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Dorrance, Kevin A; Ramchandani, Suneil; Neil, Nancy; Fisher, Harry
The Patient Protection and Affordable Care Act recently passed into law is poised to profoundly affect the provision of medical care in the United States. In today's environment, the foundation for most ongoing comparative effectiveness research is financial claims data. However, there is an alternative that possesses much richer data. That alternative, uniquely positioned to serve as a test system for national health reform efforts, is the Department of Defense Military Health System. This article describes how to leverage the Military Health System and provide effective solutions to current health care reform challenges in the United States.
Legionellosis is an infection caused by exposure to mist or vapor contaminated with Legionella bacteria. During the 16-year surveillance period, 73 cases of legionellosis were identified in active component service members; 37 were identified among the reserve component; and 1,044 were identified among all other beneficiaries of the Military Health System (MHS). Of the total 1,154 cases of legionellosis, 11 percent (n=126) were confirmed cases (i.e., reportable medical events); 52 percent (n=599) were probable cases (i.e., hospitalizations); and 37 percent (n=429) were suspected cases (i.e., ambulatory visits). Most of the cases (59%) were identified in individuals aged 60 years and older. The annual number of cases increased during the surveillance period and demonstrated a seasonal trend with more cases occurring in the summer and early fall. Recent trends in the incidence of legionellosis among MHS beneficiaries and civilian populations in the United States highlight the importance of correctly identifying the etiologic agents of bacterial pneumonia and submitting reports of cases of legionellosis through the appropriate reporting system.
5. Realign the TRICARE Management Activity and establish a Joint Military Health Service Directorate to consolidate shared services and common...Directorate to consolidate shared services and common functions Realign TRICARE Management Activity and establish a TRICARE Health Plan Agency to...Uniformed Services University of the Health Sciences, (2) TRICARE health plan, (3) Health Management Support, and (4) Shared Services division
The Department of Defense has launched several initiatives to improve efficiency and quality of care in the military health system. The goal of empaneling 1,300 to 1,500 patients per primary care manager did not correlate well with Naval Hospital Bremerton's experience and did not accurately account for military-specific requirements. The Bremerton Model Task Force was chartered to assess current business practices, identify areas for improvement, and develop a capacity model reflecting military readiness and residency training requirements. Methods included a 12-month review of patient visits and staff surveys of how providers spent their day, with time-and-motion analysis to verify assumptions. Our capacity results (average, 791 enrollees per primary care manager) demonstrated that objective measures at the local level do not support enrollment to Department of Defense-specified levels. Significant changes in "corporate culture" are necessary to accomplish the military health system goals.
Hosek, Susan D; Straus, Susan G
The Military Health System (MHS) and the Veterans Health Administration (VHA) have been among the nation's leaders in health information technology (IT), including the development of health IT systems and electronic health records that summarize patients' care from multiple providers. Health IT interoperability within MHS and across MHS partners, including VHA, is one of ten goals in the current MHS Strategic Plan. As a step toward achieving improved interoperability, the MHS is seeking to develop a research roadmap to better coordinate health IT research efforts, address IT capability gaps, and reduce programmatic risk for its enterprise projects. This article contributes to that effort by identifying gaps in research, policy, and practice involving patient privacy, consent, and identity management that need to be addressed to bring about improved quality and efficiency of care through health information exchange. Major challenges include (1) designing a meaningful patient consent procedure, (2) recording patients' consent preferences and designing procedures to implement restrictions on disclosures of protected health information, and (3) advancing knowledge regarding the best technical approaches to performing patient identity matches and how best to monitor results over time. Using a sociotechnical framework, this article suggests steps for overcoming these challenges and topics for future research.
Murnyak, George R; Spencer, Clark O; Chaney, Ann E; Roberts, Welford C
During the 1970s, the Army health hazard assessment (HHA) process developed as a medical program to minimize hazards in military materiel during the development process. The HHA Program characterizes health hazards that soldiers and civilians may encounter as they interact with military weapons and equipment. Thus, it is a resource for medical planners and advisors to use that can identify and estimate potential hazards that soldiers may encounter as they train and conduct missions. The U.S. Army Center for Health Promotion and Preventive Medicine administers the program, which is integrated with the Army's Manpower and Personnel Integration program. As the HHA Program has matured, an electronic database has been developed to record and monitor the health hazards associated with military equipment and systems. The current database tracks the results of HHAs and provides reporting designed to assist the HHA Program manager in daily activities.
measure. We examined variations in quality measure rates by service branch (Army, Air Force, Marine Corps, Navy) and TRICARE region (North, South...T15a and T15b), Army and 76 Quality of Care for PTSD and Depression in the Military Health System Air Force members showed much higher rates of...C O R P O R A T I O N Quality of Care for PTSD and Depression in the Military Health System Phase I Report Kimberly A. Hepner, Elizabeth M. Sloss
military disaster assessment team to El Salvador following an earthquake.25 While these examples illustrate a utility for U.S. military forces in...the volume and quality of planning resources for the U.S. military health systems has grown substantially for foreign disaster response. The second... environmental conditions and reliably restore the social well-being of the affected population to an acceptable level.13 Although the U.S. military has a
sultation provi’dtd in the diagnosis of disease. The Center for Advanced Pathology includes such specialized areas as forensic , radiologic, dental and...medical entomology programs within the three Military Medical- Services were-reorganized into a single Department of Defense Organizational Board
probability of a value outside 2.0 standard deviations ranges from .0456 for A-3 -Al" 122 NILITRY HEALTH SERVICE SYSTEM AMULRTORY MORKe UurNT CANdU )(U) ARMY...00 2 w w >4 &4~ ~z til 0n0 rz~ co00 P - xU) I : 0 ) ) %z E-4 z U) HHw H~~ ~ ~ 0 olf4 E1E- 004 H U) UDm 0 4 E- H wE- ~ H E-4 H 04 H Z U H Q z HO H % x z
Bastian, Nathaniel D; Kang, Hyojung; Swenson, Eric R; Fulton, Lawrence V; Griffin, Paul M
Like all health care delivery systems, the U.S. Department of Defense Military Health System (MHS) strives to achieve top preventative care and population health outcomes for its members while operating at an efficient level and containing costs. The objective of this study is to understand the overall efficiency performance of military hospitals and investigate the relationship between efficiency and wellness. This study uses data envelopment analysis and stochastic frontier analysis to compare the efficiency of 128 military treatment facilities from the Army, Navy, and Air Force during the period of 2011 to 2013. Fixed effects panel regression is used to determine the association between the hospital efficiency and wellness scores. The results indicate that data envelopment analysis and stochastic frontier analysis efficiency scores are congruent in direction. Both results indicate that the majority of the MHS hospitals and clinics can potentially improve their productive efficiency by managing their input resources better. When comparing the performance of the three military branches of service, Army hospitals as a group outperformed their Navy and Air Force counterparts; thus, best practices from the Army should be shared across service components. The findings also suggest no statistically significant, positive association between efficiency and wellness over time in the MHS.
the US Office of Management and Budget’s core- based statistical area (CBSA) to group healthcare data from the respective VA and DoD systems by...Combining Surveillance Systems: Effective Merging of U.S. Veteran and Military Health Data Julie A. Pavlin1*, Howard S. Burkom2, Yevgeniy Elbert2... data from October 2006 through September 2010 to demonstrate geographic and demographic coverage, timeliness of influenza epidemic awareness, and impact
adjunctive dental care, cataract removals, mental health, MRIs, and pregnancy excluding active labor and cesarean section . However, these procedures may not...cataracts, - mental health, and - pregnancy excluding active labor or scheduled cesarean section . In addition, the prospective reviews are required for...i Section A: General Information ................................................. I B ackground
Collmann, Jeff R.
The global scale, multiple units, diverse operating scenarios and complex authority structure of the Department of Defense Military Health System (MHS) create social boundaries that tend to reduce communication and collaboration about data security. Under auspices of the Defense Health Information Assurance Program (DHIAP), the Telemedicine and Advanced Technology Research Center (TATRC) is contributing to the MHS's efforts to prepare for and comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 through organizational and technological innovations that bridge such boundaries. Building interdisciplinary (clinical, administrative and information technology) medical information security readiness teams (MISRT) at each military treatment facility (MTF) constitutes the heart of this process. DHIAP is equipping and training MISRTs to use new tools including 'OCTAVE', a self-directed risk assessment instrument and 'RIMR', a web-enabled Risk Information Management Resource. DHIAP sponsors an interdisciplinary, triservice workgroup for review and revision of relevant DoD and service policies and participates in formal DoD health information assurance activities. These activities help promote a community of proponents across the MHS supportive of improved health information assurance. The MHS HIPAA-compliance effort teaches important general lessons about organizational reform in large civilian or military enterprises.
Mangelsdorff, A David; Rogers, Jody; Finstuen, Kenn; Pryor, Rene
The purpose of this research is to assess the impact of an educational program on the Military Health System on some of the evidence-based educational outcomes for the Individual (student) and the Society (all Army Medical Treatment Facilities). The U.S. Army-Baylor University HCA program provides a unique opportunity to assess the impact of an educational program on the Military Health System (MHS). Since the majority of the graduate students are military officers who serve in military medical treatment facilities (MTFs), tracking their career progression allows assessing the value added of the U.S. Army-Baylor University HCA experience from 1951 to 2001 (n = 2234). The context of Society outcomes includes all the Army MTFs where U.S. Army-Baylor University HCA graduates execute their leadership skills. During the time from 1994 to 2001, all of the Army MTFs in the MHS (n = 38) were examined by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). In a similar but shorter time frame (1997-2001), DoD patient satisfaction assessments were conducted. The Individual outcomes (career advancement, increase in status, higher professional association membership) demonstrate that the selection criteria used for program admission appear to be successful. The Society outcomes showed higher JCAHO scores and satisfied consumers in Army facilities with Baylor graduates as the Deputy Commander for Administration (DCA). Continued internal program assessments (curriculum reviews) and external reviews (Accrediting Commission on Education for Health Services Administration accreditations of 5 years in 1987, 8 years in 1993 and 7 years in 2001, and 7 ACHE student chapter awards) attest to the strengths of the U.S. Army-Baylor University HCA program. Educating the MHS shareholders (patients, beneficiaries, professional and support staff, senior leaders) and leveraging technology to. share best practices for all administrators (including non-Baylor graduates) will
Wilson, J P; Bulatao, P T; Rascati, K L
User satisfaction with a computerized practitioner order-entry (POE) system at two military health care facilities was studied. A survey was mailed in May 1998 to providers authorized to enter drug orders into the Composite Health Care System (CHCS) (including two clinical pharmacists) and pharmacy staff members at two department of defense (DOD) medical treatment facilities. Of 189 questionnaires with the potential to be returned completed, 112 were usable, for a net response rate of 59.3%. The internal consistency of the survey items measuring user satisfaction (Cronbach's alpha) was 0.86. The typical respondent was male, was employed by the DOD, had fair to excellent computer and typing skills, had received eight hours or less of training on the CHCS POE system, had been using the system for two years or less, and had been a health care practitioner for 10 years or less. Overall, users were satisfied with the POE system (mean +/- S.D. rating of 3.78 +/- 0.87 on a 5-point scale where 5 represented the highest satisfaction level). Satisfaction was correlated most strongly with ratings of the POE system's efficiency. Nonphysicians were more satisfied, on average, than physicians. No significant relationship was found between other individual characteristics and satisfaction. Qualitative analysis reinforced the finding that users were interested in efficiency issues. Overall, users at two military health care facilities were satisfied with a computerized POE system. Satisfaction was most strongly correlated with the perceived efficiency of the system.
Mukherji, Raj J; Egyhazy, Csaba J
This article describes a melding of a government-sponsored architecture for complex systems with open systems engineering architecture developed by the Institute for Electrical and Electronics Engineers (IEEE). Our experience in using these two architectures in building a complex healthcare system is described in this paper. The work described shows that it is possible to combine these two architectural frameworks in describing the systems, operational, and technical views of a complex automation system. The advantage in combining the two architectural frameworks lies in the simplicity of implementation and ease of understanding of automation system architectural elements by medical professionals.
Coppola, Nicholas; Satterwhite, Robin; Fulton, Lawrence V; Shanderson, Laurie L; Pasupathy, Rubini
This article reviews the history of measuring military medical health care efficiency. No single approved definition or uniform framework has ever been offered or suggested defining military medical treatment facility efficiency over the last 225 years within the Department of Defense. The purpose of this article is to consolidate much of the existing research on the latent variable of military medical efficiency over the last two centuries, and to provide health care leaders a framework for understanding past and current practices in measuring efficiency in the military health care setting.
Lennon, Robert P; Saguil, Aaron; Seehusen, Dean A; Reamy, Brian V; Stephens, Mark B
Multiple strategies have been proposed to improve health care in the United States. These include the development of communities of solution (COSs), implementation of patient-centered medical homes (PCMHs), and lengthening family medicine residency training. There is scant literature on how to build and integrate these ideal models of care, and no literature about how to build a model of care integrating all 3 strategies is available. The Military Health System has adopted the PCMH model and will offer some 4-year family medicine residency positions starting in 2013. Lengthening residency training to 4 years represents an unprecedented opportunity to weave experiential COS instruction throughout a family physician's graduate medical education, providing future family physicians the skills needed to foster a COS in their future practice. This article describes our COS effort to synergize 3 aspects of modern military medicine: self-defined community populations, the transition to the PCMH model, and the initiation of the 4-year length of training pilot program in family medicine residency training. In this way we provide a starting point and general how-to guide that can be used to create a COS integrated with other current concepts in medicine.
assessment of "outcome". Stroke , 13, 873-876. 63. Ferguson, G. H., Hildman, T., & Nichols, B. (1987). The effect of nursing care planning systems on patient...Outcome assessment. (1987). New England Journal of Medicine, 317(4), 251-252. 177. Partridge, C. J. (1982). The outcome of physiotherapy and its...measurement. Physiotherapy , 68(11), 362-363. 178. Penckofer, S. H., & Holm, K. (1984). Early appraisal of coronary revascularization on quality of life
Surgery, and Otolaryngology. All CRDAMC’s programs remain fully accredited by the Accreditation Council for Graduate Medical Education (ACGME). 55 The...also develops Military Health System (MHS) initiatives to improve the quality of healthcare across the DoD and prepares the DoD healthcare budget.12...and retention, the Services provide education , leadership development, and other training programs to support MHS needs.15 DoD Healthcare Plan
Marshall, Robert C; Doperak, Martin; Milner, Michelle; Motsinger, Charles; Newton, Terry; Padden, Maureen; Pastoor, Sara; Hughes, Cortney L; LeFurgy, Jennifer; Mun, Seong K
The patient-centered medical home (PCMH) is a primary care model that aims to provide quality care that is coordinated, comprehensive, and cost-effective. PCMH is hinged upon building a strong patient-provider relationship and using a team-based approach to care to increase continuity and access. It is anticipated that PCMH can curb the growth of health care costs through better preventative medicine and lower utilization of services. The Navy, Air Force, and Army are implementing versions of PCMH, which includes the use of technologies for improved documentation, better disease management, improved communication between the care teams and patients, and increased access to care. This article examines PCMH in the Military Health System by providing examples of the transition from each of the branches. The authors argue that the military must overcome unique challenges to implement and sustain PCMH that civilian providers may not face because of the deployment of patients and staff, the military's mission of readiness, and the use of both on-base and off-base care by beneficiaries. Our objective is to lay out these considerations and to provide ways that they have been or can be addressed within the transition from traditional primary care to PCMH.
Pertussis ("whooping cough") is a highly infectious respiratory disease caused by the bacterium Bordetella pertussis. Individuals at highest risk are infants and unvaccinated children; however, there have been recent increases in incidence among adolescent and young adult populations in the United States. During the surveillance period, there were 476 confirmed and 3,073 probable cases of pertussis among U.S. military members and other beneficiaries of the U.S. Military Health System. Among service members there were 77 and 13 confirmed cases in active and reserve component members, respectively. In comparison, infants and children aged 15 years and younger accounted for over half of all confirmed cases (n=244). Several spatiotemporal clusters of pertussis among military healthcare beneficiaries were associated with outbreaks in adjacent non-military communities, particularly in five states (California, Texas, Florida, Washington, and New York); one cluster occurred in a military community in Okinawa, Japan.
Foote, Frederick O; Bulger, Roger J; Frampton, Susan B; Pellegrino, Edmund D
This article describes the history and findings of the Epidaurus Project, a Uniformed Services University-affiliated project to bring holistic care and evidence-based design into the Military Health System (MHS). A distinguished group of civilian thought leaders contributed. The 2005 Base Realignment and Closure process offered a chance to implement the Epidaurus agenda. A new integrated healthcare delivery system, centered around the Walter Reed National Military Medical Center at Bethesda, Maryland, was the result. These facilities will be templates for a new generation of MHS "healing environments" and a model for innovative systems of healthcare nationwide. The Epidaurus Project represents a significant collaboration between civilian medicine and the military in times of war.
Bulger, Roger J.; Frampton, Susan B.; Pellegrino, Edmund D.
This article describes the history and findings of the Epidaurus Project, a Uniformed Services University–affiliated project to bring holistic care and evidence-based design into the Military Health System (MHS). A distinguished group of civilian thought leaders contributed. The 2005 Base Realignment and Closure process offered a chance to implement the Epidaurus agenda. A new integrated healthcare delivery system, centered around the Walter Reed National Military Medical Center at Bethesda, Maryland, was the result. These facilities will be templates for a new generation of MHS “healing environments” and a model for innovative systems of healthcare nationwide. The Epidaurus Project represents a significant collaboration between civilian medicine and the military in times of war. PMID:24278818
Seeley, Benjamin Eli
On February 23, 2007, Former Secretary of Defense Robert Gates said, "Our nation is truly blessed that so many talented and patriotic young people have stepped forward to serve. They deserve the very best facilities and care to recuperate from their injuries and ample assistance to navigate the next step in their lives, and that is what we intend to give them. Apart from the war itself, this department and I have no higher priority" (p. e1). Veterans and active duty Armed Forces personnel operate in a complex continuum that often requires being in harm's way to perform their duties. In doing so, their injuries encountered can be complex. Caring for those with more common injuries, such as injuries to the extremities (30% to 39.6%), is difficult; caring for those with less common injuries, such as genitourinary (0.5% to 8%), takes on an added level of complexity (Fisher, 2009). A complete picture of the injury can only be gained by visualizing their entire record of care. Traditionally, members of the health care team have not been able to link the episodes of care together seamlessly, preventing the ability to see the entire picture. The electronic health record enables better continuity of care and enhances quality (Menachemi, 2008). The availability of a system to document health care provided in austere environments and connect these data with care provided in tertiary military medical care centers using records available throughout the Veterans Health Administration (VHA) will enhance the care provided. Members of the Department of Defense, the VHA, and private sector organizations are collaborating to provide world-class seamless health care. Although the end goal of a completely integrated record has not been reached, the advent of several recent initiatives has placed military health care firmly on the track to reach those goals.
Bassoff, Betty Z.; Ortiz, Elizabeth T.
Although the military health care system is the second largest in the nation serving approximately 6,000,000 people, little research has examined military reproductive health care services or their quality. Medical services can be provided by regional military medical centers and by base infirmaries and dispensaries. Often base infirmaries and…
included active-duty spouses, we also included a variable to indicate women of child -bearing age (18 to 34) because their use is high during these years...8217) NNKPHOOHnOOOtll^HO ON CO CSI NO "tf CO CSI ON 00 CN oo vo n p N ■* H N H IS Ds ON IDvOMOHlO OCOO\\OvNrt CO ON CSI CM ON in oo N TII...0.01214 0.02340 0.02029 Family age squared Family health -0.00033 0.09397 0.00018 0.01379 -0.00029 0.15762 0.00029 0.02316 Child < age 1
Roark, G A; Tucker, S L
Military health care leaders must recognize the importance of satisfied consumers. As part of this recognition, the focus of military medicine must change from a coercive-power to a reward-power system. This change highlights the need for business practices such as marketing. Encouraging military health care administrators to learn and understand the applications of the marketing variables will enhance demand management and health care delivery for beneficiaries. This paper describes some applications of marketing variables, informs the military health care administrator about the process of marketing, and describes the utility of marketing in the current paradigm shift in military health care delivery.
the time spent on rejected timecards. For example, mistakes such as entering excess duty time could be automatically flagged as potential errors... Switzerland : Springer International Publishing, 2015). Congressional Budget Office. Approaches to Reducing Federal Spending on Military Health Care
Health Maior r~a1 minuAin PREFACE This report responds to a Congressional mandate for a study of the feability and desirability of changing the miliUa...peacetme and wartime medical care. 7he study was performed within Rand’s Health Sciences Proram under contract with the U.S. Department of Defense...Assistant Secre- tary for Health Affairs, Office of the Deputy’ Assistant Secretary for Health Progam valuation. At The Rand Corporation, the study was
asthmatics within the Military Health System (MHS). Visualizing the patterns of asthma medication use surrounding a LABA prescription is a quick way to...display and summarize time- point and interval data. EventFlow groups individuals that share the same sequence of medications and displays the... sequence patterns in the dataset, and on the right a scrollable timeline browser shows all the individual records. The top sequence in the overview
Gill, Abegail A.; Zahm, Shelia H.; Shriver, Craig D.; Stojadinovic, Alexander; McGlynn, Katherine A.; Zhu, Kangmin
Background The number of lymph nodes examined during colon cancer surgery falls below nationally recommended guidelines in the general population, with blacks and Hispanics less likely to have adequate nodal evaluation in comparison to whites. The Department of Defense’s (DoD’s) Military Health System (MHS) provides equal access to medical care for its beneficiaries, regardless of racial/ethnic background. This study aimed to investigate whether racial/ethnic treatment differences exist in the MHS, an equal access medical care system. Methods Linked data from the DoD cancer registry and administrative claims databases were used and included 2,155 colon cancer cases. Multivariate logistic regression assessed the association between race/ethnicity and the number of lymph nodes examined (<12 and ≥ 12) overall and for stratified analyses. Results No overall racial/ethnic difference in the number of lymph nodes examined was identified. Further stratified analyses yielded similar results, except potential racial/ethnic differences were found among persons with poorly differentiated tumors, where non-Hispanic blacks (NHBs) tended to be less likely to have ≥12 lymph nodes dissected (OR: 0.34, 95% CI: 0.14-0.80, p-value: 0.01) compared to non-Hispanic whites. Conclusion Racial/ethnic disparities in the number of lymph nodes evaluated among patients with colon cancer were not apparent in an equal-access healthcare system. However, among poorly differentiated tumors, there might be racial/ethnic differences in nodal yield, suggesting the possible effects of factors other than access to healthcare. PMID:25059789
Rezvantsev, M V; Kuznetsov, S M; Ivanov, V V; Zakurdaev, V V
The current article is dedicated to some features of the Russian Federation Armed Forces military personnel health monitoring such as legal and informational provision, methodological basis of functioning, historical aspect of formation and development of the social and hygienic monitoring in the Russian Federation Armed Forces. The term "military personnel health monitoring" is defined as an analytical system of constant and long-term observation, analysis, assessment, studying of factors determined the military personnel health, these factors correlations, health risk factors management in order to minimize them. The current state of the military personnel health monitoring allows coming to the conclusion that the military health system does have forces and resources for state policy of establishing the population health monitoring system implementation. The following directions of the militarily personnel health monitoring improvement are proposed: the Russian Federation Armed Forces medical service record and report system reorganization bringing it closer to the civilian one, implementation of the integrated approach to the medical service informatisation, namely, military personnel health status and medical service resources monitoring. The leading means in this direction are development and introduction of a military serviceman individual health status monitoring system on the basis of a serviceman electronic medical record card. Also it is proposed the current Russian Federation Armed Forces social and hygienic monitoring improvement at the expense of informational interaction between the two subsystems on the basis of unified military medical service space.
... sacrifices to our country, and they face different health issues than civilians. During their service, they are ... knees There may also be a risk of health problems from exposure to environmental hazards, such as ...
Swanson, Thomas M; Isaacson, Brad M; Cyborski, Cherina M; French, Louis M; Tsao, Jack W; Pasquina, Paul F
Exposure to explosive armaments during Operation Iraqi Freedom and Operation Enduring Freedom contributed to approximately 14% of the 352 612 traumatic brain injury (TBI) diagnoses in the US military between 2000 and 2016. The US Department of Defense issued guidelines in 2009 to (1) standardize TBI diagnostic criteria; (2) classify TBI according to mechanism and severity; (3) categorize TBI symptoms as somatic, psychological, or cognitive; and (4) systematize types of care given during the acute and rehabilitation stages of TBI treatment. Polytrauma and associated psychological and neurologic conditions may create barriers to optimal rehabilitation from TBI. Given the completion of recent combat operations and the transition of TBI patients into long-term care within the US Department of Veterans Affairs system, a review of the literature concerning TBI is timely. Long-term follow-up care for patients who have sustained TBI will remain a critical issue for the US military.
