First unprovoked seizures among soldiers recruited to the Israeli Defense Forces during 10 consecutive years: A population-based study.

OBJECTIVE: The management of patients after a first unprovoked seizure (FUS) can benefit from stratification of the average 50% risk for further seizures. We characterized subjects with FUSs, out of a large generally healthy homogenous population of soldiers recruited by law to the Israeli Defense Forces, to investigate the role of the type of service, as a trigger burden surrogate, in the risk for additional seizures. METHODS: Soldiers recruited between 2005 and 2014, who experienced an FUS during their service, were identified from military records. Subjects with a history of epilepsy or lack of documentation of FUS characteristics were excluded from the study. Data on demographics and military service and medical details were extracted for the eligible soldiers. RESULTS: Of 816 252 newly recruited soldiers, representing 2 138 000 person-years, 346 had an FUS, indicating an incidence rate of 16.2 per 100 000 person-years. The FUS incidence rate was higher in combat versus noncombat male and female soldiers (p < .0001). Most subjects (75.7%) were prescribed antiseizure medications (ASMs), and 29.2% had additional seizures after the FUS. Service in combat units, abnormal magnetic resonance imaging, and being prescribed ASMs were correlated with a lower risk of having multiple seizures (95% confidence interval [CI] = .48-.97, .09-.86, .15-.28, respectively). On multivariate analysis, service in combat units (odds ratio [OR] = .48 for seizure recurrence, 95% CI = .26-.88) and taking medications (OR = .46, 95% CI = .24-.9) independently predicted not having additional seizures. SIGNIFICANCE: FUS incidence rate was higher in combat soldiers, but they had a twofold lower risk of additional seizures than noncombat soldiers, emphasizing the value of strenuous triggers as negative predictors for developing epilepsy. This suggests a shift in the perception of epilepsy from a "yes or no" condition to a continuous trend of predisposition to seizures, warranting changes in the ways etiologies of epilepsy are weighted and treatments are delivered.

Cannabis approval and perceived risk of use among minority U.S. Army Reservists.

This study examined how minoritized U.S. Army Reserve/National Guard service members perceive cannabis use amid a continuously evolving societal and legal landscape in the United States. Logistic regression analyses were conducted to examine relationships between cannabis perceptions and race while considering illicit drug use norms, posttraumatic stress disorder symptomatology, and current drug use. Non-Hispanic Black soldiers had lower odds of approval for medicinal cannabis use and Hispanic soldiers had higher odds of perceived risk of cannabis use, both of which persisted when considering key covariates. These findings may be partly explained by a confluence of societal and cultural factors.

Posttraumatic growth among mental health officers who treat soldiers with non-suicidal self-harm/suicidal behavior: The role of cognitive and personality characteristics.

Mental health officers (MHO) in the military often encounter soldiers expressing distress, manifested in threats and attempts at self-harm and suicide. While these behaviors are a significant stressor for therapists, they may also be an opportunity for posttraumatic growth (PTG). We aimed to examine whether the relatively frequent exposure of MHO to soldiers who report thoughts, intentions, and attempts at self-harm and suicide is related to their PTG, as well as tested the contribution of cognitive variables (the centrality of the event and the challenge to core beliefs), and a trait not previously considered in this context, i.e. self-compassion to PTG. Self-report questionnaires were completed by130 Israeli army MHO. Of these, 98.5% reported that they are exposed to self-harm. The questionnaires were collected between the years 2020-2021. The findings show a positive linear relationship, as well as a curvilinear relationship, between PTG and exposure to expressions of self-harm and suicide, the centrality of the event, and the challenge to core beliefs. In addition, self-compassion served as a moderator in the association between exposure and PTG. The study validates the PTG model in a population that has not previously been studied in this context, and may lead to a broader understanding of PTG in this context. They may help in designing dedicated training programs for therapists dealing with reports of self-harm and suicidal behavior.

Military service and risk of subsequent drug use disorders among Swedish men.

