated with intention to remain in the military among 2018 Uniformed Services Academy of Family Physicians Omnibus Survey respondents. These results support enhancing mentorship among military medical officers.

Doing What Is Right.

Junior officers have an obligation to "lead up." They help senior officers successfully complete missions while maintaining accountability to core values and taking care of those they lead. The following case highlights one junior officer's challenge "leading up" in a very ambiguous situation.

Testing Quick Response (QR) Codes as an Innovation to Improve Feedback Among Geographically-Separated Clerkship Sites.

BACKGROUND AND OBJECTIVES: Collection of feedback regarding medical student clinical experiences for formative or summative purposes remains a challenge across clinical settings. The purpose of this study was to determine whether the use of a quick response (QR) code-linked online feedback form improves the frequency and efficiency of rater feedback. METHODS: In 2016, we compared paper-based feedback forms, an online feedback form, and a QR code-linked online feedback form at 15 family medicine clerkship sites across the United States. Outcome measures included usability, number of feedback submissions per student, number of unique raters providing feedback, and timeliness of feedback provided to the clerkship director. RESULTS: The feedback method was significantly associated with usability, with QR code scoring the highest, and paper second. Accessing feedback via QR code was associated with the shortest time to prepare feedback. Across four rotations, separate repeated measures analyses of variance showed no effect of feedback system on the number of submissions per student or the number of unique raters. CONCLUSIONS: The results of this study demonstrate that preceptors in the family medicine clerkship rate QR code-linked feedback as a high usability platform. Additionally, this platform resulted in faster form completion than paper or online forms. An overarching finding of this study is that feedback forms must be portable and easily accessible. Potential implementation barriers and the social norm for providing feedback in this manner need to be considered.

Illness in a redeployed soldier.

Overseas deployments place military personnel at risk for tropical diseases not typically observed on the U.S. mainland. This case describes the first reported case of brucellosis returning from Operation Enduring Freedom and Operation Iraqi Freedom. A 31-year-old infantry soldier complained of a 6-week history of headaches, relapsing fever, and constitutional symptoms since returning from Iraq. This soldier was determined to have the only reported case of brucellosis, but was one of many soldiers at risk from eating unpasteurized cheese on the local economy. Although malaria and leishmaniasis continue to be the most common deployment-related illnesses, brucellosis must also be considered in the differential of any redeployed soldier with headache, fever, and body aches. Public health as well as command elements must reinforce their role in preventing exposure to this pathogen.

The effects of military deployment on early child development.

PURPOSE: The purpose of this observational, point prevalence study is to determine if parental deployment affects the cognitive, social and emotional development of preschool age children in the military family. METHODS: Demographic information was collected and an age-appropriate Ages and Stages Questionnaire (ASQ-3) and Ages and Stages Social-Emotional Inventory (ASQ:SE) were administered. The primary outcome measure was the failure rates on the developmental instruments. RESULTS: We identified 151 parents of eligible children; 95 children had a parent that deployed during their lifetime. We found a significant difference in ASQ-3 failure rates for children in the deployed group compared to those in the nondeployed group. Children of deployed parents were at least twice as often to fail the ASQ-3 or ASQ:SE developmental screen compared to children whose parents did not deploy. 30.5% of children in the deployed group failed the ASQ-3 screen while 12.5% of children who did not have a deployed parent failed (P=.009). On the ASQ:SE developmental screen, 16.8% of children who had a parent deploy failed versus 5.4% of children who did not have a parent deploy (P=.031). CONCLUSIONS: This study suggests that parental deployment is related to adverse risk for developmental delays in children in military families. The psychological burden on military children could be life-long or require significant resources to address. These adverse outcomes could be possibly mitigated by early detection of developmental delay and firm attention to aggressive screening techniques in military communities.