34 OQuoted in-Fuchs 1974, p. 583. Victor Fuchs (1974, pp. 56-58) brings forth the idea of the physician as captain of the health team and identifies... Toledo . It began as a program in quality assurance with the introduction of cost components as a natural outgrowth of the examination of quality of care...1238. Friedman, Emily "Changing the Oourse of Things Costs Enter ’Medical. Education." Hospitala 53 (0 May 1979), pp. 82-85. Fuchs, Victor . "The
procurement; and research, development , test, and evaluation (RDT&E). Most of the resources appropriated for military health care are allocated to DHP. The...Retired Air Force Colonel Mike Hayden of the Military Officers Association of America (MOAA) provides a convincing analysis that about one-third of the...DoD health care expenses in at least two ways. First, given that 98% of employer-sponsored health insurance has an actuarial value of 80% or greater
35591 3559 DYSFUNCTION, NERVE, OTHER 35592 3559 NEUROPATHY , OTHER 35593 3559 PERIPHERAL /SPINAL NERVE DISORDER 35594 3559 PALSY, POSTERIOR INTERROSSEOUS...criteria for allocation of resources to DOD medical treatment facilities (MTFs). The only exception to this directive was for resources necessary to...severity and four levels of patient compliance with treatment . Since an automated system of classification is essential when dealing with a large data
Sivashchenko, P P; Ivanov, V V; Grigor'ev, S G; Baranovskiĭ, A M
For the first time were suggested some indices such as the index of ratio of one unit's (higher/highest formation) hospitalization, lost worktime, discharge and mortality to the primary morbidity for one military unit and the same index of ratio to the same criteria for the group of military unit. The mentioned peculiarities are intended for impartial and comprehensive estimation of Armed Forces of the Russian Federation military personnel health status and medical units (establishments) activity. These indices include as criteria of diseases prevalence, morbidity, hospitalization, discharge and mortality characteristics. Employment of the new tools provides the possibility of the military health care system analysis by means of such health status components as military labor character peculiarities of medical support, as well as medical service forces and resources availability in the Army, Navy and Air Force.
grow at this rate, they will reach $19.2 billion by 1995. The program is currently growing by about $1 billion a year. In 1986, the services estimated...been to the military medical facility several times for abdominal pain/severe cramps. She was repeatedly given Mylanta and told to drink peppermint ...I can handle that mistake for me but imagine if my child had the same illness and was diagnosed as growing pains are a plain headache--the suffering
Wu, Mae; Henne, Melinda; Propst, Anthony
The FAMILY Act, an income tax credit for infertility treatments, was introduced into the U.S. Senate on May 12, 2011. We estimated the costs and utilization of in vitro fertilization (IVF) in the military if infertility treatment became a tax credit or TRICARE benefit. We surveyed 7 military treatment facilities (MTFs) that offer IVF, with a 100% response rate. We first modeled the impact of the FAMILY Act on the MTFs. We then assessed the impact and costs of a TRICARE benefit for IVF. In 2009, MTFs performed 810 IVF cycles with average patient charges of $4961 and estimated pharmacy costs of $2K per cycle. With implementation of the FAMILY Act, we estimate an increase in IVF demand at the MTFs to 1165 annual cycles. With a TRICARE benefit, estimated demand would increase to 6,924 annual IVF cycles. MTF pharmacy costs would increase to $7.3 annually. TRICARE medical and pharmacy costs would exceed $24.4 million and $6.5 million, respectively. In conclusion, if the FAMILY Act becomes law, demand for IVF at MTFs will increase 29%, with a 50% decrease in patient medical expenses after tax credits. MTF pharmacy costs will rise, and additional staffing will be required to meet the demand. If IVF becomes a TRICARE benefit, demand for IVF will increase at least 2-fold. Current MTFs would be unable to absorb the increased demand, leading to increased TRICARE treatment costs at civilian centers.
Kalachev, O V; Stolyar, V P; Kuandykov, M G; Papkov, A Yu
The article presents main directions of activities of the medical service, dealing with implementation of personal electronic cards for military personnel, organizing the process of automation of medical service management, military and medical organizations and health care departments. The given article, reveals the on-going activity, concerning creation of the military-medical information system, which will unite all medical units, organizations, and governments into one information space.
Hunter, Edna J., Ed.
Recently, the military system has begun to feel the impact of the military family. Whenever sudden dramatic changes or transitions occur, crises may result either for the individual or for the institution. At present both the military system and the military family are in a period of rapid transition. Perhaps one of the most important changes that…
physical health outcomes may be interrelated and that military members with combat experiences and PTSD may benefit from blood pressure and blood sugar ...disorders, a leading cause of missed days of work. The prevalence of migraines among men and women were 6.9% and 20.9%, respectively, and recurrent
Yang, Chenglei; Wang, Lu; Sun, Bing; Yin, Xu; Wang, Xiaoting; Liu, Li; Lu, Lin
Military boxing, a kind of Chinese martial arts, is widespread and health beneficial. In this paper, the authors introduce a military boxing learning system realized by 3D motion capture, Web3D and 3D interactive technologies. The interactions with the system are natural and intuitive. Users can observe and learn the details of each action of the…
left its existing structure in place, approving instead a shared - services directorate to consolidate common MHS functions (e.g., shared information...has seven main goals: (1) consolidate functions ( shared services ) common to DoD, (2) deliver more-integrated health care in areas with more than one
1997). Barriers encountered in osteoporosis prevention are related to the fear that estrogen therapy is harmful (Salamone, Barriers to Health...immunization, mammography, cervical Papanicolaou smear, and physical examination (Dutton, 1986; Elnicki, Morris, & Shockcor, 1995). Provider-Consumer...waiting times at appointments, lack of evening and weekend appointments, inadequate physical space, and inadequate facilities for child care also
Bain, C. N.
The military implications of the reference satellite power system (SPS) were examined is well as important military related study tasks. Primary areas of investigation were the potential of the SPS as a weapon, for supporting U.S. military preparedness, and for affecting international relations. In addition, the SPS's relative vulnerability to overt military action, terrorist attacks, and sabotage was considered.
This theory originated from the work of a group of social psychologists attempting to explain behaviors related to free and low- cost screening...programs in the 1950s. The Health Promotion Model also had its origins in Bandura s Social Learning Theory and Fishbein s Theory of Reasoned Action...barriers: fear, inconvenience, provider- consumer relationship, cost, and site-related factors. Modifications to the original Barriers Scale were made 6
Elective Psychotherapy Artificial Insemination Naturopaths Autopsy Services Orthodontia Birth Control Orthotics, Orthopedic Shoes, and Arch Supports Bone...Enrollment Eligibility Reporting System ( DEERS ). This system is an extensive database that keeps track of all active duty members, their dependents...retirees and their dependents, and survivors. To maintain eligibility for Tricare benefits, a member must be enrolled in DEERS at all times and his
Pickett, Treven; Rothman, David; Crawford, Eric F; Brancu, Mira; Fairbank, John A; Kudler, Harold S
This commentary describes the prevalence of mental health problems affecting military service members and veterans in North Carolina and the rest of the nation, with a special emphasis on those who served in the recent wars in Iraq and Afghanistan. Approximately 1.9 million of these veterans have become eligible for Veterans Affairs health care since 2002, and an estimated 1.16 million veterans have registered for this care.
Shore, Jay H; Aldag, Matt; McVeigh, Francis L; Hoover, Ronald L; Ciulla, Robert; Fisher, Ashley
Mental health problems pose challenges for military veterans, returning service members, and military family members including spouses and children. Challenges to meeting mental health needs include improving access to care and improving quality of care. Mobile Health, or "mHealth," can help meet these needs in the garrison and civilian environments. mHealth brings unique capabilities to health care provision through the use of mobile device technologies. This report identifies high-priority mHealth technology development considerations in two categories. First, priority considerations specific to mental health care provision include safety, privacy, evidence-based practice, efficacy studies, and temperament. Second, priority considerations broadly applicable to mHealth include security, outcomes, ease of use, carrier compliance, hardware, provider perspectives, data volume, population, regulation, command policy, and reimbursement. Strategic planning for the advancement of these priority considerations should be coordinated with stated Department of Defense capability needs to maximize likelihood of adoption. This report also summarizes three leading, military programs focused on mHealth projects in mental health, The Telemedicine and Advanced Technology Research Center, The Military Operational Medicine Research Program, United States Army Medical Research and Materiel Command, and The National Center for Telehealth and Technology.
Ballesteros Fernández, Alfonso
The Napoleonic Wars served to consolidate Army Medical Services on a national scale. All major eminent surgeons of the moment, such as Guthrie or Larrey, took part in the fight. Larrey made the revolutionary contribution of developing the "flying ambulances", a completely new concept at the time. Although surgical techniques were already well described at the time, the deficient hemostasis, the unchecked pain, and above all the numerous infections imposed severe limitations. Mortality among the injured reached 33% and the rate of infection was 90%. The Spanish surgical school contributed to military surgery with the practice known as "the Spanish Cure" which was a conservative approach to the treatment of wounds. This approach was later adopted by the army surgeons of the other countries. Deaths by illness were ten times higher than the number of injured.
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Avshits, I V; Shirinskiĭ, V A
During a comprehensive study, the investigators have made a hygienic assessment of an academic process and the actual nutrition of military school pupils, revealed the specific features of functioning of the body's major systems in adolescents at a closed primary military education establishment, studied the body's adaptive reactions to a combination of factors during study, and hygienically evaluated the pupils' health. Their health has been shown to improve at a closed education establishment according to the basic parameters of the body's functional status and nonspecific resistance, physical development. Specific recommendations are proposed to correct daily diets for pupils of primary military education establishments in order to bring the actual nutrition of cadets in compliance with the standard physiological requirements for this group of pupils.
Kirby, Sheila Nataraj; Marsh, Julie A; McCombs, Jennifer Sloan; Thie, Harry J; Xia, Nailing; Sollinger, Jerry M
The U.S. Department of Defense has highlighted the importance of preparing health care leaders to succeed in joint, performance-based environments. The current wartime environment, rising health care costs, and an increased focus on joint operations have led to recommendations for Military Health System (MHS) transformation. Part of that transformation will involve improving the identification and development of potential MHS leaders. An examination of how candidates are identified for leadership positions, the training and education opportunities offered to them, and the competencies they are expected to achieve revealed both a range of approaches and several commonalities in the military, civilian, and government sectors. A conceptual framework guided a series of interviews with senior health care executives from a wide range of organizations and military health care leaders from the Army, Navy, and Air Force, as well as a case study of the leader development approaches used by the Veterans Health Administration. Several themes emerged in terms of how leaders are developed in each sector, including the importance of mentoring, career counseling, 360-degree feedback, self-development, and formal education and training programs. Lessons learned in the civilian and government sectors hold importance for transforming the way in which MHS identifies and develops health care officers with high leadership potential for senior executive positions.
Service members and veterans face some different health issues from civilians. Their families also face some unique challenges. Families may have to cope with Separation from their loved ones Anxiety over ...
plans: Prime, a health maintenance organization (HMO); Standard, a fee -for-service plan (FFS); and Extra, a preferred provider organization (PPO...Manager (PCM),5 who refers patients to military and civilian medical specialists as needed. TRICARE Standard is a fee -for-service (FFS) plan. All...Retirees enrolled in Prime paid an annual premium (enrollment fee ) of $260 for an individual and $520 for a family; there were no deductibles, and co
upward are usually indications of how effectively the system is developing or operating. The use of computers in information systems tends to increase...computers into information systems must always begin at the lowest level of aggregation in the job hierarchy. Only those information-processing jobs
Responses were received from 37 HSC medical treatment facilities (100%) regarding their occupational health surveillance programs. The occupational ...personnel determined to be potentially exposed to occupational or job- related hazards, medical surveillance programs are limited, if available at all. An...exposed to occupational or job-related hazards would require more adequate staffing to provide the services. Identification of personnel at risk could be
Edwards, Ryan D.
The timing of education across the life cycle is differentially associated with older age health outcomes and socioeconomic status among military retirees, a subpopulation with common levels of adolescent health, but variation in educational timing. A year of education obtained before military service lowers the probability of poor health in…
Levy, Gad; Goldstein, Liav; Barenboim, Erez; Bar-Dayan, Yaron
Patient satisfaction is gaining recognition as an important determinant of the quality of medical care. We conducted an analysis to evaluate the effect of a computerized online system that comparatively displays grades of patient satisfaction among primary care military infirmaries. Fifteen Israel Air Force primary care infirmaries served as the intervention group, and 130 Israel Defense Force infirmaries were the control group. Baseline patient satisfaction was surveyed in all infirmaries. In the intervention group only, infirmaries were resurveyed at 3-month intervals during a 1-year period. Satisfaction scores were continuously displayed on an intranet site in a comparative graphical manner by using the computerized system, available only to the intervention group. At the endpoint, patient satisfaction improved in both groups. However, the magnitude of improvement in the intervention group was significantly greater, in comparison with the control group. The most pronounced improvement was noted in availability of service (intervention group, 57.9% at baseline vs. 66.0% at endpoint, p < 0.001; control group, 67.5% vs. 69.6%, p < 0.025). We conclude that the use of this computerized system in conjunction with promotional efforts resulted in significant improvements in patient satisfaction.
GetTRDoc. pdf&AD =ADA485508 (accessed 15 May 2011). Clunan, Anne L. ed. ―Civil-Military Medicine: On Dangerous Ground.‖ Monterey, CA: Center for...pubs/govt/ AMEDD_Futures_2039_Project_072909.pdf (accessed 14 May 2011). Jones, Seth G., Lee H. Hilborne, C. Ross Anthony, Lois M. Davis, Federico...Girosi, Cheryl Benard, Rachel M. Swanger, Anita Datar Garten, and Anga Timilsina. 92 Health System Reconstruction and Nation-Building. RAND
management and financing . In August 2007, four members of the Task Force travelled to Qatar, Iraq, and Germany to meet with leadership at Military Treatment...process; – create a system of checks and balances by separating the acquisition functions from the requirements/operations and the budget/ finance ...the MHS and other experts in health care manage- ment and financing . (See Appendix D for meeting dates, locations, speakers, and participating
Jennings, Bonnie M; Loan, Lori A; Heiner, Stacy L; Hemman, Eileen A; Swanson, Kristen M
Patient satisfaction can be enhanced by narrowing gaps between what health care consumers experience and what they expect. A study was therefore conducted to better understand health care experiences and expectations among Army beneficiaries. Data collected using focus groups were analyzed by using qualitative research methods. A concept was identified and labeled "Soldier Care." It involves first-line care delivered at the unit level as well as the interface between first-line care and military treatment facilities. There are four features of Soldier Care, i.e., provider competence, the sick call cycle, getting appointments, and unit leadership. Together, these features affect soldiers' time from injury to recovery. Insights about Soldier Care can provide decision-makers with direction for initiating changes that may contribute to improved soldier satisfaction with health care.
Schaeffer, D. J.; Seastedt, T. R.; Gibson, D. J.; Hartnett, D. C.; Hetrick, B. A. D.; James, S. W.; Kaufman, D. W.; Schwab, A. P.; Herricks, E. E.; Novak, E. W.
Ecosystem responses to physical or chemical stress may vary from changes in single organisms to alteration of the structure and function of the ecosystem. These responses to stress cannol be predicted exactly. Ecosystems repeatedly exposed to physical and/or chemical stress can be used to study the separate and combined environmental effects of stress. Such studies also allow the development of procedures to select test systems for the analysis of stress in ecosystems. A preliminary field survey of six military training sites at Fort Riley, Kansas, USA, was conducted to identify and verify ecological test systems for evaluating ecosystem responses to physical and/or chemical stress. Comparisons of these data with data collected concurrently from Konza Prairie Research Natural Area reference sites showed that soil microarthropods, some species of macroarthropods, small mammals, and native earthworm species were negatively affected by stress. In contrast, plant species diversity, plant foliage biomass, soil mycorrhizae, and many soil characteristics were within the boundaries of nominal variations observed on “pristine” Konza Prairie. Introduced European earthworms appeared to be positively affected by training activities. This study provided a test of systematic procedures to support impact analysis, ecological toxicology, and ecosystem risk assessments.
consisted of 516,006 visits from six Army Medical Treatment Facilities (MTFs). U The criteria designed to evaluate the PAC/PAS were: (1) Clinical...Army Medical Treatment Facilities (MTFs). The criteria designed to evaluate the PAC/PAS were: (1) Clinical Relevance, from a clinical perspective did...system. The act specified that DOD implement a Diagnosis Related Groups (DRGs) type system to allocate resources to its medical treatment facilities (MTFs
unexplained symptoms in populations that have deployed. • Implement a joint computerized patient record and other automated recordkeeping that meets the...implementation of a health surveillance system that completely spans an individual’s time in service. • Implement strategies to address medically
Lower Limb 35591 3559 Dysfunction, Nerve, Other 35592 3559 Neuropathy , Other 66 EXTCD ICD-9-CN DESCRIPTION 35593 3559 Peripheral /Spinal Nerve...Database (ACDB) to evaluate the PAC/PAS system. The sample consisted of 516,006 visits from six Army Medical Treatment Facilities (MTFs). The criteria...consisted of 516,006 visits from si.;. Army Medical Treatment Facilities (MTFs). The criteria designed to evaluate the PAC/PAS were: (1) Clinical
O'Neal, Catherine Walker; Lucier-Greer, Mallory; Mancini, Jay A; Ferraro, Anthony J; Ross, D Bruce
In addition to facing stressors that are typical of life course development (e.g., marital struggles, balancing work/family demands), military families face additional stress attributed to their military context (e.g., deployments, relocations). Using a systems framework and stress process perspective, this study examined military couples' relational health, as a gauge for how couples collectively cope and address challenges as a united front and how their relational health influences crucial health behaviors (sleeping and eating) through the promotion or erosion of psychological resources (N = 236 couples). This study evaluated a latent variable structural equation dyadic model whereby each partner's perspective of their family's relational health was hypothesized to influence their own eating and sleeping behaviors (actor effects), as well as the eating and sleeping behaviors of their spouse (partner effects). The role of psychological resources (high self-efficacy, few depressive symptoms, and minimal anxiety) as a mechanism linking family functioning to health behaviors was also examined. Overall, the findings supported the hypothesized model, particularly for actor (intraindividual) effects. Discussion is provided pertinent to service providers and researchers, including the importance of improving, or maintaining, family relational health, as a means for encouraging positive health behaviors among active duty military members and their spouses.
Ozeroff, M. J.
The potential military role, both offensive and defensive, of a Satellite Power System (SPS) is examined. A number of potential military support possibilities are described. An SPS with military capabilities may have a strong negative impact on international relations if it is not internationalized. The SPS satellite would be vulnerable to military action of an enemy with good space capability, but would experience little or no threat from saboteurs or terrorists, except via the ground controls. The paper concludes with an outline of some of the key issues involved, and a number of recommendations for future study, including some areas for long term efforts.
Seamone, Evan R.; McGuire, James; Clark, Sean; Smee, Daniel; Dow, Daniel
The cultural divide between US military and civilian institutions amplifies the consequences of military discharge status on public health and criminal justice systems in a manner that is invisible to a larger society. Prompt removal of problematic wounded warriors through retributive justice is more expedient than lengthy mental health treatment. Administrative and punitive discharges usually preclude Department of Veterans Affairs eligibility, posing a heavy public health burden. Moving upstream—through military rehabilitative justice addressing military offenders’ mental health needs before discharge—will reduce the downstream consequences of civilian maladjustment and intergenerational transmission of mental illness. The public health community can play an illuminating role by gathering data about community effect and by advocating for policy change at Department of Veterans Affairs and community levels. PMID:25122020
Seamone, Evan R; McGuire, James; Sreenivasan, Shoba; Clark, Sean; Smee, Daniel; Dow, Daniel
The cultural divide between US military and civilian institutions amplifies the consequences of military discharge status on public health and criminal justice systems in a manner that is invisible to a larger society. Prompt removal of problematic wounded warriors through retributive justice is more expedient than lengthy mental health treatment. Administrative and punitive discharges usually preclude Department of Veterans Affairs eligibility, posing a heavy public health burden. Moving upstream--through military rehabilitative justice addressing military offenders' mental health needs before discharge--will reduce the downstream consequences of civilian maladjustment and intergenerational transmission of mental illness. The public health community can play an illuminating role by gathering data about community effect and by advocating for policy change at Department of Veterans Affairs and community levels.
Agazio, Janice Griffin; Buckley, Kathleen M
In this study, we explored what may determine, or predict, United States military women's health promotion behaviors. Using a descriptive correlational design grounded in Pender's Health Promotion model, 491 military women completed instruments measuring their demographic variables, perception of health, definition of health, self-efficacy, and interpersonal influences to determine the significant factors affecting participation in health promotion activities. The outcome indicated that self-efficacy and interpersonal influences were the most influential in determining health promotion. This research illuminates some of the challenges working women face in meeting health promotion activities and how best to support their ability to participate in healthy behaviors.
Gibbons, Susanne W; Barnett, Scott D; Hickling, Edward J
This study uses data from the 2005 Department of Defense Survey of Health-Related Behaviors Among Military Personnel to examine relationships between family stress and posttraumatic stress symptoms across 4 subgroups of Operation Iraqi Freedom-deployed (i.e., war in Iraq) or Operation Enduring Freedom-deployed (i.e., war in Afghanistan) active-duty military service members. Results suggest the following: (a) the greatest positive correlation of family stressors with posttraumatic stress symptoms was found within the military health care officer group, and (b) these military health care officers differed in family stressors mediating posttraumatic stress with divorce and financial problems accounting for significant and unique portions of the variance. Implications for care of service members and their families are discussed.
Military Personnel under the direction of Jane Bowers, Community Dental Health Hygienist , Fort Drum, New York z conducted at USA DENTAL ACTIVITY, FORT...to me by Jane Bowers, or her designee, Community Dental Health Hygienist , Fort Drum, New York, phone 315-772-7841JS7, CCd I have been given an...Accomplishments include visits for orientation and training at dental clinics at 14 additional military installations: 6 AF sites were added for enrollment purposes
Seelig, Amber D.; Jacobson, Isabel G.; Donoho, Carrie J.; Trone, Daniel W.; Crum-Cianflone, Nancy F.; Balkin, Thomas J.
Study Objectives: Examine the relationship between self-reported sleep parameters and indicators of resilience in a US military population (n = 55,021). Methods: Longitudinal analyses (2001–2008) were conducted using subjective data collected from Millennium Cohort Study questionnaires and objective data from military records that included demographics, military health, and deployment information. Subjective sleep duration and insomnia symptoms were collected on the study questionnaire. Resilience metrics included lost work days, self-rated health, deployment, frequency and duration of health care utilization, and early discharge from the military. Generalized estimating equations and survival analyses were adjusted for demographic, military, behavioral, and health covariates in all models. Results: The presence of insomnia symptoms was significantly associated with lower self-rated health, more lost work days, lower odds of deployment, higher odds of early discharge from military service early, and more health care utilization. Those self-reporting < 6 h (short sleepers) or > 8 h (long sleepers) of sleep per night had similar findings, except for the deployment outcome in which those with the shortest sleep were more likely to deploy. Conclusions: Poor sleep is a detriment to service members' health and readiness. Leadership should redouble efforts to emphasize the importance of healthy sleep among military service members, and future research should focus on the efficacy of interventions to promote healthy sleep and resilience in this population. Commentary: A commentary on this article appears in this issue on page 963. Citation: Seelig AD, Jacobson IG, Donoho CJ, Trone DW, Crum-Cianflone NF, Balkin TJ. Sleep and health resilience metrics in a large military cohort. SLEEP 2016;39(5):1111–1120. PMID:26951391
Bricknell, M C M; Hanhart, N
This paper examines the implications of the new military campaign type--Stability Operations--on military health service support. The paper uses the format of the medical estimate process and shows how the health service support planning factors of Mission Analysis; Ground; Enemy forces; Friendly forces; Time and Space; Security; Casualty Estimate; Medical Command, Control, Communication, Computers and Information (C4I); Medical Capabilities; Medical Force Protection; Medical Logistics; and Medical CBRN are affected by this change. The paper also identifies two new roles for military medical services, assistance to security sector reform and assistance to reconstruction and development. These two new roles will be discussed more fully in later papers.
Bolekhan, V N; Ivanov, V V; Ivchenko, E V; Krassiĭ, A B; Morovikova, T V; Nagibovich, O A; Rezvantsev, M V
The present review is dedicated to organization and management of military veteran's health care system of the US and UK. It is shown that despite the differences in health care systems of both countries their veterans receive the stat-of-the-art medical service which is readily available and financially affordable.
Edwards, Ryan D.