PURPOSE: Environmental factors contribute substantially to risk for drug use disorders (DUD). The current study applies multiple methods to empirically test whether military service is associated with subsequent DUD, as previous findings are inconsistent. METHODS: Longitudinal Swedish national registry data on a cohort of male conscripts born 1972-1987 (maximum N = 485,900) were used to test the association between military service and subsequent registration for DUD. Cox proportional hazard models were used in preliminary analyses, followed by three methods that enable causal inference: propensity score models, co-relative models, and instrumental variable analysis. RESULTS: Across all methods, military service was causally associated with lower risk of DUD. Hazard ratios ranged from HR = 0.43 (95% confidence intervals [CI] 0.37; 0.50) in the instrumental variable analysis to 0.77 (0.75; 0.79) in the multivariate propensity score matching analysis. This effect diminished across time. In the model including a propensity score, HRs remained below 1 across the observation period, while confidence intervals included 1 after ~ 11 years in the co-relative analysis and after ~ 21 years in the instrumental variable analysis. CONCLUSIONS: In this cohort of Swedish men, complementary methods indicate that military service conferred substantial but time-limited protection against subsequent DUD. The observed effect could be due to reduced opportunity for substance use during service, social cohesion experienced during and after service, and/or socioeconomic advantages among veterans. Additional research is necessary to clarify these protective mechanisms and determine how other environmental contexts can provide similar benefits.

Chronic frontal neurobehavioural symptoms in combat-deployed military personnel with and without a history of blast-related mild traumatic brain injury.

OBJECTIVE: This study evaluated frontal behavioural symptoms, via the FrSBe self-report, in military personnel with and without a history of blast-related mild traumatic brain injury (mild TBI). METHODS: Prospective observational cohort study of combat-deployed service members leveraging 1-year and 5-year demographic and follow up clinical outcome data. RESULTS: The blast mild TBI group (n = 164) showed greater frontal behavioural symptoms, including clinically elevated apathy, disinhibition, and executive dysfunction, during a 5-year follow-up, compared to a group of combat-deployed controls (n = 107) without mild TBI history or history of blast exposure. We also explored changes inbehaviourall symptoms over a 4-year span, which showed clinically significant increases in disinhibition in the blast mild TBI group, whereas the control group did not show significant increases in symptoms over time. CONCLUSION: Our findings add to the growing evidence that a proportion of individuals who sustain mild TBI experience persistent behavioural symptoms. We also offer a demonstration of a novel use of the FrSBe as a tool for longitudinal symptom monitoring in a military mild TBI population.

Military performance of men with attention-deficit/hyperactivity disorder: findings from a follow-up study in the Northern Finland birth cohort 1986.

PURPOSE: The aim of this study was to assess the military performance of men with adolescent attention-deficit/hyperactivity disorder (ADHD) and men with childhood ADHD (in remission during adolescence) as compared with controls without ADHD. METHODS: The study employs the general population-based Northern Finland Birth Cohort 1986 (NFBC1986) together with data received from the Finnish Defence Forces (FDF). A total of 38 men with childhood ADHD and 67 with adolescent ADHD were compared with 160 controls. RESULTS: The men with adolescent ADHD were more often deemed unfit for military service, had more military health care visits, more often committed at least one offence during service, received poorer evaluations for team leadership skills and indulged in more alcohol consumption and smoking than the controls, while those with childhood ADHD did not differ from the controls in their military fitness, but received poorer evaluations for team leadership skills and smoked more than did the controls. CONCLUSION: The conscripts with adolescent ADHD performed worse on many military parameters, but the men with ADHD in remission did not seem to suffer from such negative effects on military performance. The childhood ADHD group in particular was nevertheless somewhat limited in size, which might have led to a Type II error.

Israeli soldiers' intentions and actions toward seeking mental health help: Barriers and facilitators.