The timing of education across the life cycle is differentially associated with older-age health outcomes and socioeconomic status among military retirees, a subpopulation with common levels of adolescent health but variation in educational timing. A year of education obtained before military service lowers the probability of poor health in retirement by 2.5 percentage points, while a year obtained after service reduces poor health by only 0.6 percentage point. By contrast, education raises income and wealth uniformly through vintage. This suggests that education improves health through fostering the lifelong accumulation of healthy behaviors and habits rather than raising income or wealth. PMID:27616820
healthcare for certain non-active duty reservists and extended chiropractic care to active duty members placing yet additional pressures on defense health...coalition of lobbyists and elected representatives to implement reforms. The recent passage of the Patient Protection and Affordable Care Act (PPACA... Care Act (PPACA), Capitation, Health Savings Accounts (HAS), AHLTA, VistA, TRICARE, Military Healthcare System (MHS). 16. SECURITY CLASSIFICATION
higher than that of average civilians with the same level of education . Enlisted and officer pay now ranks in the top quartile of all high school... higher yielding equities and bonds Findings 5 Findings (Continued) Military retirement is more generous and expensive compared to the...component of overall compensation. Other elements, such as current compensation, and other benefits (e.g. healthcare and education ) constitute the broad
Blackman, Virginia Schmied; Cooper, Bruce A; Puntillo, Kathleen; Franck, Linda S
Emergency department (ED) pain assessment documentation in trauma patients is critical to ED pain care. This retrospective, cross-sectional study used trauma registry data to evaluate U.S. military combat zone trauma patients injured between 2010 and 2013 requiring ≥ 24-hr inpatient care. Study aims were to identify the frequency of combat zone ED pain assessment documentation and describe pain severity. Secondary aims were to construct statistical models to explain variation in pain assessment documentation and pain severity.Pain scores were documented in 60.5% (n = 3,339) of the 5,518 records evaluated. The proportion of records with ED pain scores increased yearly. Pain assessment documentation was associated with documentation of ED vital signs, comprehensive facility, more recent year, prehospital (PH) heart rate of 60-100 beats/min, ED Glasgow Coma Scale score of 15 vs. 14, blunt trauma, and lower injury severity score (ISS).Pain severity scores ranged from 0 to 10; mean = 5.5 (SD = 3.1); median = 6. Higher ED pain scores were associated with Army service compared with Marine Corps, no documented PH vital signs, higher PH pain score, ED respiratory rate < 12 or >16, moderate or severe ISS compared with minor ISS, treatment in a less-equipped facility, and injury in 2011 or 2012 vs. 2010. The pain severity model explained 20.4% of variance in pain severity.Overall, frequency of pain assessment documentation in combat-zone EDs improved yearly, but remained suboptimal. Pain severity was poorly predicted by demographic, clinical, and health system variables available from the trauma registry, emphasizing the importance of individual assessment.
Katz, Rebecca; Blazes, David; Bae, Jennifer; Puntambekar, Nisha; Perdue, Christopher L; Fischer, Julie
Given the unprecedented growth of global health initiatives in the past decade, informal diplomacy between technical partners plays an increasingly important role in shaping opportunities and outcomes. This article describes a course developed and executed specifically to equip U.S. military health professionals with core skills in practical diplomacy critical to help them successfully plan and implement public health surveillance, research, and capacity building programs with partner nation governments and organizations. We identified core competencies in practical diplomacy for laboratory and public health researchers, catalogued and evaluated existing training programs, and then developed a pilot course in global health diplomacy for military medical researchers. The pilot course was held in June 2012, and focused on analyzing contemporary issues related to global health diplomacy through the framework of actors, drivers, and policies that affect public health research and capacity-building, beginning at the level of global health governance and cooperation and moving progressively to regional (supranational), national, and institutional perspective. This course represents an approach geared toward meeting the needs specific to U.S. military public health personnel and researchers working in international settings.
Hill, Jeffrey V; Brown, Mark C; Diebold, Carroll J; Borders, Michael A; Staudenmeier, James; Detwiler, Howard F; Francis, Dave B
The changing role of the military presents a unique challenge for military behavioral health organizations in dealing with the geographic isolation of personnel. Telemedical solutions should help to meet this challenge. In the behavioral health arena, there are many uses for videoconferencing and other communications technology in maintaining continuity when patients or clinicians travel or deploy; assisting isolated behavioral health-care providers and general practitioners; evaluating and treating isolated military personnel; and addressing family issues. Family interventions by videoconference and other communications technology may be particularly useful in treating military personnel and in promoting morale of the fighting force. Although much remains to be researched and proven empirically, anecdotal experience supports the utility of using communications technology to enhance behavioral health interventions. This article describes the clinical videoconference experience within the Department of Psychiatry at Tripler Army Medical Center (TAMC), during a Multinational force deployment to the Sinai, and during training at the Joint Readiness Training Center, Fort Polk, Louisiana. A brief discussion of potential legal issues involving videoconferencing in behavioral health is also included.
Preece, A W; Georgiou, A G; Dunn, E J; Farrow, S C
Objectives This study investigated concerns that have been raised about past and future health effects caused by high power transmissions of high frequency (7–30 MHz) radio waves from military antenna systems at Akrotiri, Cyprus. Methods A cross‐sectional study of three villages (two exposed, one unexposed) collected longitudinal and short‐term radiofrequency measurements. Health data were collected using questionnaires containing information on demographic factors, specific illnesses, general health (SF‐36 well‐being questionnaire), reproductive history, childhood illnesses, risk perception and mortality. Analysis was with SPSS v11.5 using cross tabulations of non‐parametric data and tests for significance. Key health outcomes were subjected to logistic regression analysis. Results Field strengths within the two “exposed” villages were a maximum of 0.30 (Volts/Vm−1 metre) from the 17.6 MHz military transmissions and up to 1.4 Vm−1 from unspecified sources, mainly cell phone frequencies. The corresponding readings in the control village were <0.01 Vm−1. Compared with the control village there were highly significant differences in the reporting of migraine (OR 2.7, p<0.001), headache (OR 3.7, p<0.001), and dizziness (OR 2.7, p<0.001). Residents of the exposed villages showed greater negative views of their health in all eight domains of the SF‐36. There were also higher levels of perceived risk, particularly to noise and electromagnetic “pollution”. All three villages reported higher values of risk perception than a UK population. There was no evidence of birth abnormalities or differences in gynaecological or obstetric history. Numbers of cancers were too small to show differences. Conclusion It was clear that even this close (1–3 km) to powerful transmissions, the dominant sources of radiofrequency fields were cell phone and national broadcast systems. There was no excess of cancer, birth defects or obstetric problems
Kaiser, Alicja; Sokolowski, Marek
Study aim: To assess health and social characteristics of female candidates for professional officers and non-commissioned officers of Polish Army. Material and methods: All female students of officer and non-commissioned officer Military Academies (16 each) were studied in 2009. Two questionnaires were applied in the study: IPAQ (short) for…
Agazio, Janice G; Ephraim, Paula M; Flaherty, Norma B; Gurney, Cynthia A
The purpose of this study was to determine the extent to which selected demographic characteristics, definition of health, perceived health status, perceived self-efficacy, and resources are related to the health promoting behaviors of active-duty women with children and to describe qualitatively the experience of being an active-duty mother. Grounded in Pender's (1996) Health Promotion Model, this study used methodological triangulation to test a hypothesized model. A sample of 141 active-duty women with children using military health services participated. Resource availability and commitment were key components of being successful at balancing home and work demands.
Gaudioso, F; Anastasio, G; Truglio, O; Managò, A; Fuda, P; Degano, F; Toscano, A; Iermano, P
The Maritime Military Health submit to periodic medical examination civilian employees exposed to health risks and all military personnel. The latest, because of particular use in operational duties, as well as the characteristic of seafarers employed, undergoes an extensive medical protocol. In 2006 there were around 3200 access to the Service of Medicine Labor Navy Hospital in Augusta (SR). We wanted then to make a collection of data with purpose to highlight the diseases that most often affect the area of military jurisdiction. The illnesses were divided into two main groups: those who did not produce any result on the job because of insignificant impact functional, and those for which they have been taken to unfitness, temporary or permanent. From a statistical evaluation of the acquired data, it results that most affected systems are the skeletical, hematologic, psychic, ENT, heart, the Body Mass Index.
Software is a key component in nearly every critical system used by the Department of Defense. Attacking the software in a system- cyber warfare - is a...revolutionary method of pursuing war. This article describes various cyber warfare approaches and suggests methods to counter them.
Petri, Richard P
Background: The field of integrative health and healing (IH2) is emerging out of the dark recesses of "voodoo" stereotypes and into the light as a new and much needed health care paradigm. It is a philosophy of health and healing that seeks to place patients as the preeminent players in health management, disease prevention, and injury recovery. There is an emphasis of patient responsibility, which includes a holistic approach that merges allopathic with complementary medicine. Objective: The aim of this article is to explore the historical origins of integrative medicine and investigate the future role of the IH2 paradigm. Methods: This article reviews current available data and information regarding complementary and alternative medicine utilized in civilian and military populations as the basis for a new paradigm for a system of care-a system that empowers patients. Conclusions: The current U.S. health care system is reactive and disease-based, with a focus on reductionism. This system is not serving us well. IH2 is a new model of cost-effective patient-centered health care.
Abstract Background: The field of integrative health and healing (IH2) is emerging out of the dark recesses of “voodoo” stereotypes and into the light as a new and much needed health care paradigm. It is a philosophy of health and healing that seeks to place patients as the preeminent players in health management, disease prevention, and injury recovery. There is an emphasis of patient responsibility, which includes a holistic approach that merges allopathic with complementary medicine. Objective: The aim of this article is to explore the historical origins of integrative medicine and investigate the future role of the IH2 paradigm. Methods: This article reviews current available data and information regarding complementary and alternative medicine utilized in civilian and military populations as the basis for a new paradigm for a system of care—a system that empowers patients. Conclusions: The current U.S. health care system is reactive and disease-based, with a focus on reductionism. This system is not serving us well. IH2 is a new model of cost-effective patient-centered health care. PMID:26543516
Ganzer, Christine Anne
: The last two decades have seen increasing numbers of women entering all branches of the U.S. armed forces. Now that women in the military are no longer prohibited from holding direct combat positions, they are often exposed to traumatic events that place them at higher risk for mental health conditions. Nurses working within the Veterans Affairs (VA) system and those working in non-VA settings are likely to encounter female veterans. It's essential for all nurses to be knowledgeable about the mental health issues commonly seen in this population, and to understand the importance of screening, not only for mental health issues but also for physical conditions that may be related to service.Numerous studies have focused on the mental health effects of deployment among military men, but very few have been conducted among military women. To learn more, the literature was searched for relevant articles published between January 2005 and December 2015. The research supports the contention that both active-duty and veteran women are at increased risk for postdeployment mental health problems, including posttraumatic stress disorder, military sexual trauma, and suicide. This article discusses the relevant research; identifies gaps in the literature; and addresses the nursing practice implications, including screening.
Abram Bergson , Productivity and the Social System-The USSR and the West, Cambridge: Harvard University Press, 1978, for a detailed examination of...relative productivity and efficiency in the Soviet Union, the United States, and the West. An extension of that analysis is presented in Abram Bergson
Siegel, Benjamin S; Davis, Beth Ellen
The wars in Afghanistan and Iraq have been challenging for US uniformed service families and their children. Almost 60% of US service members have family responsibilities. Approximately 2.3 million active duty, National Guard, and Reserve service members have been deployed since the beginning of the wars in Afghanistan and Iraq (2001 and 2003, respectively), and almost half have deployed more than once, some for up to 18 months' duration. Up to 2 million US children have been exposed to a wartime deployment of a loved one in the past 10 years. Many service members have returned from combat deployments with symptoms of posttraumatic stress disorder, depression, anxiety, substance abuse, and traumatic brain injury. The mental health and well-being of spouses, significant others, children (and their friends), and extended family members of deployed service members continues to be significantly challenged by the experiences of wartime deployment as well as by combat mortality and morbidity. The medical system of the Department of Defense provides health and mental health services for active duty service members and their families as well as activated National Guard and Reserve service members and their families. In addition to military pediatricians and civilian pediatricians employed by military treatment facilities, nonmilitary general pediatricians care for >50% of children and family members before, during, and after wartime deployments. This clinical report is for all pediatricians, both active duty and civilian, to aid in caring for children whose loved ones have been, are, or will be deployed.
Poston, Walker S C; Haddock, Christopher K; Jahnke, Sara A; Hyder, Melissa L; Jitnarin, Nattinee
Military installation newspapers are a primary means used by military commanders to communicate information about topics important to military personnel including leadership, training issues, installation events, safety concerns, and vital health issues. We conducted a content analysis of military commanders' messages about health issues that were published in online military installation newspapers/newsfeeds. We identified a total of 75 publicly accessible installation newspapers/newsfeeds with commanders' messages (n = 39 Air Force, n = 19 Army, n = 7 Navy, n = 1 Marine, and n = 9 Joint Bases). Commander messages published from January 2012 to December 2012 were collected, screened, and coded. Coder inter-rater reliability was 98.9%. Among the 2,479 coded commanders' messages, 132 (5.3%) addressed a health topic as the primary focus. There were no significant differences between service branches in the percentage of health-oriented messages (χ(2) = 5.019, p = 0.285). The most commonly addressed health topics were exercise/fitness (23.5%), other mental health concerns (19.7%), alcohol/driving under the influence (13.6%), and suicide (12.1%). Tobacco use was directly addressed as a primary health aim in only two commanders' messages (1.5%). Health topics, and particularly tobacco-related content, are rarely written about by military commanders. The absence of tobacco-related health messages from line leadership contributes to the perception that tobacco control is a low priority.
The kerosene tank pressurization , valves, and solenoids require extra maintenance actions because of the helium usage. Advanced System for Feed...cylindrical one for the same surface area, volume and/or pressure . However, for the axisymmetric vehicle, the fuel tanks will be mostly conical... pressure vessels. The best way to design these tanks , and how they compare to cylindrical rocket tanks , is a current area of investigation. For the
Blaginin, A A; Ganapolskii, V P; Goncharenko, A Yu; Emelyanov, Yu A; Zhiltsova, I I; Sinelnikov, S N; Yusupov, V V
The article is devoted to the development of:an integrated system for remote assessment of the functional state of the military serivcemen. A review of domestic and foreign literature concerning this problem is presented and proposed a new look and approach to monitoring the combat capability of the military servicemen. The authors carried out analysis of the possibility of using accumulated experience and the use of high-tech means to solve an assigned task at the level
Jafari, P.; Sadeghi-Niaraki, A.
This study is about integration and evaluation of RFID and ubiquitous technologies in military logistic system management. Firstly, supply chain management and the necessity of a revolution in logistic systems especially in military area, are explained. Secondly RFID and ubiquitous technologies and the advantages of their use in supply chain management are introduced. Lastly a system based on these technologies for controlling and increasing the speed and accuracy in military logistic system in Iran with its unique properties, is presented. The system is based on full control of military logistics (supplies) from the time of deployment to replenishment using sensor network, ubiquitous and RFID technologies.
Morris, Michael J; Zacher, Lisa L; Jackson, David A
Recent news media articles have implied a direct relationship between environmental exposures such as burn pits during current deployments and the development of serious and debilitating chronic pulmonary disease. These articles suggest that the military is superficially investigating evidence that establishes a link between deployment and development of chronic lung disease. Anecdotal cases of military personnel with lung disease are detailed to suggest a systemic problem with undiagnosed and untreated pulmonary disease in deployed service members. Despite these contentions, the U.S. Army Medical Department and other agencies have been actively pursuing numerous scientific investigations into deployment-related lung disease to define the severity and prevalence of the issue. This article will review relevant research efforts by the U.S. military in the existing medical literature and address the current efforts planned by the services to systematically investigate the possibility of deployment-related pulmonary disease.
investigator(s) adhered to current guidelines promulgated by the National Institutes of Health. In the conduct of research utilizing recombinant DNA, the...investigator(s) adhered to the NIH Guidelines for Research Involving Recombinant DNA Molecules. In the conduct of research involving hazardous... Drug and Alcohol Abuse. Portions of this paper appeared in an earlier form in F.H. Gabbay, R.J. Ursano, A.E. Norwood, C.S. Fullerton, and C.C. Duncan
personnel, not covered by 10 U.S.C. 1089 , and other resources supporting that provider to the same extent as is usual and customary in civilian practice...Agreement Model 4. External Partnership Agreement Model 6 Oct 22, 87 6010.12 (Encl 1) REFERENCES, continued (e) Title 10, United States Code, Sections 1089 ...agreement. 6. Support Personnel. Non-DoD personnel, not covered by 10 U.S.C. 1089 , directly supporting a health care provider under a partnership agreement
Military veterans with mental health problems: a protocol for a systematic review to identify whether they have an additional risk of contact with criminal justice systems compared with other veterans groups
Background There is concern that some veterans of armed forces, in particular those with mental health, drug or alcohol problems, experience difficulty returning to a civilian way of life and may subsequently come into contact with criminal justice services and imprisonment. The aim of this review is to examine whether military veterans with mental health problems, including substance use, have an additional risk of contact with criminal justice systems when compared with veterans who do not have such problems. The review will also seek to identify veterans’ views and experiences on their contact with criminal justice services, what contributed to or influenced their contact and whether there are any differences, including international and temporal, in incidence, contact type, veteran type, their presenting health needs and reported experiences. Methods/design In this review we will adopt a methodological model similar to that previously used by other researchers when reviewing intervention studies. The model, which we will use as a framework for conducting a review of observational and qualitative studies, consists of two parallel synthesis stages within the review process; one for quantitative research and the other for qualitative research. The third stage involves a cross study synthesis, enabling a deeper understanding of the results of the quantitative synthesis. A range of electronic databases, including MEDLINE, PsychINFO, CINAHL, will be systematically searched, from 1939 to present day, using a broad range of search terms that cover four key concepts: mental health, military veterans, substance misuse, and criminal justice. Studies will be screened against topic specific inclusion/exclusion criteria and then against a smaller subset of design specific inclusion/exclusion criteria. Data will be extracted for those studies that meet the inclusion criteria, and all eligible studies will be critically appraised. Included studies, both quantitative and
Lande, Raymond G.
Notes that U.S. military policies emphasize humanitarian approach to issue of suicide, yet military law may view suicidal behavior as deviant and may prosecute suicide attempters. Cites convictions of soldiers for attempted and assisted suicides. Reviews recent court decisions and suggests revisions in military law. (Author/NB)
Bahadori, Mohammadkarim; Sanaeinasab, Hormoz; Ghanei, Mostafa; Mehrabi Tavana, Ali; Ravangard, Ramin; Karamali, Mazyar
Providing effective health interventions and achieving equity in health need to apply the community-based approaches such as social determinants of health. In the military organizations, these determinants have received less attention from the military health researchers and policymakers. Therefore, this study aimed to identify and explain the social determinants affecting the health of military forces in Iran. This was a qualitative study which was conducted in 2014. The required data were collected through semistructured interviews and analyzed through Conventional Content Analysis. The studied sample consisted of 22 military health experts, policymakers, and senior managers selected using purposeful sampling method with maximum variation sampling. MAXQDA.2007 was used to analyze the collected data. After analyzing the collected data, two main contents, that is, “general social determinants of health” and “military social determinants of health,” with 22 themes and 90 subthemes were identified as the social determinants of military forces' health. Main themes were religious rule, spirituality promotion policies, international military factors, military command, and so forth. Given the role and importance of social factors determining the military forces' health, it can be recommended that the military organizations should pay more attention to these determinants in making policies and creating social, economic, and cultural structures for their forces. PMID:26379716
Yang, Ge-Liang; Gu, Wei; Zhang, Hui-Qing; Zhai, Xiao-Feng; Li, Xiao-Qian; Ling, Chang-Quan
Military medicine has had a long history in China since the emergence of the war. Chinese medicine, especially Chinese herbs, was widely used in China as well as other Asian countries for the prevention and treatment of diseases in the military for hundreds of years. However, the use of Chinese medicine in military health service has never been well studied. In this article, we briefly summarize the application status of Chinese herbal medicine in military health service in China, putting particular emphasis on special military environment, in an attempt to build a bridge between Chinese medicine and military health service and promote the quality of health service for the military and maintain world peace.
Becker, Sara J.; Swenson, Rebecca; Esposito-Smythers, Christianne; Cataldo, Andrea; Spirito, Anthony
Military families with adolescents experience high levels of stress associated with parental deployment, but many of these families do not seek or utilize mental health services. The current qualitative study was designed to better understand barriers to mental health treatment experienced by adolescents in military families. Focus groups and individual interviews were conducted with military adolescents (n = 13), military (non-enlisted) parents (n = 12), and mental health service providers who treat adolescents in military families (n = 20). Discussions primarily explored barriers to seeking treatment, with supplemental questions assessing the ideal elements of mental health services for this population. Seven barriers to engaging in mental health services were identified: four internal (confidentiality concerns, stigma, ethic of self-reliance, lack of perceived relevance) and three external (time and effort concerns, logistical concerns, financial concerns). Challenges engaging military adolescents in mental health services are discussed and several recommendations are offered for service providers attempting to work with this population. PMID:25574070
MILITARY FACILITIES, *URBAN AREAS, MILITARY OPERATIONS, INFORMATION SYSTEMS , COMPUTER APPLICATIONS, ENVIRONMENTAL MANAGEMENT, LAND AREAS, GEOGRAPHICAL INFORMATION SYSTEMS , SATELLITE IMAGERY, REGIONAL PLANNING.
Paley, Blair; Lester, Patricia; Mogil, Catherine
The scope of sustained military operations in Iraq and Afghanistan has placed great demands on the Armed Forces of the United States, and accordingly, military families have been faced with deployments in more rapid succession than ever before. When military parents fulfill occupational duties during wartime, military children and families face multiple challenges, including extended separations, disruptions in family routines, and potentially compromised parenting related to traumatic exposure and subsequent mental health problems. Such challenges can begin to exert a significant toll on the well-being of both individuals and relationships (e.g., marital, parent-child) within military families. In order to respond more effectively to the needs of military families, it is essential that mental health clinicians and researchers have a better understanding of the challenges faced by military families throughout the entire deployment experience and the ways in which these challenges may have a cumulative impact over multiple deployments. Moreover, the mental health field must become better prepared to support service members and families across a rapidly evolving landscape of military operations around the world, including those who are making the transition from active duty to Veteran status and navigating a return to civilian life and those families in which parents will continue to actively serve and deploy in combat zones. In this article, we utilize family systems and ecological perspectives to advance our understanding of how military families negotiate repeated deployment experiences and how such experiences impact the well-being and adjustment of families at the individual, dyadic, and whole family level.
Haibach, Jeffrey P; Haibach, Michael Ann; Hall, Katherine S; Masheb, Robin M; Little, Melissa A; Shepardson, Robyn L; Dobmeyer, Anne C; Funderburk, Jennifer S; Hunter, Christopher L; Dundon, Margaret; Hausmann, Leslie R M; Trynosky, Stephen K; Goodrich, David E; Kilbourne, Amy M; Knight, Sara J; Talcott, Gerald W; Goldstein, Michael G
There are 2.1 million current military servicemembers and 21 million living veterans in the United States. Although they were healthier upon entering military service compared to the general U.S. population, in the longer term veterans tend to be of equivalent or worse health than civilians. One primary explanation for the veterans' health disparity is poorer health behaviors during or after military service, especially areas of physical activity, nutrition, tobacco, and alcohol. In response, the Department of Defense and Department of Veterans Affairs continue to develop, evaluate, and improve health promotion programs and healthcare services for military and veteran health behavior in an integrated approach. Future research and practice is needed to better understand and promote positive health behavior during key transition periods in the military and veteran life course. Also paramount is implementation and evaluation of existing interventions, programs, and policies across the population using an integrated and person centered approach.
Cohen, Gregory H; Fink, David S; Sampson, Laura; Galea, Sandro
Since 2001, the US military has increasingly relied on National Guard and reserve component forces to meet operational demands. Differences in preparation and military engagement experiences between active component and reserve component forces have long suggested that the psychiatric consequences of military engagement differ by component. We conducted a systematic review of prevalence and new onset of psychiatric disorders among reserve component forces and a meta-analysis of prevalence estimates comparing reserve component and active component forces, and we documented stage-sequential drivers of psychiatric burden among reserve component forces. We identified 27 reports from 19 unique samples published between 1985 and 2012: 9 studies reporting on the reserve component alone and 10 reporting on both the reserve component and the active component. The pooled prevalence for alcohol use disorders of 14.5% (95% confidence interval: 12.7, 15.2) among the reserve component was higher than that of 11.7% (95% confidence interval: 10.9, 12.6) among the active component, while there were no component differences for depression or post-traumatic stress disorder. We observed substantial heterogeneity in prevalence estimates reported by the reserve component. Published studies suggest that stage-sequential risk factors throughout the deployment cycle predicted alcohol use disorders, post-traumatic stress disorder and, to a lesser degree, depression. Improved and more standardized documentation of the mental health burden, as well as study of explanatory factors within a life-course framework, is necessary to inform mitigating strategies and to reduce psychiatric burden among reserve component forces.
Cohen, Gregory H.; Fink, David S.; Sampson, Laura; Galea, Sandro
Since 2001, the US military has increasingly relied on National Guard and reserve component forces to meet operational demands. Differences in preparation and military engagement experiences between active component and reserve component forces have long suggested that the psychiatric consequences of military engagement differ by component. We conducted a systematic review of prevalence and new onset of psychiatric disorders among reserve component forces and a meta-analysis of prevalence estimates comparing reserve component and active component forces, and we documented stage-sequential drivers of psychiatric burden among reserve component forces. We identified 27 reports from 19 unique samples published between 1985 and 2012: 9 studies reporting on the reserve component alone and 10 reporting on both the reserve component and the active component. The pooled prevalence for alcohol use disorders of 14.5% (95% confidence interval: 12.7, 15.2) among the reserve component was higher than that of 11.7% (95% confidence interval: 10.9, 12.6) among the active component, while there were no component differences for depression or post-traumatic stress disorder. We observed substantial heterogeneity in prevalence estimates reported by the reserve component. Published studies suggest that stage-sequential risk factors throughout the deployment cycle predicted alcohol use disorders, post-traumatic stress disorder and, to a lesser degree, depression. Improved and more standardized documentation of the mental health burden, as well as study of explanatory factors within a life-course framework, is necessary to inform mitigating strategies and to reduce psychiatric burden among reserve component forces. PMID:25595172
Leroux, Todd C; Kum, Hye-Chung; Dabney, Alan; Wells, Rebecca
Since the onset of the wars in Iraq and Afghanistan attention has increased on the importance of mental health with military service members. An integral component, although far less studied, are the ties between mental health and military spouses. Military deployments place considerable stress on military families. This study analyzed the mental health utilization of military spouses of active duty service members assigned to an aircraft carrier between 2011 and 2014. A negative binomial generalized estimating equation was used to examine the rate of change in mental health utilization over time against various deployment phases. Associations emerged between select deployment phases (i.e., deployment 1, between deployments, deployment 2) with increases in mental health utilization ranging between 12% and 20% for military spouses. This study demonstrated, for military spouses, the in between deployment phase has associations with mental health utilization rates similar to actual deployed periods. As a result, military leaders should continue to monitor the well-being of their service members' families throughout all deployment phases.
Holland, Kathryn J; Rabelo, Verónica Caridad; Cortina, Lilia M
In 2005, the Department of Defense reformed military sexual assault (MSA) prevention and response efforts. However, research suggests that some Service members may not be informed of MSA resources. We examined how lacking such knowledge may undermine psychological well-being (i.e., symptoms of depression and posttraumatic stress) among MSA survivors as well as Service members who feel unsafe from MSA. The data were collected by the DoD in 2010 and sampled active duty Service women and men. Experiencing MSA, feeling unsafe from MSA, and lacking knowledge of MSA resources predicted greater psychiatric symptoms. Service members who felt unsafe from MSA reported greater psychiatric symptoms as a function of lacking knowledge of MSA resources. Findings suggest that education about sexual assault resources may be critical for the protection of mental health-among survivors and nonvictims alike.
Poluboiarinov, V N; Iusov, I G; Ivanchenko, A V; Turlakov, Iu S
Complex of occupational studies and medical, statistical research helped to reveal climate, geographic and other factors influencing health state of personnel servicing military nuclear technical objects. Considering peculiarities of occupational activities in various specialists, the authors specified measures to improve medical service for nuclear technical military officers directly working with nuclear ammunition. Practical application of the measures helped to gain 1.5-1.7 times improvement in morbidity parameters among nuclear technical military officers.
Kostiuchenko, O M; Sviridova, T B
Military medical facilities of the Ministry of Defence of the Russian, have received the right to provide additional services and have been involved in the sphere of market relations. The strong influence of market relations - an objective reality that must be used for the development of military medical institutions and improving quality of care.Effective commercial activity can improve capabilities of the military medical institutions. This requires constant study of market mechanisms to implement and develop their competitive advantage. The paper substantiates the need for the participation of military medical institutions in the provision of health services to the public on the terms of compensation incurred by financial institutions costs (paid medical services, medical assistance program of compulsory and voluntary health insurance). Taking into account the specifics of military medical institutions set out basic principles and recommendations have been implementing marketing approach in their management, the practical application of which will not only increase efficiency, but also create conditions to improve the financial and economic indicators. This knowledge will help the mechanism of functioning health care market and the rules of interaction of market counterparties.
Pavalanathan, Umashanthi; Datla, Vivek V.; Volkova, Svitlana; Charles-Smith, Lauren E.; Pirrung, Megan A.; Harrison, Joshua J.; Chappell, Alan R.; Corley, Courtney D.
Social media can provide a resource for characterizing communities and small populations through activities and content shared online. For instance, studying the language use in social media within military populations may provide insights into their health and wellbeing. In this paper, we address three research questions: (1) How do military populations use social media? (2) What do military users discuss in social media? And (3) Do military users talk about health and well-being differently than civilians? Military Twitter users were identified through keywords in the profile description of users who posted geo-tagged tweets at military installations. The data was anonymized for the analysis. User profiles that belong to military population were compared to the nonmilitary population. Our results indicate that military users talk more about events in their military life, whereas nonmilitary users talk more about school, work, and leisure activities. We also found that the online content generated by both populations is significantly different, including health-related language and communication behavior.
With growing limitations on military resources, including a reduction in the overall size of our military force, the Army must make the most of every soldier in its ranks. The only way to achieve the necessary improvements in human performance with upcoming constraints will be through exploring innovative ways of thinking while implementing the best policies and doctrine that will maintain each soldier's resilience throughout their military career. Moving the Army from a traditional health care system to a system for health is expected to substantially improve and maintain soldier health and performance by focusing on 3 key areas: the Performance Triad (sleep health, physical activity, and nutrition behaviors), Delivery of Health, and Healthy Environments. The implementation of this system for health will not only improve individual soldier's resiliency/capability both throughout and beyond their military careers and benefit Army Medicine as a whole, but could also serve as a successful model for the nation if changes are adopted.
Sharp, Marie-Louise; Fear, Nicola T; Rona, Roberto J; Wessely, Simon; Greenberg, Neil; Jones, Norman; Goodwin, Laura
Approximately 60% of military personnel who experience mental health problems do not seek help, yet many of them could benefit from professional treatment. Across military studies, one of the most frequently reported barriers to help-seeking for mental health problems is concerns about stigma. It is, however, less clear how stigma influences mental health service utilization. This review will synthesize existing research on stigma, focusing on those in the military with mental health problems. We conducted a systematic review and meta-analysis of studies between 2001 and 2014 to examine the prevalence of stigma for seeking help for a mental health problem and its association with help-seeking intentions/mental health service utilization. Twenty papers met the search criteria. Weighted prevalence estimates for the 2 most endorsed stigma concerns were 44.2% (95% confidence interval: 37.1, 51.4) for "My unit leadership might treat me differently" and 42.9% (95% confidence interval: 36.8, 49.0) for "I would be seen as weak." Nine studies found no association between anticipated stigma and help-seeking intentions/mental health service use and 4 studies found a positive association. One study found a negative association between self-stigma and intentions to seek help. Counterintuitively, those that endorsed high anticipated stigma still utilized mental health services or were interested in seeking help. We propose that these findings may be related to intention-behavior gaps or methodological issues in the measurement of stigma. Positive associations may be influenced by modified labeling theory. Additionally, other factors such as self-stigma and negative attitudes toward mental health care may be worth further attention in future investigation.
Green, Sara; Nurius, Paula S.; Lester, Patricia
Understanding predictors of military spouse psychosocial vulnerability informs efforts to assess, identify, and support at-risk spouses and families. In this analysis we test the effects of family stress and strain on military spouse psychological health, using a sample of female civilian spouses (n=161). Regression findings confirm expectations of the significant contribution of family stressors, strain, and resources in explaining variation in spouses' psychological health, controlling for deployment and socioeconomic factors. Identifying the effects of family stress on military spouse psychological health supports the need for family-centered interventions and prevention programs. PMID:24415897
Ommaya, A K; Ommaya, A K; Dannenberg, A L; Salazar, A M
Hospital discharge records from military facilities and private facilities reimbursed by Civilian Health and Medical Program of the Uniformed Services for fiscal year 1992 were reviewed to identify head injury admissions. Incidence rates, case fatality rates, causes of head injuries, and direct cost for hospital admissions were computed in this well-defined population. For fiscal year 1992, there were 5,568 hospitalized cases of noncombat head injury in the military medical system. The age-adjusted head injury rates for ages 15-44 years are higher in active-duty individuals compared with other beneficiaries (1.6 times greater for men and 2.5 times greater for women). The total cost for hospitalization in this population was $43 million. Private facility rehabilitation accounted for 26% of all private facility costs but only 6% of head injury cases. Firearms and motor vehicle crashes caused the most severe injuries for cases admitted to military facilities. Motor vehicle crashes, falls, and fighting accounted for 80% of the total military facility cost for head injuries. Military active-duty individuals are at increased risk for noncombat head injury. Prevention of head injury in military settings should focus on motor vehicle crashes, fist fights (assault), and falls.
requirements for military electric power . The report offers design recommendations to minimize the procurement cost of the SOFC system. The report ...design, develop, and fabricate a military SOFC Power Plant up to 10 kW for military applications, which will include military diesel and JP-8 fuel...the military’s current and future electric power needs and capabilities, (2) the requirements for building a military SOFC power system with design
Zunino, J. L., III
The main objective of the U.S. Army's Active Coatings Technologies Program is to develop technologies that can be used in combination to tailor coatings for utilization on Army Materiel. The Active Coatings Technologies Program, ACT, is divided into several thrusts, including the Smart Coatings Materiel Program, Munitions Coatings Technologies, Active Sensor packages, Systems Health Monitoring, Novel Technology Development, as well as other advanced technologies. The goal of the ACT Program is to conduct research leading to the development of multiple coatings systems for use on various military platforms, incorporating unique properties such as self repair, selective removal, corrosion resistance, sensing, ability to modify coatings' physical properties, colorizing, and alerting logistics staff when tanks or weaponry require more extensive repair. A partnership between the U.S. Army Corrosion Office at Picatinny Arsenal, NJ along with researchers at the New Jersey Institute of Technology, NJ, Clemson University, SC, University of New Hampshire, NH, and University of Massachusetts (Lowell), MA, are developing the next generation of Smart Coatings Materiel via novel technologies such as nanotechnology, Micro-electromechanical Systems (MEMS), meta-materials, flexible electronics, electrochromics, electroluminescence, etc. This paper will provide the reader with an overview of the Active Coatings Technologies Program, including an update of the on-going Smart Coatings Materiel Program, its progress thus far, description of the prototype Smart Coatings Systems and research tasks as well as future nanotechnology concepts, and applications for the Department of Defense.
Trump, David H
Self-rated general health is one element of the standard health assessment required of U.S. military service members upon completion of major deployments. A cohort study of 22,229 male U.S. Army and Air Force personnel returning from Europe or Southwest Asia in 2000 used survival analysis methods and Cox proportional hazard models to examine postdeployment self-rated health (SRH) status and subsequent hospitalization, separation, and ambulatory care visits. Self-rated health was fair/poor for 1.5% and good for 20.4%; 11% documented at least one health concern. During 30,433 person-years of follow-up (median, 1.5 person-years), there were 22.8 hospitalizations per 1,000 person-years and 4.0 ambulatory care visits per person-years. After adjustment, deployers with fair/poor SRH had an increased risk for hospitalization (hazard ratio [HRI, 1.6; 95% confidence interval [CI], 1.0,2.7); the risk was lower for those with good SRH (HR, 1.3; 95% CI,1.1,1.5). Deployers with fair/poor SRH health had an increased risk for illness-related ambulatory care visits (HR, 1.8, 95%; CI, 1.6,2.1) and administrative visits (HR, 1.4; 95% CI, 1.1,1.7), but not injury-related visits (HR, 1.2; 95% CI, 0.8,1.7). Self-reported low health status and other health concerns identify military members with higher levels of health care needs following return from major deployments.
5 26 12 37 45 20 14 15 14 2 21 6 12 35 12 7 11 59 23 13 3 6 6 12 3 9 45 45 8 36 8 4 25 Lyme disease Malaria...policy mandates the reporting of cases of 67 diff erent diseases and injuries whose occurrence may represent a signifi cant threat to public health and
D'Angelo, Matthew R; Saperstein, Adam K; Seibert, Diane C; Durning, Steven J; Varpio, Lara
Despite efforts to increase patient safety, hundreds of thousands of lives are lost each year to preventable health care errors. The Institute of Medicine and other organizations have recommended that facilitating effective interprofessional health care team work can help address this problem. While the concept of interprofessional health care teams is known, understanding and organizing effective team performance have proven to be elusive goals. Although considerable research has been conducted in the civilian sector, scholars have yet to extend research to the military context. Indeed, delivering the highest caliber of health care to our service men and women is vitally important. This commentary describes a new initiative as the Uniformed Services University of the Health Sciences aimed at researching the characteristics of successful military interprofessional teams and why those characteristics are important. It also describes the interprofessional education initiative that Uniformed Services University is launching to help optimize U.S. military health care.
findings for this study for this reporting period. Mental health literacy , Mental Health First Aid (MHFA), curriculum adaptation 6 DMohatt@wiche.edu 3...collection instruments to assess impact of mental health literacy program in the military setting. REPORTABLE OUTCOMES: None at this time
study to examine predicted dose - response relationships. The field study is being carried out with military (Air Force) personnel. Working groups have been convened and, currently, the Tier I phase is being planned.
attention within the military, the use of smokeless tobacco (chewing tobacco and snuff ) has not been a focus of medical services or research...INTRODUCTION While smoking cessation has received considerable attention within the military, the use of smokeless tobacco (chewing tobacco and snuff ) has...tobacco juice while using snuff or chew. Table 3. Current Tobacco Use of DoD Smokeless Tobacco Participants – Indicators of Dependence Current
Bradburne, Christopher; Graham, David; Kingston, H M; Brenner, Ruth; Pamuku, Matt; Carruth, Lucy
Systems biology ('omics) technologies are emerging as tools for the comprehensive analysis and monitoring of human health. In order for these tools to be used in military medicine, clinical sampling and biobanking will need to be optimized to be compatible with downstream processing and analysis for each class of molecule measured. This article provides an overview of 'omics technologies, including instrumentation, tools, and methods, and their potential application for warfighter exposure monitoring. We discuss the current state and the potential utility of personalized data from a variety of 'omics sources including genomics, epigenomics, transcriptomics, metabolomics, proteomics, lipidomics, and efforts to combine their use. Issues in the "sample-to-answer" workflow, including collection and biobanking are discussed, as well as national efforts for standardization and clinical interpretation. Establishment of these emerging capabilities, along with accurate xenobiotic monitoring, for the Department of Defense could provide new and effective tools for environmental health monitoring at all duty stations, including deployed locations.
Kees, Michelle; Rosenblum, Katherine
The decade long conflicts in Iraq and Afghanistan have placed considerable strain on military families. Given robust data showing high rates of deployment-related psychological health problems in spouses and children, and the near absence of evidence-based psychological health programs for military families in the community, interventions are urgently needed to support and strengthen spouses as they adjust to deployment transitions and military life experiences. This Phase 1 pilot study evaluated the feasibility and acceptability of a resiliency intervention for military spouses in civilian communities (HomeFront Strong; HFS), and generated preliminary efficacy data regarding impacts on psychological health and adjustment. Through two group cohorts, 14 women completed the intervention, with 10 women providing pre- and postgroup assessment data. Findings support feasibility of the intervention and high rates of program satisfaction. Participants reported learning new strategies and feeling more knowledgeable in their ability to use effective coping skills for managing deployment and military-related stressors. Participation in HFS was also associated with reduction in levels of anxiety and perceived stress, and improvements in life satisfaction and life engagement. HFS is a promising community-based intervention for military spouses designed to enhance resiliency, reduce negative psychological health symptoms, and improve coping.
Esposito-Smythers, Christianne; Wolff, Jennifer; Lemmon, Keith M; Bodzy, Mary; Swenson, Rebecca R; Spirito, Anthony
The United States military force includes over 2.2 million volunteer service members. Three out of five service members who are deployed or are preparing for deployment have spouses and/or children. Stressors associated with the deployment cycle can lead to depression, anxiety, and behavior problems in children, as well as psychological distress in the military spouse. Further, the emotional and behavioral health of family members can affect the psychological functioning of the military service member during the deployment and reintegration periods. Despite widespread acknowledgment of the need for emotional and behavioral health services for youth from military families, many professionals in a position to serve them struggle with how to best respond and select appropriate interventions. The purpose of this paper is to provide an empirically based and theoretically informed review to guide service provision and the development of evidence based treatments for military youth in particular. This review includes an overview of stressors associated with the deployment cycle, emotional and behavioral health consequences of deployment on youth and their caretaking parent, and existing preventative and treatment services for youth from military families. It concludes with treatment recommendations for older children and adolescents experiencing emotional and behavioral health symptoms associated with the deployment cycle.
QFOXGHDUHDFRGH 1995 Special Human Engineering Design Criteria for Military Systems, Equipment and Facilities: MIL- STD -1472D Checklist Lockheed...a sequential listing of all major MIL- STD -1472D Section 5.0 paragraph headings. The main paragraph headings serve as easy reminders to make sure no
Stevens, Carolyn S.
Military families face challenges not found in other work environments. Shifting work schedules that are often longer than the typical 8-hour day, as well as the ever-present possibility of being deployed anywhere in the world on a moment's notice, require a child care system that is flexible but maintains high-quality standards. The U.S.…
There is a paucity of data on the associations of recent divorce on the health and military outcomes of service members during the recent conflicts...Participants of the Millennium Cohort Study who were divorced between baseline and follow-up surveys were compared with those who remained married...sociodemographic, baseline behavioral, and military covariates. Compared with those who remained married, service members who recently divorced were
Padden, Diane L; Connors, Rebecca A; Agazio, Janice G
The purpose of this research was to describe predictors of participation in health-promoting behaviors among military spouses. A total of 105 female spouses of currently deployed active duty military members were surveyed to determine their perceived stress and participation in the health-promoting behaviors of exercise, diet, checkups, substance use/avoidance, social behaviors, stress management/rest, and safety/environmental behaviors. Demographic and deployment information was also collected. Regression analyses showed perceived stress was predictive of several health behaviors including exercise, social behaviors, stress management/rest, and safety/environmental behaviors. Increased perceived stress was associated with decreased participation in these behaviors. Deployment factors predicted only dietary behaviors and stress management/rest. As the minimum anticipated length of the deployment increased, healthy dietary behavior decreased. Likewise, as the number of deployments experienced increased, stress management and rest decreased. Stress brought on by military deployment may have detrimental effects upon participation in a health-promoting lifestyle.
California Health Interview Survey.” http://www.healthpolicy.ucla.edu/shic-county.html UNC Chapel Hill, Cecil G. Sheps Center for Health Services Research...D. Kallich, and Dana Goldman . 2000. “Providing Managed Care Options for a Large Population: Evaluating the CHAMPUS Reform Initiative.”. Military
Health and Well-Being across the Military Spectrum (Bien-être et santé mentale dans le milieu militaire). RTO-MP-HFM-205 14. ABSTRACT Sleep is a...than 85%, and 42% took longer than 30 minutes to fall asleep (Peterson et al., 2008). The Mental Health Advisory Team (MHAT) Reports V (OTSMNC-I...gender, lower reported general health , and reported mental health symptoms. Findings from a study of 130 injured service members with extremity trauma
Ledford, Otto C., Jr.; Bennett, Rodney G.
The utility of on-orbit servicing of spacecraft has been demonstrated by NASA several times using shuttle-based astronaut EVA. There has been interest in utilizing on-orbit servicing for military space systems as well. This interest has been driven by the increasing reliance of all branches of the military upon space-based assets, the growing numbers, complexity, and cost of those assets, and a desire to normalize support policies for space-based operations. Many military satellites are placed in orbits which are unduly hostile for astronaut operations and/or cannot be reached by the shuttle. In addition, some of the projected tasks may involve hazardous operations. This has led to a focus on robotic systems, instead of astronauts, for the basis of projected servicing systems. This paper describes studies and activities which will hopefully lead to on-orbit servicing being one of the tools available to military space systems designers and operators. The utility of various forms of servicing has been evaluated for present and projected systems, critical technologies have been identified, and strategies for the development and insertion of this technology into operational systems have been developed. Many of the projected plans have been adversely affected by budgetary restrictions and evolving architectures, but the fundamental benefits and requirements are well understood. A method of introducing servicing capabilities in a manner which has a low impact on the system designer and does not require the prior development of an expensive infrastructure is discussed. This can potentially lead to an evolutionary implementation of the full technology.
COVERED 00-00-2009 to 00-00-2009 4. TITLE AND SUBTITLE Military Medical Care : Questions and Answers 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c...deliver health care during wartime. The military health system also provides health care services through either Department of Defense (DOD...medical facilities, known as “military treatment facilities” or “MTFs” as space is available, or, through private health care providers. Known as “Tricare
Recruiters for the various US armed forces have free access to our nation's high schools, as mandated by the No Child Left Behind Act. Military recruiter behaviors are disturbingly similar to predatory grooming. Adults in the active military service are reported to experience increased mental health risks, including stress, substance abuse, and suicide, and the youngest soldiers consistently show the worst health effects, suggesting military service is associated with disproportionately poor health for this population. We describe the actions of a high school parent teacher student association in Seattle, Washington, which sought to limit the aggressive recruitment of children younger than 18 years into the military. PMID:21088269
Pavlovskiĭ, L N
The article presents data on the outstanding Soviet theorist and the organizer of Health Care, full member of Academy of Medical Science of the U.S.S.R., the Hero of Socialist Work, the colonel general of a health service E.I. Smirnov who has developed a lot on the theory and practice of civil and military public health services. Its contribution to communication between organizational forms of medical maintenance of armies and principles of military art, and also dependence of quality of medical aid to the population on the organizational structure of a treatment-and-prophylactic network were considered. E.I. Smirnova's personal role in improvement of organizational forms of medical maintenance of armies, theory and practice development of intermediate treatments with evacuation to destination, in the organization of antiepidemic maintenance of armies and development number of actual questions of modern military medicine are shown in the article.
Schultz, Gregory; Mhaskar, Rahul; Prouty, Mark; Miller, Jonathan
A new generation of ultra-high sensitivity magnetic sensors based on innovative micro-electromechanical systems (MEMS) are being developed and incorporated into military systems. Specifically, we are currently working to fully integrate the latest generation of MicroFabricated Atomic Magnetometers (MFAMs) developed by Geometrics on defense mobility systems such as unmanned systems, military vehicles and handheld units. Recent reductions in size, weight, and power of these sensors has enabled new deployment opportunities for improved sensitivity to targets of interest, but has also introduced new challenges associated with noise mitigation, mission configuration planning, and data processing. Our work is focused on overcoming the practical aspects of integrating these sensors with various military platforms. Implications associated with utilizing these combined sensor systems in working environments are addressed in order to optimize signal-to-noise ratios, detection probabilities, and false alarm mitigation. Specifically, we present collaborative work that bridges the gap between commercial specialists and operation platform integration organizations including magnetic signature characterization and mitigation as well as the development of simulation tools that consider a wide array of sensor, environmental, platform, and mission-level parameters. We discuss unique deployment concepts for explosive hazard target geolocation, and data processing. Applications include configurations for undersea and underground threat detection - particularly those associated with stationary or mobile explosives and compact metallic targets such as munitions, subsea threats, and other hazardous objects. We show the potential of current and future features of miniaturized magnetic sensors including very high magnetic field sensitivities, bandwidth selectivity, and array processing.
During the American occupation of Japan (1945–1952), young public health officers from the US Army Medical Corps were posted in local US Army military government teams. These young doctors (aged 25 to 27 years), who had not absorbed the strong anti-Japanese tradition of the US military during World War II, seem to have alleviated the initial resentment felt by the Japanese toward the new governors of their homeland. The case of the Kyoto Military Government Team illustrates the Kyoto citizenry’s positive view of some American-directed public health measures. The team’s services helped to counter widely held negative views on colonialism, occupation, and public health; lessened resentment toward the unilateral command structure of the occupation forces; and contributed to improved relations between the United States and Japan at the local level. PMID:18235076
Jitnarin, Nattinee; Poston, Walker S C; Haddock, Christopher K; Jahnke, Sara
The purpose of this study was to conduct a content analysis of Veterans and Military Service Organizations (VMSOs) magazines to determine what health-related topics VMSOs target and how they inform their constituencies about health issues. Health-related topics in 288 VMSOs' magazines from 21 VMSOs published in 2011 and 2012 were coded by trained raters using a standardized manual. The top three most addressed health topics were Health Services (Health care, Insurance), Disability and Disability benefits, and post-traumatic stress disorder. Topics least frequently covered were Tobacco and Smoking cessation, Illegal drugs, Alcohol, Gulf War Syndrome, and Weight and Body composition. VMSOs are concerned about the health and well-being of their members given the considerable amount of content devoted to certain health topics such as health insurance concerns, disability, and post-traumatic stress disorder. However, other health concerns that affect a considerable number of both current military personnel and veterans and cost both the Department of Veterans Affairs and the Department of Defense millions annually, such as drug and alcohol problems, and tobacco use and smoking cessation, are infrequently covered. The results of this study improve our understanding of the health-related information that reaches the military and veteran populations through this important media outlet.