BACKGROUND: While military settings may increase psychological distress, soldiers frequently avoid seeking professional help. This study aimed to examine barriers and facilitators associated with intentions to seek help and actually seeking help from a mental health officer (MHO) and how these differ among soldiers who had sought help in the past and those who had not. METHOD: This cross-sectional study included 263 combat and noncombat soldiers. The Health Belief Model and the Help-Seeking Model were the theoretical framework used to map the potential variables associated with soldiers' decision to seek help. RESULTS: Stigma and administrative barriers were found to be significant barriers to both the intention to seek help and actually consulting an MHO. These findings were more definitive among combat soldiers. The belief in the effectiveness of mental health treatment was positively associated with the intention to seek help. Positive associations were found between well-being, perceived seriousness of one's condition, and belief in the effectiveness of mental health care and intention to seek MHO help. Distress and self-concealment were positively associated with actual consultation with an MHO. Public stigma about seeking help was associated with both the intention to seek mental health assistance and actually consulting an MHO. CONCLUSION: Military commanders should make an effort to make soldiers feel safe to seek mental health assistance by creating a supportive organizational atmosphere to reduce the stigma associated with mental health care.

A stepped down physical activity support program for military service veterans: The Active Choices pilot study.

ISSUE ADDRESSED: Referral to supervised physical activity (PA) programs is an effective treatment for military service veterans (MSVs) suffering from a range of chronic diseases. However, many MSVs fail to maintain PA regimes once discharged from supervision. This pilot study assessed Active Choices, a stepped-down program to support MSVs in the transition from allied health treatment to self-managed PA. METHODS: Participants were 34 Australian MSVs (mean [SD] age = 61 [15.8] years) who were completing supervised referral to an exercise physiologist or physiotherapist. MSVs stepped-down to Active Choices and received a 12-week, evidence-based PA support program (2020-2021). Analyses compared within-group changes in accelerometer-assessed PA at three time points (Weeks 0, 12, and 24; linear mixed model). Program retention, PA choices, and allied healthcare service costs were also evaluated. RESULTS: Relative to baseline (64 [26] min/day), mean (SD) moderate-to-vigorous PA increased (74 [28] min/day; p < .05) and was maintained (62 [28] min/day) at weeks 12 and 24, respectively. Retention in the program was high (86% [29/34 participants] completion rate at 12 weeks), with water-based group activities the most popular PAs of choice (14/24 activities). Average allied healthcare service costs during the study were lower than typical costs for MSVs (60.51 vs. 97.06 AUD/week). CONCLUSION: The findings highlight the potential of Active Choices to support MSVs in the transition from supervised to self-managed MVPA. SO WHAT?: The program could promote the health of veterans and reduce costs for ongoing referral if impact is replicated at scale.

Military service experiences and reasons for service separation among lesbian, gay, and bisexual individuals in a large military cohort.

BACKGROUND: The well-being of lesbian, gay, and bisexual (LGB) individuals is a topic of increasing concern within the military where significant institutional barriers, targeted aggression, and differential organizational policies such as "Don't Ask Don't Tell" have historically contributed to experiences of exclusion and discrimination. However, limited research has examined specific military and post-separation experiences among LGB service members and veterans. The goal of this study was to examine differences in military and service separation experiences by sexual orientation among a large representative sample of United States service members and veterans. METHODS: Survey data from the 2016 Millennium Cohort Study follow-up questionnaire were used to assess sexual orientation and multiple outcomes of interest: military experiences (morale, feelings about the military, missed workdays) and service separation experiences (reasons for separation, post-separation employment). The associations between sexual orientation (LGB versus heterosexual) and each of these outcomes were evaluated in a series of adjusted logistic regression models, stratified by sex when interactions were observed. RESULTS: Of the 99,599 participants, 3.4% identified as LGB. In adjusted models, LGB service members had significantly higher odds than heterosexual service members of feeling: unimpressed by the quality of unit leadership, unsupported by the military, and negative about the military overall. Bisexual women were more likely than heterosexual women to feel less unit camaraderie; both gay and bisexual men felt less camaraderie than heterosexual men. LGB veterans were more likely than heterosexual peers of the same sex to separate from service due to unplanned administrative reasons. Compared to heterosexual women, lesbian and bisexual women were more likely to separate from service due to dissatisfaction with promotions/pay and disability/medical reasons, while bisexual women specifically separated due to dissatisfaction with leadership and incompatibility with the military. Gay and bisexual men also reported separating due to incompatibility with the military, but only bisexual men were more likely to report separating due to disability/medical reasons compared to heterosexual men. CONCLUSIONS: Less positive military- and separation-specific experiences disproportionately affected LGB service members in this study. Promoting inclusion and increasing support for LGB service members may improve satisfaction with military service and retention.