Organization; Instructor Complement; Curriculum; Manpower Levels; Military Academies; Other Advanced Officer Training; The Military Academy of the General Staff; Post Graduate Programs ; Central Hierarchy; Overall Manpower Estimates.
STRIKING THE BALANCE BETWEEN DISCIPLINE AND JUSTICE : THE COMMANDER’S ROLE IN THE MILITARY JUSTICE SYSTEM AND ITS IMPACT ON THE... Justice : The Commander’s Role in the Military Justice System and its Impact on the Military Profession 5a. CONTRACT NUMBER 5b. GRANT NUMBER...several members of Congress to propose legislation that would remove commanders from the military justice process. Since enforcement of an ethical code
Machuca, Ana; Torres, Karin; Morris, Pamela; Whitley, William
This paper will summarize some of challenges faced by military students enrolled in an associate and bachelors online program at American Public University System (APUS). The survey results on which the study is based exposed the following problems faced by military personnel: 48.7% had difficulties working around military obligations, 33.3%…
Irhebhude, Martins E.; Edirisinghe, Eran A.
This paper presents an automatic, machine vision based, military personnel identification and classification system. Classification is done using a Support Vector Machine (SVM) on sets of Army, Air Force and Navy camouflage uniform personnel datasets. In the proposed system, the arm of service of personnel is recognised by the camouflage of a persons uniform, type of cap and the type of badge/logo. The detailed analysis done include; camouflage cap and plain cap differentiation using gray level co-occurrence matrix (GLCM) texture feature; classification on Army, Air Force and Navy camouflaged uniforms using GLCM texture and colour histogram bin features; plain cap badge classification into Army, Air Force and Navy using Speed Up Robust Feature (SURF). The proposed method recognised camouflage personnel arm of service on sets of data retrieved from google images and selected military websites. Correlation-based Feature Selection (CFS) was used to improve recognition and reduce dimensionality, thereby speeding the classification process. With this method success rates recorded during the analysis include 93.8% for camouflage appearance category, 100%, 90% and 100% rates of plain cap and camouflage cap categories for Army, Air Force and Navy categories, respectively. Accurate recognition was recorded using SURF for the plain cap badge category. Substantial analysis has been carried out and results prove that the proposed method can correctly classify military personnel into various arms of service. We show that the proposed method can be integrated into a face recognition system, which will recognise personnel in addition to determining the arm of service which the personnel belong. Such a system can be used to enhance the security of a military base or facility.
24061 ABSTRACT Many future military operations are expected to occur in urban environments. These complex, 3D battlefields intro- duce many...from ISIM, France, and an M.S. in computer science in 1999 from the University of Central Florida. His research interests are in computer graphics, 3D ...information needed and reduce it to a minimum during high-stress situations. The Shared Information Database The system contains a detailed 3D
of Psychological Health at United States Marine Corps Arlington, VA Matthew K. Nock, PhD Professor of Psychology , Harvard University Research...email@example.com u William P. Nash, MD CAPT (Retired), MC, USN Director of Psychological Health at United States Marine Corps Arlington, VA...William.P.Nash@usmc.mil Katharine W. Nassauer, PhD Psychological Health and Resilience Portfolio Manager Military Operational Medicine Research
Hill, Neil; Fallowfield, Joanne; Price, Susan; Wilson, Duncan
Food and nutrition are fundamental to military capability. Historical examples demonstrate that a failure to supply adequate nutrition to armies inevitably leads to disaster; however, innovative measures to overcome difficulties in feeding reap benefits, and save lives. In barracks, UK Armed Forces are currently fed according to the relatively new Pay As You Dine policy, which has attracted criticism from some quarters. The recently introduced Multi-Climate Ration has been developed specifically to deal with issues arising from Iraq and the current conflict in Afghanistan. Severely wounded military personnel are likely to lose a significant amount of their muscle mass, in spite of the best medical care. Nutritional support is unable to prevent this, but can ameliorate the effects of the catabolic process. Measuring and quantifying nutritional status during critical illness is difficult. A consensus is beginning to emerge from studies investigating the effects of nutritional interventions on how, what and when to feed patients with critical illness. The Ministry of Defence is currently undertaking research to address specific concerns related to nutrition as well as seeking to promote healthy eating in military personnel. PMID:21149358
Henry Ford Health Systems evolved from a hospital into a system delivering care to 2.5 million patients and includes the Cancer Epidemiology, Prevention and Control Program, which focuses on epidemiologic and public health aspects of cancer.
use of ammonia for duplication is reltively safe, ammonia leaks can result and can be dangerous. Ammonia fumes were detected in some installations...the sophis - tication of the system. Manual systems will utilize optical projection systems to enable users at a particular work station to view the...C. Turner , Supervisor, Special Actions Unit, OPRB, MSD Ms. M. Hill, Chief, Micrographics, OPRB, MSD Ms. C. Howard, Pre/Post Inspection Clerk, OPRB
Levitt, Gwen A
As the number of troops returning home from the Middle East continues to rise, so does the need for psychiatric treatment. More and more often, civilian mental health facilities will be faced with treating active duty service members. Because the patients are active duty status, civilian providers need to become familiar with the unique intricacies and challenges of interacting with military command and mental health clinics. Concepts such as confidentiality and consent have a slightly different meaning in the military that affects care in the civilian realm. Diagnoses, medication choices, and treatment planning can also have an impact on a service member's career in the military that civilian providers may not recognize. This guide serves as a "beginner's" manual for working with active duty service members.
first concept, termed Systems Thinking deals with sets of elements in which the behavior of each element affects the behavior of the whole; the...independent subgroups cannot be formed. The key to systems thinking is synthesis, the putting of elements together and considering their connections and
Morris, J.D.; Emrich, M.L.; Hwang, Ho-Ling; Meador, M.
Historically, budget preparation processes have been difficult to accomplish. Errors and inconsistencies cause problems for the analyst during budget review. This paper discusses the development and testing of an expert system to aid budget preparation. The prototyping tool, its capabilities, and their application are discussed. Shown are the pilot testing procedures and their role in system development. Current status and enhancements (including software updates and future testing) are also presented. 12 refs., 3 figs.
Rodriguez, Aubrey J.; Margolin, Gayla
Though military service, and particularly absence due to deployment, has been linked to risk for depression and anxiety among some spouses and children of active duty service members, there is limited research to explain the heterogeneity in family members’ reactions to military service stressors. The current investigation introduces the Timeline Followback Military Family Interview (TFMFI) as a clinically useful strategy to collect detailed time-linked information about the service member’s absences. Two dimensions of parent absence—the extent to which absences coincide with important family events and cumulative time absent—were tested as potential risks to family members’ mental health. Data from 70 mother-adolescent pairs revealed that the number of important family events missed by the service member was linked to elevated youth symptoms of depression, even when accounting for the number of deployments and cumulative duration of the service member’s absence. However, youth who reported more frequent contact with the service member during absences were buffered from the effects of extensive absence. Mothers’ symptoms were associated with the cumulative duration of the service members’ time away, but not with family events missed by the service member. These results identify circumstances that increase the risk for mental health symptoms associated with military family life. The TFMFI provides an interview-based strategy for clinicians wishing to understand military family members’ lived experience during periods of service member absence. PMID:26075736
Rodriguez, Aubrey J; Margolin, Gayla
Although military service, and particularly absence due to deployment, has been linked to risk for depression and anxiety among some spouses and children of active duty service members, there is limited research to explain the heterogeneity in family members' reactions to military service stressors. The current investigation introduces the Timeline Followback Military Family Interview (TFMFI) as a clinically useful strategy to collect detailed time-linked information about the service member's absences. Two dimensions of parent absence--the extent to which absences coincide with important family events and cumulative time absent--were tested as potential risks to family members' mental health. Data from 70 mother-adolescent pairs revealed that the number of important family events missed by the service member was linked to elevated youth symptoms of depression, even when accounting for the number of deployments and cumulative duration of the service member's absence. However, youth who reported more frequent contact with the service member during absences were buffered from the effects of extensive absence. Mothers' symptoms were associated with the cumulative duration of the service members' time away, but not with family events missed by the service member. These results identify circumstances that increase the risk for mental health symptoms associated with military family life. The TFMFI provides an interview-based strategy for clinicians wishing to understand military family members' lived experience during periods of service-member absence.
Kark, J D; Kedem, R; Revach, M
At age 17 years Israelis undergo medical examination for the purpose of health classification for military service. The potential use of this extensive data collection system for epidemiologic studies is illustrated for selected conditions. Trends in diagnosed disorders over a 25-year period are exemplified in the changing prevalence of tuberculosis, bronchial asthma, diabetes, epilepsy and heart defects. Within birth cohorts, cross-sectional analyses of height, body mass, blood pressure and disorders--such as bronchial asthma, allergic rhinitis, diabetes, psychiatric diagnoses and such genetic conditions as familial Mediterranean fever--point to clear ethnic differences. Educational level is strongly associated with measures of health status. Potential uses of this resource include: detecting groups in need of preventive, curative and rehabilitative care, assessing changing needs and priorities of health care, evaluation of intervention programs and health services provided in childhood, a wide spectrum of etiologic studies including assessment of health effects of social change, follow-up studies including the natural history of disorders, and developing data systems such as national registries of rare or important conditions. Issues relating to data reliability and validity, changing disease classification and nonexamination of groups exempted from military service limit interpretation of findings and restrict uses of this resource. Emphasis on standardization of data collection and diagnostic criteria, quality assurance and improved data management will be necessary.
Luxton, David D; Pruitt, Larry D; O'Brien, Karen; Stanfill, Katherine; Jenkins-Guarnieri, Michael A; Johnson, Kristine; Wagner, Amy; Thomas, Elissa; Gahm, Gregory A
Home-based telemental health (TMH) treatments have the potential to address current and future health needs of military service members, veterans, and their families, especially for those who live in rural or underserved areas. The use of home-based TMH treatments to address the behavioral health care needs of U.S. military healthcare beneficiaries is not presently considered standard of care in the Military Health System. The feasibility, safety, and clinical efficacy of home-based TMH treatments must be established before broad dissemination of home-based treatment programs can be implemented. This paper describes the design, methodology, and protocol of a clinical trial that compares in-office to home-based Behavioral Activation for Depression (BATD) treatment delivered via web-based video technology for service members and veterans with depression. This grant funded three-year randomized clinical trial is being conducted at the National Center for Telehealth and Technology at Joint-base Lewis-McChord and at the Portland VA Medical Center. Best practice recommendations regarding the implementation of in-home telehealth in the military setting as well as the cultural and contextual factors of providing in-home care to active duty and veteran military populations are also discussed.
with about 1.4% reporting illicit drug, synthetic cannabis , or inhalant use in the past 12 months.1 About one-quarter (24.9%) of active duty personnel...drug use began by asking about the use of a variety of illicit drugs such as marijuana, cocaine, and heroin. Two substances, synthetic cannabis and...of any “illicit” drug use. Since survey administration in 2011, many of the compounds found in synthetic cannabis have been classified by the military
Purpose The present study aimed to determine the effect of demographic characteristics, occupation, anthropometric indices, and leisure-time physical activity levels on coronary risk and health-related quality of life among military police officers from the State of Santa Catarina, Brazil. Methods The sample included 165 military police officers who fulfilled the study’s inclusion criteria. The International Physical Activity Questionnaire and the Short Form Health Survey were used, in addition to a spreadsheet of socio-demographic, occupational and anthropometric data. Statistical analyses were performed using descriptive analysis followed by Spearman Correlation and multiple linear regression analysis using the backward method. Results The waist-to-height ratio was identified as a risk factor low health-related quality of life. In addition, the conicity index, fat percentage, years of service in the military police, minutes of work per day and leisure-time physical activity levels were identified as risk factors for coronary disease among police officers. Conclusions These findings suggest that the Military Police Department should adopt an institutional policy that allows police officers to practice regular physical activity in order to maintain and improve their physical fitness, health, job performance, and quality of life. PMID:24766910
Gibbons, Susanne W; Howe, Edmund Randy
Our past lessons from war trauma have taught us that mental health-care stigma and other issues surrounding mental health-seeking behaviors can negatively impact the healing trajectory and long-term function for service members and their families. It can take years to decades before a service member seeks professional help for psychological distress, if he or she seeks it at all. Unfortunately, signs of personal and family problems can be subtle, and consequences, such as suicide, tragic. In this chapter, we consider the story one military health-care provider submitted in response to a study solicitation that read: Please provide your personal story telling me about any psychological distress you may have experienced after returning from deployment and your personal challenges accessing care and/or remaining in treatment. This story is analyzed to explore the moral implications of his experience for the military and for other service members. The main points to be highlighted are that altruism can leave altruists more vulnerable, military mental health stigma may exacerbate this risk, and military families may profoundly be affected.
Bangert, David; Doktor, Boert; Johnson, Erik
Interviews with 48 military health care professionals identified 20 objectives and 4 learning clusters for a telemedicine training curriculum. From these clusters, web-based modules were developed addressing clinical learning, technology, organizational issues, and introduction to telemedicine. (Contains 19 references.) (SK)
This analysis of the Armenian health system reviews the developments in organization and governance, health financing, healthcare provision, health reforms and health system performance since 2006. Armenia inherited a Semashko style health system on independence from the Soviet Union in 1991. Initial severe economic and sociopolitical difficulties during the 1990s affected the population health, though strong economic growth from 2000 benefited the populations health. Nevertheless, the Armenian health system remains unduly tilted towards inpatient care concentrated in the capital city despite overall reductions in hospital beds and concerted efforts to reform primary care provision. Changes in health system financing since independence have been more profound, as out-of-pocket (OOP) payments now account for over half of total health expenditure. This reduces access to essential services for the poorest households - particularly for inpatient care and pharmaceuticals - and many households face catastrophic health expenditure. Improving health system performance and financial equity are therefore the key challenges for health system reform. The scaling up of some successful recent programmes for maternal and child health may offer solutions, but require sustained financial resources that will be challenging in the context of financial austerity and the low base of public financing.
Padden, Diane L; Connors, Rebecca A; Posey, Sheena M; Ricciardi, Richard; Agazio, Janice G
The purpose of this study was to understand the factors influencing the health promoting behaviors (HPBs) of military spouses. Pender's Health Promotion Model provided the theoretical framework guiding this study. One hundred twelve female spouses were surveyed regarding their perceived health status, perceived stress, self-efficacy, social support, and participation in HPBs. Perceived health status, self-efficacy, social support, and HPBs were positively related, whereas perceived stress was negatively related. Hierarchical multiple regression analysis showed perceived stress and social support to be predictive of an overall health promoting lifestyle (HPLPII), with the full model explaining 49.7% of the variance.
Suris, Alina; Lind, Lisa; Kashner, T. Michael; Borman, Patricia D.
The present study examined psychiatric, physical, and quality-of-life functioning in a sample of 270 women veterans receiving outpatient treatment at a Veterans Affairs medical center. Participants were interviewed regarding their civilian (CSA) and military sexual assault (MSA) histories, and data regarding quality of life and health outcomes…
DeFraites, Robert F; Chambers, William C
The purpose of medical situational awareness is to provide useful and actionable information for preparing and employing medical assets in support of a wide variety of operational missions around the world, and monitoring and protecting the health of the force in the face of rapidly changing health threats. Since 2005, the Medical Situational Awareness in the Theater Advanced Concept Technology Demonstration has exploited advances in information technology, geographic information systems, and open systems architecture to produce a functioning prototype of a medical situational enhancement capability. In May 2006, this prototype supported the medical staff of a combined/joint task force in a realistic command postexercise featuring a simulated outbreak of influenza during Exercise COBRA GOLD in Thailand. The proliferation and maturation of geographic information systems present many opportunities for the military medical community to improve the health of the populations for which it is responsible.
Order Code RL33537 Military Medical Care : Questions and Answers Updated May 20, 2008 Richard A. Best Jr. Specialist in National Defense Foreign...control number. 1. REPORT DATE 20 MAY 2008 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Military Medical Care : Questions and...8-98) Prescribed by ANSI Std Z39-18 Military Medical Care : Questions and Answers Summary The primary mission of the military health system, which
system). The poly(ester-urethane) binder is formed at the time of application and is generated via reaction between a hydroxide group carried by a...or biuret form of hexamethylene diisocyanate (HDI) (Figure 3). Coatings “A” and “C” employ organic solvents, and coatings “B” and “D” have sharply...two part coatings. (Potential side reactions not included for simplicity.) Figure 3: HDI based polyurethanes. A) HDI isocyanurate. B) HDI
improved patient outcomes . Case Study: the Veterans Health Administration’s Approach to Leader Development 129 How to Incentivize Although we...communication. performance measurement and improvement Epidemiological methods include medical surveillance, interventions , and risk communication... Outcome measurements allow the health care leaders to make fact-based decisions. Patient safety involves all activities aimed at minimizing the
Dyson, R. J. E.
The advanced propulsion monitoring system is described. The system was developed in order to fulfill a growing need for effective engine health monitoring. This need is generated by military requirements for increased performance and efficiency in more complex propulsion systems, while maintaining or improving the cost to operate. This program represents a vital technological step in the advancement of the state of the art for monitoring systems in terms of reliability, flexibility, accuracy, and provision of user oriented results. It draws heavily on the technology and control theory developed for modern, complex, electronically controlled engines and utilizes engine information which is a by-product of such a system.
facilities and awarding construction contracts, and >’i AIJM~ 0 ~e~tOsI@SL UNCLASSIFIED SECUIT~Y CLASSIFICATION OF THIS PAGE (Moon Dale Entered) UNCLASS I FI...ED iCUMTY CL IASSIFICATION OF THIS PA@9(Whm Duae Ehtawu* 0 BLOCK 20. (CONT’d). construction administration. The information provided in this report say...APPROXIMATE TIME SCALE IMONTHSI 0 DCSLDG.DA Directive OCE DesignOCE DIVISION A/E Determine Systems Use Engr. Division Feasibility A/E itar
Keene, Lionel Thomas
Modern military coating systems, as fielded by all branches of the U.S. military, generally consist of a diverse array of organic and inorganic components that can complicate their physicochemical analysis. These coating systems consist of VOC-solvent/waterborne automotive grade polyurethane matrix containing a variety of inorganic pigments and flattening agents. The research presented here was designed to overcome the practical difficulties regarding the study of such systems through the combined application of several cross-disciplinary techniques, including vibrational spectroscopy, electron microscopy, microtomy, ultra-fast laser ablation and optical interferometry. The goal of this research has been to determine the degree and spatial progression of weathering-induced alteration of military coating systems as a whole, as well as to determine the failure modes involved, and characterizing the impact of these failures on the physical barrier performance of the coatings. Transmission-mode Fourier Transform Infrared (FTIR) spectroscopy has been applied to cross-sections of both baseline and artificially weathered samples to elucidate weathering-induced spatial gradients to the baseline chemistry of the coatings. A large discrepancy in physical durability (as indicated by the spatial progression of these gradients) has been found between older and newer generation coatings. Data will be shown implicating silica fillers (previously considered inert) as the probable cause for this behavioral divergence. A case study is presented wherein the application of the aforementioned FTIR technique fails to predict the durability of the coating system as a whole. The exploitation of the ultra-fast optical phenomenon of femtosecond (10-15S) laser ablation is studied as a potential tool to facilitate spectroscopic depth profiling of composite materials. Finally, the interferometric technique of Phase Shifting was evaluated as a potential high-sensitivity technique applied to the
applicability to the military healthcare provider. Comprehensive electronic search was performed utilizing MEDLINE, Cochrane Database, PubMed, CINAHL ( EBSCO ...Database PubMed, CINAHL ( EBSCO ), Health and Wellness Resource Center, Nursing and Allied Health Source, Applied Social Sciences Index (CSA), PsycARTICLES...prevention of PTSD among such an at risk group of workers. Methods A comprehensive search was performed of MEDLINE, Cochrane Database, Pub Med, CINAHL ( EBSCO
Ye, Feng; Liu, Xu; Liu, Yuan; Zhang, Lulu
Background Relatively few articles have focused on exploring factors influencing soldiers’ overall satisfaction and differences between inpatients’ and outpatients’ satisfaction, particularly in the Chinese army. Elucidating factors influencing military inpatient and outpatient care separately and analyzing their differences may provide more information for the healthsystem. Methods The Revised China National Health Service Survey questionnaire was used in the survey. The questionnaire included 5 sections and 32 items concerning demographic, inpatient, and outpatient characteristics and perception variables for both inpatients and outpatients. Bivariate and multivariate techniques were used to reveal relationships between satisfaction and the variables assessed. Results Outpatients’ and inpatients’ overall satisfaction rates were 19.0% and 18.5%, respectively. The strongest determinant of outpatients’ satisfaction was satisfaction with doctor’s communication regarding therapeutic regimen followed by length of military service, level of trust in medical staff, and disease severity. Determinants of inpatients’ satisfactionincludedstaff categories, satisfaction with environment, and satisfaction with medical quality. Conclusion The factors influencing military outpatients’ satisfaction differed from those of inpatients. Exploring the causes of satisfaction and dissatisfaction with military health institutions is important in their fulfillment of their responsibility to maintain soldiers’ health. PMID:27007805
Maloney, J P; Anderson, F D; Gladd, D L; Brown, D L; Hardy, M A
The purpose of this study was to describe health care providers' perceptions of their work environment at a large U.S. Army medical center, and to compare the findings to other military medical centers. The sample (N = 112) consisted of the professional nursing staff working on the nine inpatient units. The Work Environmental Scale (WES) was used to measure perceptions of the workplace relative to gender, position (head nurses, staff nurses, and agency nurses), specialty nursing (intensive care unit [ICU] versus non-ICU), education (MSN, BSN, and ADN), and patterns of differences between the WES subscales of four military medical centers. Results of the study indicate that there were no significant gender differences. Head nurses, non-ICU nurses, and MSN nurses perceived their environment more positively. There were significant differences in the WES subscales between the military hospitals. Implications for nursing using the WES were recommended.
Arnett, Michael V; Lim, Julia T
Ciguatera toxin is a marine neurotoxin produced by microorganisms that becomes concentrated in predatory fish. Toxicity in humans results from the ingestion of contaminated fish harvested in tropical waters. Clinical manifestations of illness include the rapid onset of gastrointestinal symptoms and neurological abnormalities. Because of the rapid onset of symptoms and the potential for case clusters from a common source ingestion of contaminated fish, there is the potential that ciguatera poisoning may initially mimic illnesses caused by antipersonnel biological and chemical agents. We present data on an active duty soldier who presented to sick call for evaluation of new onset paresthesias and was diagnosed with ciguatera toxin poisoning. We also present a review of ciguatera poisoning literature with emphasis on the distinguishing features between ciguatoxin and other neurotoxins of military significance.
Chokshi, M; Patil, B; Khanna, R; Neogi, S B; Sharma, J; Paul, V K; Zodpey, S
Health systems and polices have a critical role in determining the manner in which health services are delivered, utilized and affect health outcomes. ‘Health' being a state subject, despite the issuance of the guidelines by the central government, the final prerogative on implementation of the initiatives on newborn care lies with the states. This article briefly describes the public health structure in the country and traces the evolution of the major health programs and initiatives with a particular focus on newborn health. PMID:27924110
Khodjamurodov, Ghafur; Rechel, Bernd
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Tajikistan is undergoing a complex transition from a health system inherited from the Soviet period to new forms of management, financing and health care provision. Following independence and the consequences of the civil war, health funding collapsed and informal out-of-pocket payments became the main source of revenue, with particularly severe consequences for the poor. With the aim of ensuring equitable access to health care and formalizing out-of-pocket payments, the Ministry of Health developed a programme that encompassed a basic benefit package (also known as the guaranteed benefit package) for people in need and formal co-payments for other groups of the population. One of the main challenges for the future will be to reorient the health system towards primary care and public health rather than hospital-based secondary and tertiary care. Pilots of primary care reform, introducing per capita financing, are under way in three of the country's oblasts. There are marked geographical imbalances in health care resources and financing, favouring the capital and regional centres over rural areas. There are also significant inequities in health care expenditures across regions. The quality of care is another major concern, owing to the lack of investment in health facilities and technologies, an insufficient supply of pharmaceuticals, poorly trained health care workers, and a lack of medical protocols and systems for quality improvement.
Voelker, Margaret D; Saag, Kenneth G; Schwartz, David A; Chrischilles, Elizabeth; Clarke, William R; Woolson, Robert F; Doebbeling, Bradley N
The Gulf War's impact on veterans' health-related quality of life (HRQL) remains unclear. The authors examined the HRQL of military personnel deployed to the Gulf War Theater compared with those not deployed. In 1995-1996, a structured, population-based telephone survey was conducted 5 years postconflict among a cohort originally from Iowa on active duty during the conflict. The sample included 4,886 eligible subjects stratified by deployment and military status and proportionately distributed within five substrata. The Medical Outcome Study Short Form-36 (SF-36) assessed HRQL, and multivariable linear regression identified pre- and perideployment risk factors. A total of 3,695 respondents (76%) participated. Nondeployed participants reported excellent health more often than deployed participants (31% vs. 21%, p < 0.01). SF-36 scores for deployed participants were poorer than those for nondeployed controls across all health domains. Modifiable factors such as smoking and military preparedness, and other factors such as predeployment physical and mental health morbidity, were independent risk factors for poorer HRQL after deployment. Deployed veterans reported slightly poorer HRQL even after the authors adjusted for other risk factors. Further investigation of factors influencing postdeployment HRQL is needed. Routine collection of health information by using standardized instruments pre- and perideployment should be implemented.
Background Combat-intense, lengthy, and multiple deployments in Iraq and Afghanistan have characterized the new millennium. The US military's all-volunteer force has never been better trained and technologically equipped to engage enemy combatants in multiple theaters of operations. Nonetheless, concerns over potential lasting effects of deployment on long-term health continue to mount and are yet to be elucidated. This report outlines how findings from the first 7 years of the Millennium Cohort Study have helped to address health concerns related to military service including deployments. Methods The Millennium Cohort Study was designed in the late 1990s to address veteran and public concerns for the first time using prospectively collected health and behavioral data. Results Over 150 000 active-duty, reserve, and National Guard personnel from all service branches have enrolled, and more than 70% of the first 2 enrollment panels submitted at least 1 follow-up survey. Approximately half of the Cohort has deployed in support of operations in Iraq and Afghanistan. Conclusion The Millennium Cohort Study is providing prospective data that will guide public health policymakers for years to come by exploring associations between military exposures and important health outcomes. Strategic studies aim to identify, reduce, and prevent adverse health outcomes that may be associated with military service, including those related to deployment. PMID:21281496
Lekhan, Valery; Rudiy, Volodymyr; Shevchenko, Maryna; Nitzan Kaluski, Dorit; Richardson, Erica
This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population's health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3 % in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conflict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system.
Schaffer, Bradley J
The objective of this study is to examine the health characteristics of military veterans identified through the Criminal Justice System (CJS) with partner violence and their relationships with their fathers. The 282 veterans involved in the CJS participated to complete a psycho-social assessment which included partner violence and ascertained their relationships with their fathers. The mean age of the men in the study was 44.9 years old. The majority were divorced, Caucasian, had a high school education, and served in the Army. This sample shows the benefit of integrating partner violence and relationships with fathers into the assessment process and highlights the need for more research.
outlines how findings from the first 7 years of the Millennium Cohort Study have helped to address health concerns related to military service...standard health assessment instruments embedded in the study questionnaire found high inter- nal consistency for 14 of 16 health components [ 7 ]. Only...moderate stability was found for more dynamic variables [ 7 ]. Deployment and Deployment-Related Exposures A major objective when designing the
Binder, Michael L.; Calvo, Alberto B.; Gibson, Gregory J.
This paper describes a Decision Support System for military display acquisition being developed under U.S. Display Consortium (USDC) sponsorship. The core of the system is a standard Life-Cycle Cost model. The system will use World Wide Web technology to make it widely accessible to Industry and Government Program Offices for use in the Display Acquisition Decision Process. Web-LCCA (Life-Cycle Cost Analyzer), a derivative of TASC's LCCATM, has been designed to aid in the evaluation of different Display System acquisition options. The target users of Web-LCCA are display vendors (Industry) and buyers (Government Program Offices). Web-LCCA will be USDC's standard tool for supporting cost tradeoffs and acquisition decisions among current operational displays and new flat panel display products.
Meynard, Jean-Baptiste; Chaudet, Herve; Green, Andrew D; Jefferson, Henry L; Texier, Gaetan; Webber, Daniel; Dupuy, Bruce; Boutin, Jean-Paul
Background In recent years a wide variety of epidemiological surveillance systems have been developed to provide early identification of outbreaks of infectious disease. Each system has had its own strengths and weaknesses. In 2002 a Working Group of the Centers for Disease Control and Prevention (CDC) produced a framework for evaluation, which proved suitable for many public health surveillance systems. However this did not easily adapt to the military setting, where by necessity a variety of different parameters are assessed, different constraints placed on the systems, and different objectives required. This paper describes a proposed framework for evaluation of military syndromic surveillance systems designed to detect outbreaks of disease on operational deployments. Methods The new framework described in this paper was developed from the cumulative experience of British and French military syndromic surveillance systems. The methods included a general assessment framework (CDC), followed by more specific methods of conducting evaluation. These included Knowledge/Attitude/Practice surveys (KAP surveys), technical audits, ergonomic studies, simulations and multi-national exercises. A variety of military constraints required integration into the evaluation. Examples of these include the variability of geographical conditions in the field, deployment to areas without prior knowledge of naturally-occurring disease patterns, the differences in field sanitation between locations and over the length of deployment, the mobility of military forces, turnover of personnel, continuity of surveillance across different locations, integration with surveillance systems from other nations working alongside each other, compatibility with non-medical information systems, and security. Results A framework for evaluation has been developed that can be used for military surveillance systems in a staged manner consisting of initial, intermediate and final evaluations. For each stage
Gerkens, Sophie; Merkur, Sherry
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Belgian population continues to enjoy good health and long life expectancy. This is partly due to good access to health services of high quality. Financing is based mostly on proportional social security contributions and progressive direct taxation. The compulsory health insurance is combined with a mostly private system of health care delivery, based on independent medical practice, free choice of physician and predominantly fee-for-service payment. This Belgian HiT profile (2010) presents the evolution of the health system since 2007, including detailed information on new policies. While no drastic reforms were undertaken during this period, policy-makers have pursued the goals of improving access to good quality of care while making the system sustainable. Reforms to increase the accessibility of the health system include measures to reduce the out-of-pocket payments of more vulnerable populations (low-income families and individuals as well as the chronically ill). Quality of care related reforms have included incentives to better integrate different levels of care and the establishment of information systems, among others. Additionally, several measures on pharmaceutical products have aimed to reduce costs for both the National Institute for Health and Disability Insurance (NIHDI) and patients, while maintaining the quality of care.
Didenko, L V; Ustinova, L A; Khyzhniak, M I
Fitness of soldiers in military reserve for military service at the stage in the Armed Forces of Ukraine has been studied in the article. It has been established that the growing number of soldiers in military reserve with changes in health and physical condition indicates insufficient level of their health which has a negative impact on their capability and gradually on their fitness for military service. Priorities of changes in organization of the process of completion by human resources of the soldiers' military reserve in the Armed Forces of Ukraine during their transition towards professional army have been defined, to include optimization of criteria of fitness for military service.
Taylor, Marcus K; Hilton, Susan M; Campbell, Justin S; Beckerley, Shiloh E; Shobe, Katharine K; Drummond, Sean P A
Sleep disruption is an emergent military health issue, but remarkably little is known of its prevalence or comorbidities in the combat zone. This study was designed to quantify the prevalence and mental health correlates of sleep disruption among military personnel serving within a ground combat zone during Operation Enduring Freedom. This was a large, cross-sectional survey of active duty and reserve U.S. Navy personnel (N = 3,175). Self-reported sleep measures included total hours of sleep per day, total hours of sleep required to feel well-rested, difficulty falling asleep, and difficulty staying asleep. The survey also measured mental health symptoms, including post-traumatic stress symptoms, anxiety, and depression. Participants reported an average of 5.9 hours of sleep per day despite requiring on average 6.8 hours to feel well rested. More than half (56%) were classified as sleep deficient, and 67% reported 6 or fewer hours of sleep per day. Adjusted for covariates, individuals endorsing sleep disruption were at substantially elevated risk of meeting criteria for post-traumatic stress disorder, generalized anxiety disorder, and major depressive disorder. This study documents the prevalence of sleep disruption in a very large and difficult-to-access sample of military members serving in a combat zone, and details robust associations with mental health.
military pro- vide fulltime child care for personnel’s children (Brende, 1977; Nida , 1980). Wheatland (1977) discovered problems in offering child...according to Nida (1980). Specific areas of concern in military child care include the following: Overseas Schooling. In Europe, 130,000 American children...NICHOLS, R. The support of Army families during the absence of their-sponsors. U.S. Army War College, Carlisle Barracks, PA, 1g76. NIDA , P.D. What you
Chevreul, Karine; Berg Brigham, Karen; Durand-Zaleski, Isabelle; Hernandez-Quevedo, Cristina
This analysis of the French health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The French population has a good level of health, with the second highest life expectancy in the world for women. It has a high level of choice of providers, and a high level of satisfaction with the health system. However, unhealthy habits such as smoking and harmful alcohol consumption remain significant causes of avoidable mortality. Combined with the significant burden of chronic diseases, this has underscored the need for prevention and integration of services, although these have not historically been strengths of the French system. Although the French health care system is a social insurance system, it has historically had a stronger role for the state than other Bismarckian social insurance systems. Public financing of health care expenditure is among the highest in Europe and out-of-pocket spending among the lowest. Public insurance is compulsory and covers the resident population; it is financed by employee and employer contributions as well as increasingly through taxation. Complementary insurance plays a significant role in ensuring equity in access. Provision is mixed; providers of outpatient care are largely private, and hospital beds are predominantly public or private non-profit-making. Despite health outcomes being among the best in the European Union, social and geographical health inequities remain. Inequality in the distribution of health care professionals is a considerable barrier to equity. The rising cost of health care and the increasing demand for long-term care are also of concern. Reforms are ongoing to address these issues, while striving for equity in financial access; a long-term care reform including public coverage of long-term care is still pending.
Webb-Murphy, Jennifer A; De La Rosa, Gabriel M; Schmitz, Kimberly J; Vishnyak, Elizabeth J; Raducha, Stephanie C; Roesch, Scott C; Johnston, Scott L
Military personnel deployed to Joint Task Force Guantanamo Bay (JTF-GTMO) faced numerous occupational stressors. As part of a program evaluation, personnel working at JTF-GTMO completed several validated self-report measures. Personnel were at the beginning, middle, or end of their deployment phase. This study presents data regarding symptoms of posttraumatic stress disorder, alcohol abuse, depression, and resilience among 498 U.S. military personnel deployed to JTF-GTMO in 2009. We also investigated individual and organizational correlates of mental health among these personnel. Findings indicated that tenure at JTF-GTMO was positively related to adverse mental health outcomes. Regression models including these variables had R2 values ranging from .02 to .11. Occupation at JTF-GTMO also related to mental health such that guards reported poorer mental health than medical staff. Reluctance to seek out mental health care was also related to mental health outcomes. Those who reported being most reluctant to seek out care tended to report poorer mental health than those who were more willing to seek out care. Results suggested that the JTF-GTMO deployment was associated with significant psychological stress, and that both job-related and attitude-related variables were important to understanding mental health symptoms in this sample.
Military chemical warfare agent testing from World War I to 1975 produced thousands of veterans with concerns about how their participation affected their health. A companion article describes the history of these experiments, and how the lack of clinical data hampers evaluation of long-term health consequences. Conversely, much information is available about specific agents tested and their long-term health effects in other populations, which may be invaluable for helping clinicians respond effectively to the health care and other needs of affected veterans. The following review describes tested agents and their known long-term health consequences. Although hundreds of chemicals were tested, they fall into only about a half-dozen pharmaceutical classes, including common pharmaceuticals; anticholinesterase agents including military nerve agents and pesticides; anticholinergic glycolic acid esters such as atropine; acetylcholine reactivators such as 2-PAM; psychoactive compounds including cannabinoids, phencyclidine, and LSD; and irritants including tear gas and riot control agents.
Ollivier, Lénaïck; Decam, Christophe; Pommier de Santi, Vincent; Darar, Houssein Y; Dia, Aïssata; Nevin, Remington L; Romand, Olivier; Bougère, Jacques; Deparis, Xavier; Boutin, Jean-Paul
Despite an increase in foreign tourism and in the numbers of foreign military personnel deployed to Djibouti, little is known about the risk of gastrointestinal illness in this country in eastern Africa. To assess risk and to describe common features of gastrointestinal illnesses, reports of illness derived from military health surveillance data collected during 2005-2009 among French service members deployed to Djibouti were reviewed. Diarrhea was the most common problem; it had an annual incidence ranging from 260 to 349 cases per 1,000 person-years. The risk was higher among soldiers deployed short-term (four months) than among soldiers deployed long-term (two years). This five-year review of French health surveillance data documents a significant burden of diarrhea among French soldiers in Djibouti. The identification of factors associated with risk may permit efficient targeting of interventions to reduce morbidity from gastrointestinal illness.
de Saint-Julien, Jacques; Auroy, Yves; Pons, François
In view of the recent evolution of military conflicts, particularly in the Afghan theater, and the conditions in which wounded warriors are managed in the field prior to hospitalization, the authors examine the technical specificities of medical teams, based on studies of avoidable mortality. War surgery has become a separate specialty, following the disappearance in France of the general surgical specialty, of which it was the military coun-terpart. The authors stress the role of hemorrhaging and its treatment, based on three strategies: damage control resuscitation, blood transfusion, and early evacuation within the "golden hour ". The French Armed Forces Health Service, in a new strategic plan, is refocusing its activity on war traumatology, through better education and training of medical-surgical teams and by opening up its scholarship structures to the French civilian public health service sector.
Sagan, Anna; Panteli, Dimitra; Borkowski, W; Dmowski, M; Domanski, F; Czyzewski, M; Gorynski, Pawel; Karpacka, Dorota; Kiersztyn, E; Kowalska, Iwona; Ksiezak, Malgorzata; Kuszewski, K; Lesniewska, A; Lipska, I; Maciag, R; Madowicz, Jaroslaw; Madra, Anna; Marek, M; Mokrzycka, A; Poznanski, Darius; Sobczak, Alicja; Sowada, Christoph; Swiderek, Maria; Terka, A; Trzeciak, Patrycja; Wiktorzak, Katarzyna; Wlodarczyk, Cezary; Wojtyniak, B; Wrzesniewska-Wal, Iwona; Zelwianska, Dobrawa; Busse, Reinhard
Since the successful transition to a freely elected parliament and a market economy after 1989, Poland is now a stable democracy and is well represented within political and economic organizations in Europe and worldwide. The strongly centralized health system based on the Semashko model was replaced with a decentralized system of mandatory health insurance, complemented with financing from state and territorial self-government budgets. There is a clear separation of health care financing and provision: the National Health Fund (NFZ) the sole payer in the system is in charge of health care financing and contracts with public and non-public health care providers. The Ministry of Health is the key policy-maker and regulator in the system and is supported by a number of advisory bodies, some of them recently established. Health insurance contributions, borne entirely by employees, are collected by intermediary institutions and are pooled by the NFZ and distributed between the 16 regional NFZ branches. In 2009, Poland spent 7.4% of its gross domestic product (GDP) on health. Around 70% of health expenditure came from public sources and over 83.5% of this expenditure can be attributed to the (near) universal health insurance. The relatively high share of private expenditure is mostly represented by out-of-pocket (OOP) payments, mainly in the form of co-payments and informal payments. Voluntary health insurance (VHI) does not play an important role and is largely limited to medical subscription packages offered by employers. Compulsory health insurance covers 98% of the population and guarantees access to a broad range of health services. However, the limited financial resources of the NFZ mean that broad entitlements guaranteed on paper are not always available. Health care financing is overall at most proportional: while financing from health care contributions is proportional and budgetary subsidies to system funding are progressive, high OOP expenditures
Assessment Program (DLAP), which incorporates the active duty health behaviors study and expands the scope to include the National Guard and Reserves, as...well as other special studies . Findings from the program provide information on the fitness of the force, including estimates of alcohol, drug, and...first to include Coast Guard personnel. The study has three broad aims for active duty military personnel: continue to assess the nature, extent, and
Azzopardi Muscat, Natasha; Calleja, Neville; Calleja, Antoinette; Cylus, Jonathan
This analysis of the Maltese health system reviews the developments in its organization and governance, health financing, health-care provision, health reforms and health system performance. The health system in Malta consists of a public sector, which is free at the point of service and provides a comprehensive basket of health services for all its citizens, and a private sector, which accounts for a third of total health expenditure and provides the majority of primary care. Maltese citizens enjoy one of the highest life expectancies in Europe. Nevertheless, non-communicable diseases pose a major concern with obesity being increasingly prevalent among both adults and children. The health system faces important challenges including a steadily ageing population, which impacts the sustainability of public finances. Other supply constraints stem from financial and infrastructural limitations. Nonetheless, there exists a strong political commitment to ensure the provision of a healthcare system that is accessible, of high quality, safe and also sustainable. This calls for strategic investments to underpin a revision of existing processes whilst shifting the focus of care away from hospital into the community.
Monteith, Lindsey L; Bahraini, Nazanin H; Matarazzo, Bridget B; Gerber, Holly R; Soberay, Kelly A; Forster, Jeri E
No studies have examined whether military sexual trauma, as measured and defined within the Veterans Health Administration (VHA), is associated with suicidal ideation among Veterans in VHA care, when taking prior suicide attempts into account. Research regarding the role of gender in this association is also limited. The present study examined: (1) whether military sexual trauma was associated with the presence of past-week suicidal ideation among 354 Veterans in VHA (310 men, 44 women); (2) whether gender moderated the association between military sexual trauma and suicidal ideation. Information regarding military sexual trauma, suicidal ideation, suicide attempt, and psychiatric diagnoses was obtained from self-report instruments and medical records. Adjusting for age, gender, combat, posttraumatic stress disorder, depressive disorders, negative affect, and lifetime suicide attempt, Veterans with military sexual trauma were significantly more likely to report suicidal ideation, compared to Veterans without military sexual trauma. Furthermore, the association between military sexual trauma and suicidal ideation was stronger for men compared to women. These results contribute to a growing literature identifying military sexual trauma as a risk factor for suicidal thoughts and behaviors among Veterans in VHA care and emphasize the importance of screening for suicidal ideation among survivors of military sexual trauma.
Ellsworth, Leanna; O'Keeffe, Annmaree
Background The Inuit are an indigenous people totalling about 160,000 and living in 4 countries across the Arctic – Canada, Greenland, USA (Alaska) and Russia (Chukotka). In essence, they are one people living in 4 countries. Although there have been significant improvements in Inuit health and survival over the past 50 years, stark differences persist between the key health indicators for Inuit and those of the national populations in the United States, Canada and Russia and between Greenland and Denmark. On average, life expectancy in all 4 countries is lower for Inuit. Infant mortality rates are also markedly different with up to 3 times more infant deaths than the broader national average. Underlying these statistical differences are a range of health, social, economic and environmental factors which have affected Inuit health outcomes. Although the health challenges confronting the Inuit are in many cases similar across the Arctic, the responses to these challenges vary in accordance with the types of health systems in place in each of the 4 countries. Each of the 4 countries has a different health care system with varying degrees of accessibility and affordability for Inuit living in urban, rural and remote areas. Objective To describe funding and governance arrangements for health services to Inuit in Canada, Greenland, USA (Alaska) and Russia (Chukotka) and to determine if a particular national system leads to better outcomes than any of the other 3 systems. Study design Literature review. Results It was not possible to draw linkages between the different characteristics of the respective health systems, the corresponding financial investment and the systems’ effectiveness in adequately serving Inuit health needs for several reasons including the very limited and inadequate collection of Inuit-specific health data by Canada, Alaska and Russia; and second, the data that are available do not necessarily provide a feasible point of comparison in terms of
Eaton, Karen M; Hoge, Charles W; Messer, Stephen C; Whitt, Allison A; Cabrera, Oscar A; McGurk, Dennis; Cox, Anthony; Castro, Carl A
Military spouses must contend with unique issues such as a mobile lifestyle, rules and regulations of military life, and frequent family separations including peacekeeping and combat deployments. These issues may have an adverse effect on the health of military spouses. This study examined the mental health status, rates of care utilization, source of care, as well as barriers and stigma of mental health care utilization among military spouses who were seeking care in military primary care clinics. The data show spouses have similar rates of mental health problems compared to soldiers. Spouses were more likely to seek care for their mental health problems and were less concerned with the stigma of mental health care than were soldiers. Services were most often received from primary care physicians, rather than specialty mental health professionals, which may relate to the lack of availability of mental health services for spouses on military installations.
Sanchez, Jose L; Sanchez, Joyce L; Cooper, Michael J; Hiser, Michelle J; Mancuso, James D
Tuberculosis (TB) is a communicable disease that poses a threat to force health protection to the U.S. military. The rate of TB disease in the military is low; however, there are unique challenges for its control in this setting. As a low-risk population, TB testing in the U.S. military can be scaled back from the universal testing approach used previously. Reactivation of latent TB infection (LTBI) present at accession into service is the most important factor leading to TB disease; therefore, its diagnosis and treatment among recruits should be given a high priority. Deployment and overseas military service is an uncommon but important source of TB infection, and rigorous surveillance should be ensured. Case management of TB disease and LTBI can be improved by the use of cohort reviews at the service and installation levels and case finding and delays in the diagnosis of TB disease can be improved by education of providers, as well as increased use of molecular diagnostic tests. Program outcomes can be improved by making LTBI treatment compulsory, offering shorter treatment regimens, and increasing accountability through oversight and evaluation. The diagnosis of LTBI can be improved by implementing targeted testing in all settings and reducing confirmatory interferon-gamma release assay testing.
Hom, Melanie A; Stanley, Ian H; Schneider, Matthew E; Joiner, Thomas E
Research has demonstrated that military service members are at elevated risk for a range of psychiatric problems, and mental health services use is a conduit to symptom reduction and remission. Nonetheless, there is a notable underutilization of mental health services in this population. This systematic review aimed to identify and critically examine: (1) rates of service use; (2) barriers and facilitators to care; and (3) programs and interventions designed to enhance willingness to seek care and increase help-seeking behaviors among current military personnel (e.g., active duty, National Guard, Reserve). Overall, 111 peer-reviewed articles were identified for inclusion. Across studies, the rate of past-year service use among service members with mental health problems during the same time frame was 29.3% based on weighted averages. Studies identified common barriers to care (e.g., concerns regarding stigma, career impact) and facilitators to care (e.g., positive attitudes toward treatment, family/friend support, military leadership support) among this population. Although programs (e.g., screening, gatekeeper training) have been developed to reduce these barriers, leverage facilitators, and encourage service use, further research is needed to empirically test the effectiveness of these interventions in increasing rates of service utilization. Critical areas for future research on treatment engagement among this high-risk population are discussed.
Dimova, Antoniya; Rohova, Maria; Moutafova, Emanuela; Atanasova, Elka; Koeva, Stefka; Panteli, Dimitra; van Ginneken, Ewout
In the last 20 years, demographic development in Bulgaria has been characterized by population decline, a low crude birth rate, a low fertility rate, a high mortality rate and an ageing population. A stabilizing political situation since the early 2000s and an economic upsurge since the mid-2000s were important factors in the slight increase of the birth and fertility rates and the slight decrease in standardized death rates. In general, Bulgaria lags behind European Union (EU) averages in most mortality and morbidity indicators. Life expectancy at birth reached 73.3 years in 2008 with the main three causes of death being diseases of the circulatory system, malignant neoplasms and diseases of the respiratory system. One of the most important risk factors overall is smoking, and the average standardized death rate for smoking-related causes in 2008 was twice as high as the EU15 average. The Bulgarian health system is characterized by limited statism. The Ministry of Health is responsible for national health policy and the overall organization and functioning of the health system and coordinates with all ministries with relevance to public health. The key players in the insurance system are the insured individuals, the health care providers and the third party payers, comprising the National Health Insurance Fund, the single payer in the social health insurance (SHI) system, and voluntary health insurance companies (VHICs). Health financing consists of a publicprivate mix. Health care is financed from compulsory health insurance contributions, taxes, outofpocket (OOP) payments, voluntary health insurance (VHI) premiums, corporate payments, donations, and external funding. Total health expenditure (THE) as a share of gross domestic product (GDP) increased from 5.3% in 1995 to 7.3% in 2008. At the latter date it consisted of 36.5% OOP payments, 34.8% SHI, 13.6% Ministry of Health expenditure, 9.4% municipality expenditure and 0.3% VHI. Informal payments in the health
De Pietro, Carlo; Camenzind, Paul; Sturny, Isabelle; Crivelli, Luca; Edwards-Garavoglia, Suzanne; Spranger, Anne; Wittenbecher, Friedrich; Quentin, Wilm
This analysis of the Swiss health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Swiss health system is highly complex, combining aspects of managed competition and corporatism (the integration of interest groups in the policy process) in a decentralized regulatory framework shaped by the influences of direct democracy. The health system performs very well with regard to a broad range of indicators. Life expectancy in Switzerland (82.8 years) is the highest in Europe after Iceland, and healthy life expectancy is several years above the European Union (EU) average. Coverage is ensured through mandatory health insurance (MHI), with subsidies for people on low incomes. The system offers a high degree of choice and direct access to all levels of care with virtually no waiting times, though managed care type insurance plans that include gatekeeping restrictions are becoming increasingly important. Public satisfaction with the system is high and quality is generally viewed to be good or very good. Reforms since the year 2000 have improved the MHI system, changed the financing of hospitals, strengthened regulations in the area of pharmaceuticals and the control of epidemics, and harmonized regulation of human resources across the country. In addition, there has been a slow (and not always linear) process towards more centralization of national health policy-making. Nevertheless, a number of challenges remain. The costs of the health care system are well above the EU average, in particular in absolute terms but also as a percentage of gross domestic product (GDP) (11.5%). MHI premiums have increased more quickly than incomes since 2003. By European standards, the share of out-of-pocket payments is exceptionally high at 26% of total health expenditure (compared to the EU average of 16%). Low and middle-income households contribute a greater share of their income to
Buller, Mark; Welles, Alexander; Chadwicke Jenkins, Odest; Hoyt, Reed
Military personnel are often asked to accomplish rigorous missions in extremes of climate, terrain, and terrestrial altitude. Personal protective clothing and individual equipment such as body armor or chemical biological suits and excessive equipment loads, exacerbate the physiological strain. Health, over even short mission durations, can easily be compromised. Measuring and acting upon health information can provide a means to dynamically manage both health and mission goals. However, the measurement of health state in austere military environments is challenging; (1) body worn sensors must be of minimal weight and size, consume little power, and be comfortable and unobtrusive enough for prolonged wear; (2) health states are not directly measureable and must be estimated; (3) sensor measurements are prone to noise, artifact, and failure. Given these constraints we examine current successful ambulatory physiological status monitoring technologies, review maturing sensors that may provide key health state insights in the future, and discuss unconventional analytical techniques that optimize health, mission goals, and doctrine from the perspective of thermal work strain assessment and management.