Demographic, military, and health comorbidity variables by mild TBI and PTSD status in the LIMBIC-CENC cohort.

OBJECTIVE: To describe associations of demographic, military, and health comorbidity variables between mild traumatic brain injury (mTBI) history and posttraumatic stress disorder (PTSD) status in a sample of Former and current military personnel. SETTING: Participants recruited and tested at seven VA sites and one military training facility in the LIMBIC-CENC prospective longitudinal study (PLS), which examines the long-term mental health, neurologic, and cognitive outcomes among previously combat-deployed U.S. Service Members and Veterans (SM/Vs). PARTICIPANTS: A total of 1,540 SM/Vs with a history of combat exposure. Data were collected between 1/1/2015 through 3/31/2019. DESIGN: Cross-sectional analysis using data collected at enrollment into the longitudinal study cohort examining demographic, military, and health comorbidity variables across PTSD and mTBI subgroups. MAIN MEASURES: PTSD Checklist for DSM-5 (PCL-5), mTBI diagnostic status, Patient Health Questionnaire 9-item (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), AUDIT-C, and other self-reported demographic, military, and health comorbidity variables. RESULTS: Ten years following an index date of mTBI exposure or mid-point of military deployment, combat-exposed SM/Vs with both mTBI history and PTSD had the highest rates of depression symptoms, pain, and sleep apnea risk relative to SM/Vs without both of these conditions. SM/Vs with PTSD, irrespective of mTBI history, had high rates of obesity, sleep problems, and pain. CONCLUSION: The long-term symptom reporting and health comorbidities among SM/Vs with mTBI history and PTSD suggest that ongoing monitoring and intervention is critical for addressing symptoms and improving quality of life.

Subjective well-being among male veterans in later life: the enduring effects of early life adversity.

OBJECTIVES: This study investigated the association between childhood and young adult adversities and later-life subjective well-being among older male veterans. We also explored whether early-life parent-child relationships and later-life social engagement served as moderators and mediators, respectively. METHODS: Data were from the 2008 to 2012 waves of the Health and Retirement Study for male veterans (N = 2026). Subjective well-being measures included depressive symptoms, self-rated health, and life satisfaction. Linear regression with the Process macro was employed to estimate the relationships. RESULTS: Adverse childhood experiences (ACEs) were positively associated with number of depressive symptoms and negatively related to life satisfaction. Combat exposure, a young adulthood adversity experience, was positively associated with depressive symptoms, but not with self-rated health or life satisfaction. Later-life social engagement mediated the relationship between ACEs and subjective well-being indices. Parent-child relationship quality did not moderate the association between the measures of adversity and any measure of subjective well-being. DISCUSSION: Childhood adversity and combat exposure were related to worse later life subjective well-being. Also, later-life social engagement mediated the association of two early life adversity measures and subjective well-being. Future research should examine subjective well-being and early life adversity for female veterans and should employ more detailed information about combat exposure.

Assessing the Clinical Utility of a Wearable Device for Physiological Monitoring of Heart Rate Variability in Military Service Members with Traumatic Brain Injury.