Abstract In general, there is agreement that robust integrated information systems are the foundation for building successful regional health care delivery systems. Integrated Advanced Information Management System (IAIMS) institutions that, over the years, have developed strategies for creating cohesive institutional information systems and services are finding that IAIMS strategies work well in the even more complex regional environment. The key elements of IAIMS planning are described and lessons learned are discussed in the context of regional health information systems developed. The challenges of aligning the various information agencies and agendas in support of a regional health information system are complex ; however, the potential rewards for health care in quality, efficacy, and cost savings are enormous. PMID:9067887
Russell, Mark C; Figley, Charles R
On March 23, 2010, President Barack Obama signed the Affordable Care Act (ACA) into law. Implications of the ACA on mental health care for 9.7 million military active-duty, reserve, and family members and 22.2 million veterans, as well as 1.3 uninsured veterans, is reviewed in light of a major crisis. The authors trace historical roots of the ACA to the World War II generation and efforts to transform the mental health care system by implementing hard-won war trauma lessons. The authors posit 9 principles reflected in the ACA that represent unfulfilled generational war trauma lessons and potential transformation of the military and national mental health care systems.
Lai, Taavi; Habicht, Triin; Kahur, Kristiina; Reinap, Marge; Kiivet, Raul; van Ginneken, Ewout
This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. Without doubt, the main issue has been the 2008 financial crisis. Although Estonia has managed the downturn quite successfully and overall satisfaction with the system remains high, it is hard to predict the longer-term effects of the austerity package. The latter included some cuts in benefits and prices, increased cost sharing for certain services, extended waiting times, and a reduction in specialized care. In terms of health outcomes, important progress was made in life expectancy, which is nearing the European Union (EU) average, and infant mortality. Improvements are necessary in smoking and alcohol consumption, which are linked to the majority of avoidable diseases. Although the health behaviour of the population is improving, large disparities between groups exist and obesity rates, particularly among young people, are increasing. In health care, the burden of out-of-pocket payments is still distributed towards vulnerable groups. Furthermore, the number of hospitals, hospital beds and average length of stay has decreased to the EU average level, yet bed occupancy rates are still below EU averages and efficiency advances could be made. Going forwards, a number of pre-crisis challenges remain. These include ensuring sustainability of health care financing, guaranteeing a sufficient level of human resources, prioritizing patient-centred health care, integrating health and social care services, implementing intersectoral action to promote healthy behaviour, safeguarding access to health care for lower socioeconomic groups, and, lastly, improving evaluation and monitoring tools across the health system.
Jackonis, Michael J; Deyton, Lawrence; Hess, William J
This essay discusses the challenges faced by veterans returning to society in light of the current organization and structure of the military, veterans', and overall U.S. health care systems. It also addresses the need for an integrated health care financing and delivery system to ensure a continuum of care for service members, veterans, dependents, and other family members. The health care systems of both the Department of Defense and the Department of Veterans Affairs execute their responsibilities to active duty service members, while their families and retirees/veterans are under separate legal authorities. Although they perform their mandates with extraordinary commitment and demonstrably high quality, both systems need to explore improved communication, coordination, and sharing, as well as increased collaboration with the Department of Health and Human Services programs serving the same populations, far beyond current efforts. The health care-related missions and the locus of health care delivery of each agency are admittedly unique, but their distinctions must not be permitted to impede system integration and coordination of a continuum of care provided to the men and women who serve the nation, and their families.
fair and poor health. The next two charts are the comparisons of self-reported by diagnosed high blood pressure and cholesterol. 45 SELF-REPORTED by...DIAGNOSED HIGH BLOOD PRESSURE DIAGNOSED Count I HBP NORMAL NO I BLOOD INDICATION I PRESSURE I I Row I I I I Total SELF REPORTED...analysis, we decided to identify those individuals who indicated that they had high blood pressure and/or cholesterol when they did not and vice versa. The
policy changes over the past decade have made TRICARE even more financially appealing. In 2000, DoD reduced the catastrophic cap—the maxi - mum out-of...which would reduce taxable compensation. Total, 2014- 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2023 Changes in Discretionary Spending Budget...usage of employment-based health care plans, which would reduce taxable compensation. Total 2014- 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
factors that are affecting not only DoD but also civilian health care in general. Currently 50 million Americans including many senior citizens, do not...time the United States was involved in World War I, World War II and the Korean War combined. Since January 2009, over 5000 American soldiers have been...Administration to inspect. Many MTF’s-and WRAMC in particular-have been described as rat and cockroach infested, with stained carpets, cheap
Bell, Margret E; Reardon, Annemarie
Given the frequent occurrence and significant health impact of sexual harassment and sexual assault in the military, it is important that for health care providers working with Veterans to have at least some basic knowledge in this area. Targeting providers addressing mental health and psychosocial issues, but also applicable to clinicians working with survivors in a variety of capacities, this article provides an overview of clinical care with survivors of sexual trauma in the military, particularly those who are OEF/OIF Veterans. We cover basic background information, focusing primarily on the impact of sexual trauma in the military, how survivor's reactions are shaped by various aspects of the military context, and general principles to assist clinicians in working effectively with survivors, whatever their role.
Green, Bart N; Johnson, Claire D; Daniels, Clinton J; Napuli, Jason G; Gliedt, Jordan A; Paris, David J
This literature review examined studies that described practice, utilization, and policy of chiropractic services within military and veteran health care environments. A systematic search of Medline, CINAHL, and Index to Chiropractic Literature was performed from inception through April 2015. Thirty articles met inclusion criteria. Studies reporting utilization and policy show that chiropractic services are successfully implemented in various military and veteran health care settings and that integration varies by facility. Doctors of chiropractic that are integrated within military and veteran health care facilities manage common neurological, musculoskeletal, and other conditions; severe injuries obtained in combat; complex cases; and cases that include psychosocial factors. Chiropractors collaboratively manage patients with other providers and focus on reducing morbidity for veterans and rehabilitating military service members to full duty status. Patient satisfaction with chiropractic services is high. Preliminary findings show that chiropractic management of common conditions shows significant improvement.
Framework,‖ New Partnership for Africa’s Development, June 2005, http://www.reliefweb.int/rw/ lib.nsf/db900sid/ PANA -794D7A/$file/nepad-jun2005.pdf...out that because the military used US Dollars on a large scale , the Afghan population was reluctant to trade in Afghan currency. Spending by the...NEPAD Secretariat. ―African Post-Conflict Reconstruction Policy Framework.‖ June 2005. http://www.reliefweb.int/rw/lib.nsf/db900sid/ PANA -794D7A/$file
Vladescu, Cristian; Scintee, Silvia Gabriela; Olsavszky, Victor; Hernandez-Quevedo, Cristina; Sagan, Anna
This analysis of the Romanian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Romanian health care system is a social health insurance system that has remained highly centralized despite recent efforts to decentralize some regulatory functions. It provides a comprehensive benefits package to the 85% of the population that is covered, with the remaining population having access to a minimum package of benefits. While every insured person has access to the same health care benefits regardless of their socioeconomic situation, there are inequities in access to health care across many dimensions, such as rural versus urban, and health outcomes also differ across these dimensions. The Romanian population has seen increasing life expectancy and declining mortality rates but both remain among the worst in the European Union. Some unfavourable trends have been observed, including increasing numbers of new HIV/AIDS diagnoses and falling immunization rates. Public sources account for over 80% of total health financing. However, that leaves considerable out-of-pocket payments covering almost a fifth of total expenditure. The share of informal payments also seems to be substantial, but precise figures are unknown. In 2014, Romania had the lowest health expenditure as a share of gross domestic product (GDP) among the EU Member States. In line with the government's objective of strengthening the role of primary care, the total number of hospital beds has been decreasing. However, health care provision remains characterized by underprovision of primary and community care and inappropriate use of inpatient and specialized outpatient care, including care in hospital emergency departments. The numbers of physicians and nurses are relatively low in Romania compared to EU averages. This has mainly been attributed to the high rates of workers emigrating abroad over the
Golota, A S; Krassiĭ, A B; Nagibovich, O A; Sivashchenko, P P
The current article is dedicated to the state of health of the US Armed Forces military active component personnel in 2012 according to the report published by the Armed Forces Health Surveillance Center in April 2013 issue of Center's Medical Surveillance Monthly Report. Sequentially, the key characteristics of ambulatory visits and hospitalization for the leading disease chapters and certain disease groups have been presented. The data have been given for the total personnel as well as for male and female separately. The general hospitalization has also been presented for the US Armed Forces components.
Gaal, Peter; Szigeti, Szabolcs; Csere, Marton; Gaskins, Matthew; Panteli, Dimitra
Hungary has achieved a successful transition from an overly centralized, integrated Semashko-style health care system to a purchaser provider split model with output-based payment methods. Although there have been substantial increases in life expectancy in recent years among both men and women, many health outcomes remain poor, placing Hungary among the countries with the worst health status and highest rate of avoidable mortality in the EU (life expectancy at birth trailed the EU27 average by 5.1 years in 2009). Lifestyle factors especially the traditionally unhealthy Hungarian diet, alcohol consumption and smoking play a very important role in shaping the overall health of the population.In the single-payer system, the recurrent expenditure on health services is funded primarily through compulsory, non-risk-related contributions made by eligible individuals or from the state budget. The central government has almost exclusive power to formulate strategic direction and to issue and enforce regulations regarding health care. In 2009 Hungary spent 7.4% of its gross domestic product (GDP) on health, with public expenditure accounting for 69.7% of total health spending, and with health expenditure per capita ranking slightly above the average for the new EU Member States, but considerably below the average for the EU27 in 2008. Health spending has been unstable over the years, with several waves of increases followed by longer periods of cost-containment and budget cuts. The share of total health expenditure attributable to private sources has been increasing, most of it accounted for by out-of-pocket (OOP) expenses. A substantial share of the latter can be attributed to informal payments, which are a deeply rooted characteristic of the Hungarian health system and a source of inefficiency and inequity. Voluntary health insurance, on the other hand, amounted to only 7.4% of private and 2.7% of total health expenditure in 2009. Revenue sources for health have been
Rishel, Carrie W.; Hartnett, Helen P.
The prevalence of mental health disorders constitutes a nationwide public health crisis. Estimates suggest that more than 90 million people live in areas designated mental health professional shortage areas, with almost 6,000 additional practitioners needed to meet the service needs in these areas. Military personnel and veterans have greater…
Smith, Harry F
In an era of decreased resources, optimizing worker safety and health has become increasingly challenging. Data obtained from the Army and Navy Safety Centers suggest that current strategies for managing worker safety and health can be improved. In the past, work safety management practices placed sole responsibility for safety upon the worker. More recently, safety and health practices have recognized that organizational climate and structure influence worker safety and health. Furthermore, although worker safety and health, work site health promotion, and risk management efforts have been managed autonomously, all three components are interrelated and dependent on one another to achieve greater worker safety and health. The intent of this article is to increase awareness and marketing among military medicine staff members of the crucial components of an improved health and safety program. This article explains common organizational barriers to achieving worker safety and health, provides an understanding of the interconnectedness of occupational safety and health, health promotion, and risk management, and suggests strategies for optimizing worker safety and health.
Lefort, Hugues; Ferrandis, Jean-Jacques; Tabbagh, Xavier; Lanoe, Vincent; Tourtier, Jean-Pierre
After the sanitary disaster caused by the first months of the conflict, the Health service of the French armies undertook a true revolution. By 1918, it had become the most efficient of all the opposing armies. At the end of 1914, through the spacing out of the evacuating hospitals within the zone of the armies, the most efficient teams were placed as close as possible to the front. Injured soldiers were categorized at every step of the chain. Technical progress, especially in war surgery, pushed medicine into the moderne era.
Zellman, Gail L.; Gates, Susan M.; Cho, Michelle; Shaw Rebecca
This research brief summarizes research suggesting that the U.S. Department of Defense may wish to consider expanding its child care benefits to cover more military families and a broader set of child care needs. [For "Options for Improving the Military Child Care System. Occasional Paper Summary", see ED502782. For the full paper, see ED502783.
Khizhnaya, Anna V.; Kutepov, Maksim M.; Gladkova, Marina N.; Gladkov, Alexey V.; Dvornikova, Elena I.
The necessity of enhancement of the information component in the military engineer training is determined by the result of a comparative analysis of global and national engineering education standards. The purpose is to substantiate the effectiveness and relevance of applying information technology in the system of military engineer training of…
Barry, Tom; Cunningham, Harry
Viewgraphs and discussion of onboard system health assessment are presented. Success of the space station program will be measured by how well it addresses the basic requirements for (1) maintaining the orbiting Space Station Freedom fully operational for its projected life of thirty years, and (2) the cost-effective execution of the overall space station program. Onboard system health assessment must provide complete and thorough testing capabilities along with effective associated redundancy/fault management.
Chevreul, Karine; Durand-Zaleski, Isabelle; Bahrami, Stéphane Bahrami; Hernández-Quevedo, Cristina; Mladovsky, Philipa
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The French health care system is a mix of public and private providers and insurers. Public insurance, financed by both employees and employer contributions and earmarked taxes, is compulsory and covers almost the whole population, while private insurance is of a complementary type and voluntary. Providers of outpatient care are largely private. Hospital beds are predominantly public or private non-profit-making. The French population enjoys good health and a high level of choice of providers. It is relatively satisfied with the health care system. However, as in many other countries, the rising cost of health care is of concern with regards to the objectives of the health care system. Many measures were or are being implemented in order to contain costs and increase efficiency. These include, for example, developing pay-for-performance for both hospitals and self-employed providers and increasing quality of professional practice; refining patient pathways; raising additional revenue for statutory health insurance (SHI); and increasing the role of voluntary health insurance (VHI). Meanwhile, socioeconomic disparities and geographic inequality in the density of health care professionals remain considerable challenges to providing a good level of equity in access to health care. Organizational changes at the regional level are important in attempting to tackle both equity and efficiency-related challenges. While the organizational structure of the system
This research focuses on designing an optimal restraint system for usage in a military vehicle applications. The designed restraint system must accommodate a wide range of DHM's and ATD's with and without PPE such as: helmet, boots, and body armor. The evaluation of the restraint systems were conducted in a simulated vehicle environment, which was utilized to downselect the ideal restraint system for this program. In December of 2011 the OCP TECD program was formulated to increase occupant protection. To do this, 3D computer models were created to accommodate the entire Soldier population in the Army. These models included the entire PPE, which were later utilized for space claim activities and for designing new seats and restraints, which would accommodate them. Additionally, guidelines to increase protection levels while providing optimal comfort to the Soldier were created. The current and emerging threats were evaluated and focused on at the time of the program inception. Throughout this program various activities were conducted for restraint downselection including Soldier evaluations of various restraint system configurations. The Soldiers were given an opportunity to evaluate each system in a representative seat, which allowed them to position themselves in a manner consistent with the mission requirements. Systems ranged from fully automated to manual adjustment type systems. An evaluation of each particular system was conducted and analyzed against the other systems. It was discovered that the restraint systems, which utilize retractors allowed for automatic webbing stowage and allowed for easier access and repeatability when donning and doffing the restraint. It was also found that when an aid was introduced to help the Soldier don the restraint, it was more likely that such system would be utilized. Restraints were evaluated in drop tower experiments in addition to actual blast tests. An evaluation with this amount of detail had not been attempted
This article examines the issue of separation and its impact on military families, including on infants and toddlers. Deployments and unaccompanied tours of duty (temporary assignments and 12-24 month assignments, both without family members, respectively) take military personnel away from their loved ones for extended periods of time. …
Senkubuge, Flavia; Modisenyane, Moeketsi; Bishaw, Tewabech
Background The rising burden of disease and weak health systems are being compounded by the persistent economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health systems, including dealing with social, environmental, and economic determinants through multisectoral responses. Methods A review and analysis of data on strengthening health sector reform and health systems was conducted. Attention was paid to the goal of health and interactions between health sector reforms and the functions of health systems. Further, we explored how these interactions contribute toward delivery of health services, equity, financial protection, and improved health. Findings Health sector reforms cannot be developed from a single global or regional policy formula. Any reform will depend on the country's history, values and culture, and the population's expectations. Some of the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a comprehensive policy package for health sector reforms; improving alignment of planning and coordination; use of reliable data; engaging ‘street level’ policy implementers; strengthening governance and leadership; and allowing a holistic and developmental approach to reforms. Conclusions The process of reform needs a fundamental rather than merely an incremental and evolutionary change. Without radical structural and systemic changes, existing governance structures and management systems will continue to fail to address the existing health problems. PMID:24560261
Romaní-Romaní, Franco; Curisinche-Rojas, Maricela; Arteaga, Norka Rojas; Lopez, Pedro Riega; Cabezas, César
There is a gap between human resources and technical-operational education that limits the Peruvian health system's ability to implement public health interventions. The Peruvian Ministry of Health, through the National Health Institute and the Ministry of Defense, implemented a Public Health Training Program addressed to young full-time military servicemen, on the basis of the competency profile of a public health technician. The program consists of seven thematic units given in 390 hours, 200 of which correspond to classroom and field practices. Between July 2014 and December 2015, the program has been carried out in 10 venues of the three armed forces, training and certifying 405 young servicemen. The intervention provides the military service with an additional educational benefit, making it more appealing as a chance for development and opens up a line of work in the public health sector for young people in more remote areas. This experience seeks to increase public health-trained human resources to a technical-operational level. In collaboration with regional governments, graduates are expected to be welcomed and included in the public health system.
The Design of a Portable and Deployable Solar Energy System for Deployed Military Applications Justin Tyner, Matt Coates, Dave Holloway, Kyle...energy systems and to specifically design a portable solar energy system for use tailored for a deployed military/combat unit. We considered ease...where diesel generators are superior and areas where the solar energy systems are superior. The remainder of this paper outlines our process and
medicine. These guidelines, along with creation of a two-year Masters degree (Master of Science in Social Medicine ) were designed to train physicians for...MSc Social Medicine and pass appropriate examinations. It is difficult for one unaccustomed to the system to determine what is really different about a
Richardson, Erica; Malakhova, Irina; Novik, Irina; Famenka, Andrei
This analysis of the Belarusian health system reviews the developments in organization and governance, health financing, healthcare provision, health reforms and health system performance since 2008. Despite considerable change since independence, Belarus retains a commitment to the principle of universal access to health care, provided free at the point of use through predominantly state-owned facilities, organized hierarchically on a territorial basis. Incremental change, rather than radical reform, has also been the hallmark of health-care policy, although capitation funding has been introduced in some areas and there have been consistent efforts to strengthen the role of primary care. Issues of high costs in the hospital sector and of weaknesses in public health demonstrate the necessity of moving forward with the reform programme. The focus for future reform is on strengthening preventive services and improving the quality and efficiency of specialist services. The key challenges in achieving this involve reducing excess hospital capacity, strengthening health-care management, use of evidence-based treatment and diagnostic procedures, and the development of more efficient financing mechanisms. Involving all stakeholders in the development of further reform planning and achieving consensus among them will be key to its success.
Hartman, Richard T; Wolfson, Jay; Yevich, Steven J
An evaluation research methodology was used to determine whether deployment health surveillance for Special Operations Forces conformed with Department of Defense policy directives for the specified target population. Data for this methodology were based on pre- and postdeployment health assessments as well as patient encounters recorded during deployments. The data represented 1,094 individual and unique Special Operations Forces members deployed to 12 different countries from October 2000 through December 2001. Results from the study suggested that military deployment health surveillance policy goals for predeployment medical referrals, patient data capture, and documentation during the deployment and postdeployment medical referrals were being poorly met when Department of Defense and Joint Chiefs of Staff mandates were applied to Special Operations Forces in an unconventional operations environment. Preliminary evaluation indicates that deployment health surveillance implementation could be improved with the introduction of policy awareness education, training, and technology.
Miller, Laurence; Miller, Halle B; Bjorklund, David
Military deployment of a parent carries with it a number of stresses for children, all centering around uncertainty, instability and unpredictability. This article conceptualizes military deployment and relocation stress in the context of attachment theory, and describes the types of adverse outcomes that can occur as the result of impaired attachment. It then presents a set of practical recommendations for mental health clinicians and counselors for helping children and families cope productively and negotiate the developmental hurdles associated with maintaining healthy attachment and family stability in the face of military deployment.
Critchley JA, Unal B. Is smokeless tobacco a risk factor for coronary heart disease ? A systematic review of epidemiological studies . Eur J...LF, Lopez-Guzman A, Hodges JS. The association of periodontal disease parameters with systemic medical conditions and tobacco use. J Clin...smokeless tobacco (chewing tobacco and snuff) has not been a focus of medical services or research. Epidemiological data suggest that while smoking
Hourani, Laurel L; Williams, Thomas V; Kress, Amii M
This study examined the extent to which high levels of occupational and family stress were associated with mental health problems and productivity loss among active duty military personnel. We analyzed data from the 2002 Department of Defense Survey of Health-Related Behaviors among Military Personnel, which provided extensive population-based information on 12,756 active duty personnel in all branches of the military worldwide. Military personnel reported higher levels of stress at work than in their family life. The personnel reporting the highest levels of occupational stress were those 25 or younger, those who were married with spouses not present, and women. Personnel with high levels of stress had significantly higher rates of mental health problems and productivity loss than those with less stress. We recommend that prevention and intervention efforts geared toward personnel reporting the highest levels of stress be given priority for resources in this population.
Grundy, Quinn; Malone, Ruth E.
Tobacco use is prevalent among service members, but civilian public health groups have not effectively addressed military tobacco control policy issues. We conducted focus groups in 2010 and 2012 with participants from public health and tobacco control organizations regarding their understanding of the military and of tobacco use in that context. Misperceptions were common. Military personnel were believed to be young, from marginalized populations, and motivated to join by lack of other options. Tobacco use was considered integral to military life; participants were sometimes reluctant to endorse stronger tobacco control policies than those applied to civilians, although some believed the military could be a social policy leader. Engaging public health professionals as effective partners in tobacco-free military efforts may require education about and reframing of military service and tobacco control policy. PMID:25713938
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The health status of the Greek population has strongly improved over the last few decades and seems to compare relatively favourably with other OECD and European Union (EU) countries. The health system is a mixture of public integrated, public contract and public reimbursement models, comprising elements from both the public and private sectors and incorporating principles of different organizational patterns. Access to services is based on citizenship as well as on occupational status.The system is financed by the state budget, social insurance contributions and private payments.The largest share of health expenditure constitutes private expenditure, mainly in the form of out of pocket payments which is also the element contributing most to the overall increase in health expenditure. The delivery of health care services is based on both public and private providers. The presence of private providers is more obvious in primary care,especially in diagnostic technologies, private physicians' practices and pharmaceuticals. Despite success in improving the health of the population, the Greek health care system faces serious structural problems concerning the organization, financing and delivery of services. It suffers from the absence of cost-containment measures and defined criteria for funding, resulting in sickness funds experiencing economic constraints and budget deficits. The high percentage of private expenditure goes against the principle of fair
Buchko, L A; Tkacheva, E N; Érkenova, N V
Health resort treatment is one of the stages of rehabilitation for children. The Central Military health resort for children is a dynamic diversified health resort for the treatment of children and adults, using its arsenal all available, at the resort natural factors. In the conditions of sanatorium for the treatment of children apply advanced medical technologies, the development of modern medical equipment.
Sareen, Jitender; Afifi, Tracie O.; Taillieu, Tamara; Cheung, Kristene; Turner, Sarah; Bolton, Shay-Lee; Erickson, Julie; Stein, Murray B.; Fikretoglu, Deniz; Zamorski, Mark A.