Introduction: Autonomic dysfunction has been implicated as a consequence of traumatic brain injury (TBI). Heart rate variability (HRV) may be a viable measure of autonomic dysfunction that could enhance rehabilitative interventions for individuals with TBI. This pilot study sought to assess the feasibility and validity of using the Zeriscope™ platform system in a real-world clinical setting to measure HRV in active-duty service members with TBI who were participating in an intensive outpatient program. Methods: Twenty-five service members with a history of mild, moderate, or severe TBI were recruited from a military treatment facility. A baseline assessment was conducted in the cardiology clinic where point validity data were obtained by comparing a 5-min recording of a standard 12-lead electrocardiogram (ECG) output against the Zeriscope platform data. Results: Compared with the ECG device, the Zeriscope device had a concordance coefficient (rc) of 0.16, falling below the standard deemed to represent acceptable accuracy in HR measurement (i.e., 0.80). Follow-up analyses excluding outliers did not significantly improve the concordance coefficient to an acceptable standard for the total participant sample. System Usability Survey responses showed that participants rated the Zeriscope system as easy to use and something that most people would learn to use quickly. Conclusions: This study demonstrated promise in ambulatory HRV measurement in a representative military TBI sample. Future research should include further refinement of such ambulatory devices to meet the specifications required for use in a military active-duty TBI population.

Understanding processes that advance suicidal behavior among Israeli active duty soldiers: A mediation model.

OBJECTIVES: The current study was aimed to identify the factors and mechanisms that promote nonsuicidal self-injury and suicidal ideation (SI) as precursors of suicidal behaviors in a sample of 553 Israeli active-duty soldiers. METHODS: A mediation model was used to examine the contribution of posttraumatic stress disorder (PTSD) symptoms, emotion-regulation difficulties, habituation, and risk-taking behaviors to soldiers' self-injury and SI. RESULTS: Results indicated direct effects between PTSD symptoms and self-injury and SI, as well as between emotion regulation difficulties and self-injury. Indirect effects were found between PTSD symptoms and nonsuicidal self-injury (NSSI) through the mechanisms of habituation and risk-taking behavior and between difficulties in emotion regulation and NSSI through the mechanism of risk-taking behaviors. CONCLUSION: To tackle soldiers' suicidal behaviors, clinicians might assess soldiers' PTSD symptoms and difficulties in emotion regulation and intervene by lessening their access to thrill-seeking situations and situations that increase habituation to pain and death.

Life satisfaction of Korean Vietnam War Veterans in later life: A lifespan approach.

The current study examined correlates of life satisfaction among Korean Vietnam War Veterans. The sample included 450 male Veterans from the Korean Vietnam War Veterans Study, surveyed by mail in 2013 (Mean age = 67.4 years old, SD = 3.0). A hierarchical analysis was conducted by entering four blocks of variables: first demographic factors, and then pre-military service, military service, and post-military service variables. Each successive regression analysis showed a significant additional contribution to the variance in life satisfaction. In the final model, Korean Veterans had higher life satisfaction when they were married, had higher monthly income and poorer childhood family environment, appraised their military service in a positive light, and had less stressors after homecoming and better perceived physical health. However, combat exposure and social support after homecoming were not independently associated with life satisfaction in the final model. These results imply that both pre- and post-military service factors, as well as cognitive appraisals of military service, should be considered in understanding the subjective well-being of Korean Vietnam War Veterans in later life.

Military carrier choice during the Covid-19 pandemic in Hungary.

Covid-19 pandemic has changed availability of reasonable jobs. To avoid joblessness, many young adults selected military service in Hungary. The aim of this research was to study their motivation, their individual needs and the way they think about the military forces. In this study, half-structured, focus group interviews with standard questions have been qualitatively analyzed by applying the Grounded Theory (GT) method. Three levels of coding were applied: open (basic), axial and selective coding. This process resulted in fewer codes representing larger categories leading to a final concentrated overview of the interviews. Three selective codes (Enrollment, Pathfinding, Fulfillment), and many sub-codes were identified. We could establish that the effect of the Covid-19 pandemic for the military career-choice really can be detected in many individuals. The military force offers for them safe, predictable existence and career image, in which, in addition to continuous learning and development, teamwork and camaraderie provides major motivations.

Resting-state magnetoencephalography source magnitude imaging with deep-learning neural network for classification of symptomatic combat-related mild traumatic brain injury.

Combat-related mild traumatic brain injury (cmTBI) is a leading cause of sustained physical, cognitive, emotional, and behavioral disabilities in Veterans and active-duty military personnel. Accurate diagnosis of cmTBI is challenging since the symptom spectrum is broad and conventional neuroimaging techniques are insensitive to the underlying neuropathology. The present study developed a novel deep-learning neural network method, 3D-MEGNET, and applied it to resting-state magnetoencephalography (rs-MEG) source-magnitude imaging data from 59 symptomatic cmTBI individuals and 42 combat-deployed healthy controls (HCs). Analytic models of individual frequency bands and all bands together were tested. The All-frequency model, which combined delta-theta (1-7 Hz), alpha (8-12 Hz), beta (15-30 Hz), and gamma (30-80 Hz) frequency bands, outperformed models based on individual bands. The optimized 3D-MEGNET method distinguished cmTBI individuals from HCs with excellent sensitivity (99.9 ± 0.38%) and specificity (98.9 ± 1.54%). Receiver-operator-characteristic curve analysis showed that diagnostic accuracy was 0.99. The gamma and delta-theta band models outperformed alpha and beta band models. Among cmTBI individuals, but not controls, hyper delta-theta and gamma-band activity correlated with lower performance on neuropsychological tests, whereas hypo alpha and beta-band activity also correlated with lower neuropsychological test performance. This study provides an integrated framework for condensing large source-imaging variable sets into optimal combinations of regions and frequencies with high diagnostic accuracy and cognitive relevance in cmTBI. The all-frequency model offered more discriminative power than each frequency-band model alone. This approach offers an effective path for optimal characterization of behaviorally relevant neuroimaging features in neurological and psychiatric disorders.

Is there an association between a history of military service and cancer diagnosis? Results from a US national-level study of self-reported outcomes.

PURPOSE: To examine cancer prevalence in men with and without military service history, using national-level self-reported outcomes. METHODS: A cross-sectional survey-based US study, including men aged 18 and above from the Health Information National Trends Survey database between 2011 and 2014. The primary endpoint was self-reported cancer prevalence. Multivariable logistic regression analyses assessed the association of various covariates with the prevalence of cancer. RESULTS: A total of 4,527 men were analyzed, with 1,352 (29.9%) reporting a history of military service. Compared to men with no military service history, men with a military service history were older (median of 65 [IQR 56, 74] vs. 53 [IQR 41, 62] years, p < 0.0001), more commonly Caucasian (71.4% vs. 61.4%, p < 0.0001), born in the US (95.6% vs. 79.5%, p < 0.0001), attained higher education level and annual household income (p < 0.0001), and consisted of more smokers(58.3% vs. 44.5%, p < 0.0001). The age-adjusted comparison demonstrated a higher cancer prevalence in men with military service history (20.5% vs. 7.6%, p < 0.0001). Specifically, genitourinary, dermatological, gastrointestinal, and hematological cancers were generally more prevalent. Adjusting for all available confounders, multivariable models showed that military service history was associated with 1.56 (95% CI 1.20-2.03), and 1.57 (95% CI 1.07-2.31) increased odds of having any cancer, and specifically genitourinary cancer, respectively. CONCLUSIONS: Further research is needed to ascertain whether the association between military service and increased cancer diagnosis results from better screening programs or increased exposure to risk factors during military service.

Military service and related risk factors for amyotrophic lateral sclerosis.

BACKGROUND: The cause of amyotrophic lateral sclerosis (ALS) is unknown, but occupations have been explored as a potential proxy measure of risk. There is a substantial body of literature connecting military service to ALS. We aimed to summarize and assess the quality of this evidence. METHODS: Systematic review of the literature, including observational studies which explored one of the following exposures: general military service (army, air force, marines, or navy); or specific exposures associated with military service measured among military personnel. The outcome of interest was ALS incidence, which could include onset, diagnosis, or death from ALS. RESULTS: A total of 2642 articles were screened. Following exclusion, 19 articles remained for inclusion in the systematic review, including 1 meta-analysis and 18 original observational studies. Most studies were of moderate quality. In general, the relationship between military service was suggestive of an increased risk, particularly among Gulf War and WWII veterans. Exposure to pesticides (including Agent Orange) certain chemicals (exhaust, burning agents), heavy metals, and head trauma appeared to increase the risk of ALS among military personnel. CONCLUSIONS: There is a possible association between military service and the subsequent development of ALS; however, the evidence was limited. Studies were generally hindered by small sample sizes and inadequate follow-up time. Future studies should endeavor to objectively measure specific exposures, or combinations thereof, associated with military service, as this will be of vital importance in implementing preventative strategies into military organizations.

Clinically-diagnosed vitamin deficiencies and disorders in the entire United States military population, 1997-2015.

BACKGROUND: This study examined incidence rates, temporal trends, and demographic factors associated with vitamin deficiencies/disorders in all United States military personnel from 1997 to 2015 (mean N = 1,382,266/year). METHODS: Employing an ecological study design, the Defense Medical Epidemiological Database and specific International Classification of Diseases codes were used to determine incidence rates for clinically-diagnosed vitamin deficiencies/disorders. Associations with demographic factors were examined. RESULTS: The overall incidence rate of vitamin deficiencies/disorders was 92.7 cases/100,000 person-years (p-yr). Highest rates were for vitamin D (53.7 cases/100,000 p-yr), other B-complex vitamins (20.2 cases, 100,000 p-yr), vitamin B12 anemia (7.6 cases/100,000 p-yr), deficiencies of "other vitamins" (5.9 cases/100,000 p-yr), and vitamin A (2.5 cases/100,000 p-yr). Thiamin, riboflavin, niacin, pyridoxine, folate, vitamin C, and vitamin K deficiencies and hypervitaminoses A and D had < 1 case/100,000 p-yr. Rates for vitamin D, other B-complex, "other vitamin", and thiamin deficiencies increased over time, while vitamin A and C deficiencies decreased. Women had higher incidence rates for all examined deficiencies/ disorders except niacin and vitamin C. Incidence rates rose with age in 8 of 15 deficiency/disorder categories and blacks had higher incidence rates in 9 of 15 deficiency/disorder categories. CONCLUSIONS: The overall rate of clinically-diagnosed vitamin deficiencies and disorders was low but higher in women and minority subgroups. As for most illnesses, the diagnosed incidence of such disorders may be an underestimate of the actual incidence. These findings can guide clinical decision making with regard to testing for nutritional deficiencies and delivering public health information to at risk populations. CLINICAL TRIAL REGISTRATION: (No. ISRCTN58987177 ). Registration date 9 October 2019.

Post-9/11 service members: Associations between gender, marital status, and psychiatric aeromedical evacuations from combat zones.

Psychiatric aeromedical evacuations are one of the leading causes of medical related evacuations of US military personnel from combat. Currently, no studies have examined gender and marital status of individuals who were evacuated from combat for a psychiatric diagnosis. Psychiatric aeromedical evacuation data from 5,957 United States military personnel deployed to Iraq or Afghanistan between 2001 and 2013 were analyzed using chi-square tests of independence, odds ratios (OR), and standardized residuals. Analyses showed that female service members were evacuated at higher rates (178 per 100,000) than males (115 per 100,000). When compared to nonmarried females, married females did not present with increased risk of psychiatric aeromedical evacuation on any diagnosis. Married males, however, were more likely to be evacuated than married females for PTSD (OR = 1.98) and TBI (OR = 1.14). Likewise, married males, compared to nonmarried males, were more likely to be evacuated for PTSD (OR = 1.66) and anxiety (OR = 1.38). Although deployments can be extremely stressful experiences for some military service members, they may be especially so among unmarried females and married males. This study provides a unique contribution to enhancing the understanding of risk factors related to psychiatric aeromedical evacuation for deployed service members.