Background: In the context of the Canadian mission in Afghanistan, substantial media attention has been placed on mental health and lack of access to treatment among Canadian Forces personnel. We compared trends in the prevalence of suicidal behaviour and the use of mental health services between Canadian military personnel and the general population from 2002 to 2012/13. Methods: We obtained data for respondents aged 18–60 years who participated in 4 nationally representative surveys by Statistics Canada designed to permit comparisons between populations and trends over time. Surveys of the general population were conducted in 2002 (n = 25 643) and 2012 (n = 15 981); those of military personnel were conducted in 2002 (n = 5153) and 2013 (n = 6700). We assessed the lifetime and past-year prevalence of suicidal ideation, plans and attempts, as well as use of mental health services. Results: In 2012/13, but not in 2002, military personnel had significantly higher odds of both lifetime and past-year suicidal ideation than the civilian population (lifetime: adjusted odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17–1.50; past year: adjusted OR 1.34, 95% CI 1.09–1.66). The same was true for suicidal plans (lifetime: adjusted OR 1.64, 95% CI 1.35–1.99; past year: adjusted OR 1.66, 95% CI 1.18–2.33). Among respondents who reported past-year suicidal ideation, those in the military had a significantly higher past-year utilization rate of mental health services than those in the civilian population in both 2002 (adjusted OR 2.02, 95% CI 1.31–3.13) and 2012/13 (adjusted OR 3.14, 95% CI 1.86–5.28). Interpretation: Canadian Forces personnel had a higher prevalence of suicidal ideation and plans in 2012/13 and a higher use of mental health services in 2002 and 2012/13 than the civilian population. PMID:27221270
McFarlane, Alexander C
Post-traumatic stress disorder (PTSD) can be caused by life threatening illness, such as cancer and coronary events. The study by Forbes et al. made the unexpected finding that military personnel evacuation with medical illness have similar rates of PTSD to those evacuated with combat injuries. It may be that the illness acts as a nonspecific stressor that interacts with combat exposures to increase the risk of PTSD. Conversely, the inflammatory consequence of systemic illness may augment the effects to traumatic stress and facilitate the immunological abnormalities that are now being associated with PTSD and depression. The impact of the stress on cytokine systems and their role in the onset of PTSD demands further investigation. Military personnel evacuated due to physical illness require similar screening and monitoring for the risk of PTSD to those injured who are already known to be at high risk.
Rice, Valerie J; Vu, Tan; Butler, Jenny; Marra, Diane; Merullo, Donna; Banderet, Louis
During scholastic or physical performance testing, individuals who fear failure tend to focus on their fears instead of the task and often perform poorly. This study examined the relationship between fear-of-failure (FoF) and performance among 200~students (male=140, female =60) attending Health Care Specialist Advanced Individual Training (AIT) at Ft. Sam Houston. Performance measures included grade point average, pass/fail status, Army Physical Fitness Test scores, and number of musculoskeletal injuries. Pearson Product Moment Correlations revealed that Soldiers who scored higher on a FoF scale also had higher final grades (r=0.16, p=0.02, r
unify the processes, technology, training, procedures and funding for military mail. Such an approach would allow DoD to achieve economies of scale...business model that capitalizes on economies of scale and organizational efficiencies • Require compatibility with current supply chain management...0 8 8 0 0 0 210 2016 2226 0 0 0 210 2024 2234 Government Service (GS) 29 48 290 2 352 Contractors 36 63 199 65 363 Totals 630 793 3243 532 5198 US
monitoring and protection during the pre-deployment, deployment and post -deployment phases, military-medical standardization, combat trauma, diseases...pré-déploiement, de déploiement et de post -déploiement, la normalisation médicale militaire, les traumatismes de combat et les malades et blessés...Holyk Post -Deployment Phase Medical Status Monitoring Functions 7 by V. Varus The Program of Reforming the Public Health System of Ukraine and the
Souza, Luciane Albuquerque Sá de; Torres, Ana Raquel Rosas; Barbosa, Genário Alves; Lima, Tiago Jessé Souza de; Souza, Luana Elayne Cunha de
The objective of this study is to investigate the role of self-efficacy beliefs as a mediator of the relationship between the subjective well-being and general health of military cadets (police and firefighters). For this study, 228 cadets participated, the majority being Military Police officer candidates (65%), male (79%), between 17 and 34 years of age (99%), and unmarried (74%). They responded to questionnaires on general health (GHQ-12), perceived general self-efficacy, to the multiple scales that cover subjective well-being, and demographic questions. Initial regression analyses indicate the predictive power of subject well-being regarding general health. Subsequently, the mediation analyses provide satisfactory evidence for the role of perceived self-efficacy as a mediator of the relationship between the subjective well-being variables and the overall health of military cadets. The implications of these results for the professional training of the cadets are discussed.
System IBM International Business Machines NEWS Navy Electronic Warfare Simulator NHS National Hurricane Center NYMEX New York Mercantile ...LIFTING OFF OF THE DIGITAL PLATEAU WITH MILITARY DECISION SUPPORT SYSTEMS A Monograph by MAJ Stephen J. Banks United States Army...Plateau With Military Decision Support Systems 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Banks, Stephen
Ringard, Ånen; Sagan, Anna; Sperre Saunes, Ingrid; Lindahl, Anne Karin
Norways five million inhabitants are spread over nearly four hundred thousand square kilometres, making it one of the most sparsely populated countries in Europe. It has enjoyed several decades of high growth, following the start of oil production in early 1970s, and is now one of the richest countries per head in the world. Overall, Norways population enjoys good health status; life expectancy of 81.53 years is above the EU average of 80.14, and the gap between overall life expectancy and healthy life years is around half the of EU average. The health care system is semi decentralized. The responsibility for specialist care lies with the state (administered by four Regional Health Authorities) and the municipalities are responsible for primary care. Although health care expenditure is only 9.4% of Norways GDP (placing it on the 16th place in the WHO European region), given Norways very high value of GDP per capita, its health expenditure per head is higher than in most countries. Public sources account for over 85% of total health expenditure; the majority of private health financing comes from households out-of-pocket payments.The number of practitioners in most health personnel groups, including physicians and nurses, has been increasing in the last few decades and the number of health care personnel per 100 000 inhabitants is high compared to other EU countries. However, long waiting times for elective care continue to be a problem and are cause of dissatisfaction among the patients. The focus of health care reforms has seen shifts over the past four decades. During the 1970s the focus was on equality and increasing geographical access to health care services; during the 1980s reforms aimed at achieving cost containment and decentralizing health care services; during the 1990s the focus was on efficiency. Since the beginning of the millennium the emphasis has been given to structural changes in the delivery and organization of health care and to policies
Davis, A.W.; Roberts, R.S.
Sensory information is critical to the telerobotic operation of mobile robots. In particular, visual sensors are a key component of the sensor package on a robot engaged in urban military operations. Visual sensors provide the robot operator with a wealth of information including robot navigation and threat assessment. However, simple countermeasures such as darkness, smoke, or blinding by a laser, can easily neutralize visual sensors. In order to provide a robust visual sensing system, an infrared sensor is required to augment the primary visual sensor. An infrared sensor can acquire useful imagery in conditions that incapacitate a visual sensor. A simple approach to incorporating an infrared sensor into the visual sensing system is to display two images to the operator: side-by-side visual and infrared images. However, dual images might overwhelm the operator with information, and result in degraded robot performance. A better solution is to combine the visual and infrared images into a single image that maximizes scene information. Fusing visual and infrared images into a single image demands balancing the mixture of visual and infrared information. Humans are accustom to viewing and interpreting visual images. They are not accustom to viewing or interpreting infrared images. Hence, the infrared image must be used to enhance the visual image, not obfuscate it.
Istepanian, Robert; Laxminarayan, Swamy; Pattichis, Constantinos S.
M-health can be defined as the "emerging mobile communications and network technologies for healthcare systems.' This book paves the path toward understanding the future of m-health technologies and services and also introducing the impact of mobility on existing e-health and commercial telemedical systems. M-Health: Emerging Mobile Health Systems presents a new and forward-looking source of information that explores the present and future trends in the applications of current and emerging wireless communication and network technologies for different healthcare scenaria.
In this opinion piece, the author brings together and discusses the collective relevance of possible health effects of microwave or radar exposure in military, broadcasting, and occupational circumstances, with a view to assuring optimal protective practices. Sources of the information presented include 1) historical data, 2) experiences of Polish soldiers, 3) a study of U.S. naval personnel using radar in the Korean War, 4) preliminary findings of exposures to the Skrunda, Latvia, transmitter, 5) data obtained near Hawaiian broadcasting facilities, 6) occupational studies of electronic and electrical workers, including ham radio operators, 7) reproductive outcomes among physiotherapists using short-wave and microwave diathermy, and 8) U.S. foreign service personnel exposed at Embassies in Eastern Europe. Some of the data are available in the peer-reviewed literature, others in abstracts, reports, or other non-peer-reviewed forms. Some were obtained under Freedom of Information statutes and are incomplete. For some of these, there is reason to believe that further evidence desired by the investigator was not obtained. Some are case-referent studies, but most are not. Some are ecological, and all are retrospective. Few have reliable dose estimations, and none has accurate dosage information on each subject. None includes evidence of tissue heating or any short-term effect. Possible outcomes considered included 1) blood count changes, 2) evidence of somatic mutation, 3) impairment of reproductive outcomes, especially increased spontaneous abortion, and 4) increase in cancer incidence and mortality, especially of the hematopoietic system, brain, and breast. The author presents evidence that sufficient microwave exposures are associated with all four of these outcomes, concluding that the possible effects and their timings with respect to exposure are qualitatively similar to those on ionizing radiation. A prudent course of action would be to provide more protection
García-Armesto, Sandra; Begoña Abadía-Taira, María; Durán, Antonio; Hernández-Quevedo, Cristina; Bernal-Delgado, Enrique
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. This edition of the Spanish HiT focuses on the consequences of the totally devolved status, consolidated in 2002, and the implementation of the road map established by the 2003 SNS Cohesion and Quality Act. Many of the steps already taken underline the improvement path chosen: the SNS Inter-territorial Council (CISNS) comprising the national and regional health ministries was upgraded to the highest SNS authority, paving the way for a brand new consensus-based policy-making process grounded in knowledge management; its effects are progressively starting to be evident. It led the way to the SNS common benefits basket or the SNS human resources policy framework, laying the cornerstones for coordination and the enactment of the SNS Quality Plan. The Plan includes the work in progress to implement the national health information system, the development of a single electronic clinical record (eCR) containing relevant clinical information guaranteeing to patients continuity of care outside their Autonomous Community (AC) of residence or a single patient ID to be used across the country, thus creating the basis for the SNS functional single insurer. It has also become one of the main drivers for the design, implementation and monitoring of quality standards across the SNS, developing national health strategies to tackle both most prevalent chronic diseases (e.g. cancer, cardiovascular diseases, diabetes) and rare diseases, as well as the National Strategy on
The shrinking size and weight of electronic circuitry has given rise to a new generation of smart clothing that enables biological data to be measured and transmitted. As the variation in the number and type of deployable devices and sensors increases, technology must allow their seamless integration so they can be electrically powered, operated, and recharged over a digital pathway. Nyx Illuminated Clothing Company has developed a lightweight health monitoring system that integrates medical sensors, electrodes, electrical connections, circuits, and a power supply into a single wearable assembly. The system is comfortable, bendable in three dimensions, durable, waterproof, and washable. The innovation will allow astronaut health monitoring in a variety of real-time scenarios, with data stored in digital memory for later use in a medical database. Potential commercial uses are numerous, as the technology enables medical personnel to noninvasively monitor patient vital signs in a multitude of health care settings and applications.
FINAL REPORT Superconducting Magnetic Tensor Gradiometer System for Detection of Underwater Military Munitions SERDP Project MR-1661 JUNE...SUBTITLE Superconducting Magnetic Tensor Gradiometer System for Detection of Underwater Military Munitions 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c...platform. • For limited platform movement, such as might be expected in an underwater capsule, use of global feedback field cancellation coil may
PAGES 119 14. SUBJECT TERMS Hazing, psychological and physical impact, academic and military performance impact, Plebe Summer, Fourth Class... Plebe Summer and the Fourth Class Development System ..............................................................33 b. Objectives of the Fourth...Duties ......................................................35 4. Expectations of Plebes
Callahan, Charles W; Zimring, Craig
The development of medical care for U.S. military families and retirees was serendipitous, a fortunate accident. The formal development of military family medical care required the evolution of three factors: the emergence of a standing army, frontiers to guard, and a peace to defend. These factors were first realized in the late 19th Century, and beginning at that point in U.S. history, seven key years highlight major milestones in the history of military family member medical care. At the same time, these years exemplify changing ideas of disease and of health care and how the physical design of clinics and hospitals reflects and impacts these ideas. The Fort Belvoir Community Hospital, which opens in 2011, exemplifies the Nation's best example of green hospital construction, patient and family centered care, and evidence-based design in a Culture of Excellence that demonstrates that military family medical care is finally "deliberate by design."
Hatch, Stephani L; Harvey, Samuel B; Dandeker, Christopher; Burdett, Howard; Greenberg, Neil; Fear, Nicola T; Wessely, Simon
This study focuses on the influence of structural aspects of social integration (social networks and social participation outside work) on mental health (common mental disorders (CMD), that is, depression and anxiety symptoms, post-traumatic stress disorder (PTSD) symptoms and alcohol misuse). This study examines differences in levels of social integration and associations between social integration and mental health among service leavers and personnel still in service. Data were collected from regular serving personnel (n=6,511) and regular service leavers (n=1,753), from a representative cohort study of the Armed Forces in the UK. We found that service leavers reported less social participation outside work and a general disengagement with military social contacts in comparison to serving personnel. Service leavers were more likely to report CMD and PTSD symptoms. The increased risk of CMD but not PTSD symptoms, was partially accounted for by the reduced levels of social integration among the service leavers. Maintaining social networks in which most members are still in the military is associated with alcohol misuse for both groups, but it is related to CMD and PTSD symptoms for service leavers only.
Džakula, Aleksandar; Sagan, Anna; Pavić, Nika; Lonćčarek, Karmen; Sekelj-Kauzlarić, Katarina
Croatia is a small central European country on the Balkan peninsula, with a population of approximately 4.3 million and a gross domestic product (GDP) of 62% of the European Union (EU) average (expressed in purchasing power parity; PPP) in 2012. On 1 July 2013, Croatia became the 28th Member State of the EU. Life expectancy at birth has been increasing steadily in Croatia (with a small decline in the years following the 1991 to 1995 War of Independence) but is still lower than the EU average. Prevalence of overweight and obesity in the population has increased during recent years and trends in physical inactivity are alarming. The Croatian Health Insurance Fund (CHIF), established in 1993, is the sole insurer in the mandatory health insurance (MHI) system that provides universal health coverage to the whole population. The ownership of secondary health care facilities is distributed between the State and the counties. The financial position of public hospitals is weak and recent reforms were aimed at improving this. The introduction of concessions in 2009 (public private partnerships whereby county governments organize tenders for the provision of specific primary health care services) allowed the counties to play a more active role in the organization, coordination and management of primary health care; most primary care practices have been privatized. The proportion of GDP spent on health by the Croatian government remains relatively low compared to western Europe, as does the per capita health expenditure. Although the share of public expenditure as a proportion of total health expenditure (THE) has been decreasing, at around 82% it is still relatively high, even by European standards. The main source of the CHIFs revenue is compulsory health insurance contributions, accounting for 76% of the total revenues of the CHIF, although only about a third of the population (active workers) is liable to pay full health care contributions. Although the breadth and scope
Alexander-Bratcher, Kimberly M; Martin, Grier; Purcell, William R; Watson, Michael; Silberman, Pam
The North Carolina Institute of Medicine Task Force on Behavioral Health Services for the Military and Their Families examined the adequacy of Medicaid- and state-funded services for mental health conditions, developmental disabilities (including traumatic brain injury), and substance abuse that are currently available in North Carolina to military service members, veterans, and their families. The task force determined that there are several gaps in services and made 13 recommendations related to federal, state, and local community resources. This article reviews the work of the task force and current efforts to improve services in North Carolina.
Iverson, David L.
The Inductive Monitoring System (IMS) software was developed to provide a technique to automatically produce health monitoring knowledge bases for systems that are either difficult to model (simulate) with a computer or which require computer models that are too complex to use for real time monitoring. IMS uses nominal data sets collected either directly from the system or from simulations to build a knowledge base that can be used to detect anomalous behavior in the system. Machine learning and data mining techniques are used to characterize typical system behavior by extracting general classes of nominal data from archived data sets. IMS is able to monitor the system by comparing real time operational data with these classes. We present a description of learning and monitoring method used by IMS and summarize some recent IMS results.
Aran, Daniel; Laca, Hernán
This paper describes the Uruguayan health system, including its structure and coverage, its financial sources, the level and distribution of its health expenditure, the physical, material and human resources available, its stewardship functions, the institutions in charge of information and research, and the level and type of citizen's participation in the operation and evaluation of the system. The most recent policy innovations are also discussed, including the creation of the National Comprehensive Health System, the National Health Insurance, the National Health Fund and the Comprehensive Health Care Program. Finally, the impact of these innovations in health expenditure, fairness of health financing, coverage levels and main health indicators is analyzed.
Buczak, Anna L.; Baugher, Benjamin; Guven, Erhan; Moniz, Linda; Babin, Steven M.; Chretien, Jean-Paul
Influenza is a highly contagious disease that causes seasonal epidemics with significant morbidity and mortality. The ability to predict influenza peak several weeks in advance would allow for timely preventive public health planning and interventions to be used to mitigate these outbreaks. Because influenza may also impact the operational readiness of active duty personnel, the US military places a high priority on surveillance and preparedness for seasonal outbreaks. A method for creating models for predicting peak influenza visits per total health-care visits (ie, activity) weeks in advance has been developed using advanced data mining techniques on disparate epidemiological and environmental data. The model results are presented and compared with those of other popular data mining classifiers. By rigorously testing the model on data not used in its development, it is shown that this technique can predict the week of highest influenza activity for a specific region with overall better accuracy than other methods examined in this article. PMID:27127415
Federal budget scientific institution "Nizhny Novgorod research institute for hygiene and occupational pathology", Federal service of supervision in sphere of protection of the rights of consumers and wellbeing of the person. The authors have evaluated physical development of contract military persons divided in following age groups (under 30, 30-34, 35-39, 40-44, 45-49, over 50 years old), according to morphofunctional indices, index of functional measurement in human organism, pathological affection. Obtained data give evidence about presence of health risk factors in all observed groups. Preventive measures are the most necessary in 1 and 2 groups. The highest health risk group is age group of 35-39 years old.
providers, subject to regulations. Certain types of care , such as most dentistry and chiropractic services, are excluded. In addition to Tricare...COVERED 00-00-2009 to 00-00-2009 4. TITLE AND SUBTITLE Military Medical Care : Questions and Answers 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c...deliver health care during wartime. The military health system also provides health care services through either Department of Defense (DOD) medical
... out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from Veterans Health Administration? Cancel Unsubscribe Working... Subscribe Subscribed Unsubscribe 12, ...
of special interest && of outstanding interest 1. Bailey J, Spott MA, Costanzo G, et al. Joint trauma system: development, conceptual framework and...optimal elements [e manual]. US Department of Defense. US Army Institute for Surgical Research; 2012. 2. Eastridge BJ, Costanzo G, Jenkins D, et al
Klin, Ami; Wetherby, Amy M.; Woods, Juliann; Saulnier, Celine; Stapel-Wax, Jennifer; Klaiman, Cheryl; Jones, Warren; Rubin, Emily; Scahill, Lawrence; Call, Nathan; Bearss, Karen; Gunter, Chris; Courtemanche, Charles J.; Lemieux, Anthony; Cox, James C.; Mandell, David S.; Van Decar, James P.; Miller, Ronald A.; Shireman, Cherri L.
The burdens faced by military families who have a child with autism are unique. The usual challenges of securing diagnostic, treatment, and educational services are compounded by life circumstances that include the anxieties of war, frequent relocation and separation, and a demand structure that emphasizes mission readiness and service. Recently established military autism-specific health care benefits set the stage for community-viable and cost-effective solutions that can achieve better outcomes for children and greater well-being for families. Here we argue for implementation of evidence-based solutions focused on reducing age of diagnosis and improving access to early intervention, as well as establishment of a tiered menu of services, individualized to the child and family, that fit with the military ethos and system of health care. Absence of this new model of care could compromise the utility and sustainability of the autism-specific benefit. PMID:25745376
Wright, Paul J; Kim, Paul Y; Wilk, Joshua E; Thomas, Jeffrey L
Frequent deployments to Iraq and Afghanistan have placed a strain on military retention. There is a need to determine contributing factors predicting intent to leave the military. The purpose of this study was to determine to what extent soldiers' mental health symptoms and perceptions of organizational climate are associated with intent to leave the military. Participants (n = 892) were soldiers of one infantry brigade combat team stationed in the United States, anonymously surveyed approximately 6 months after returning from a combat deployment to Iraq. The survey assessed overall deployment experiences, mental health symptoms, and perceptions of organizational climate. Results showed that soldiers reporting higher perceived organizational support were significantly less likely to report intent to leave and those screening positive for anxiety were significantly more likely to report intent to leave than those not screening positive. Implications of these results for Army clinicians and career counselors are discussed.
Sirintrapun, S Joseph; Artz, David R
This article provides surgical pathologists an overview of health information systems (HISs): what they are, what they do, and how such systems relate to the practice of surgical pathology. Much of this article is dedicated to the electronic medical record. Information, in how it is captured, transmitted, and conveyed, drives the effectiveness of such electronic medical record functionalities. So critical is information from pathology in integrated clinical care that surgical pathologists are becoming gatekeepers of not only tissue but also information. Better understanding of HISs can empower surgical pathologists to become stakeholders who have an impact on the future direction of quality integrated clinical care.
Sirintrapun, S Joseph; Artz, David R
This article provides surgical pathologists an overview of health information systems (HISs): what they are, what they do, and how such systems relate to the practice of surgical pathology. Much of this article is dedicated to the electronic medical record. Information, in how it is captured, transmitted, and conveyed, drives the effectiveness of such electronic medical record functionalities. So critical is information from pathology in integrated clinical care that surgical pathologists are becoming gatekeepers of not only tissue but also information. Better understanding of HISs can empower surgical pathologists to become stakeholders who have an impact on the future direction of quality integrated clinical care.
Global Positioning System ( GPS ) 5a...2003. 15. SUBJECT TERMS Space Vehicles, MMGR, AFRL, JPO, Mixed-Mode Global Positioning System Receiver, GPS 16. SECURITY CLASSIFICATION OF...239.18 1 Military/Civilian Mixed-Mode Global Positioning System ( GPS ) Receiver (MMGR) Andy Peczalski, Honeywell Aerospace Electronic Systems
Stevelink, S A M; Malcolm, E M; Mason, C; Jenkins, S; Sundin, J; Fear, N T
Background Having a visual, hearing or physical impairment (defined as problems in body function or structure) may adversely influence the mental well-being of military personnel. This paper reviews the existing literature regarding the prevalence of mental health problems among (ex-)military personnel who have a permanent, predominantly, physical impairment. Method Multiple electronic literature databases were searched for relevant studies (EMBASE (1980–January 2014), MEDLINE (1946–January 2014), PsycINFO (2002–January 2014), Web of Science (1975–January 2014)). Results 25 papers were included in the review, representing 17 studies. Studies conducted among US military personnel (n=8) were most represented. A range of mental health disorders were investigated; predominately post-traumatic stress disorder (PTSD), but also depression, anxiety disorder (excluding PTSD), psychological distress and alcohol misuse. The findings indicate that mental health disorders including PTSD (range 2–59%), anxiety (range 16.1–35.5%), depression (range 9.7–46.4%) and psychological distress (range 13.4–36%) are frequently found whereby alcohol misuse was least common (range 2.2–26.2%). Conclusions Common mental health disorders were frequently identified among (ex-)military personnel with a physical impairment. Adequate care and support is necessary during the impairment adaptation process to facilitate the psychosocial challenges (ex-)military personnel with an impairment face. Future research should be directed into factors impacting on the mental well-being of (ex-)military personnel with an impairment, how prevalence rates vary across impairment types and to identify and act on specific needs for care and support. PMID:25227569
Whitehead, P C; Carpenter, D
This study examined the reasons why military personnel in the Canadian Forces (CF) engaged in risky sexual practices despite their knowledge acquired during educational/informal training programs. Analytic induction and grounded theory were used to generate and test their explanations. Interviews were first conducted with seven key informants and later with 71 members of the CF in order to formulate, test and reshape hypotheses accounting for heterosexual acts without the use of condoms. Findings suggest that unsafe sexual behavior were not viewed as irrational or deviant. Rather, they were considered meaningful for the individual concerned and conformed to certain cultural ideals. Unsafe sexual practices were rooted in localized socially constructed meanings of sex, risk and relationships within the military. The meanings have implications for the ways in which public health information was taken up and used by armed forces personnel, and led individuals to put themselves at risk of HIV infection and other sexually transmitted diseases in certain social contexts. This relatively new explanation of taking sexual risks forms the basis for programs and interventions of a type not hitherto tried in armed service environments.
Vincent-Johnson, Nancy A
Even though privately-owned pet care is a lower priority mission than military working dog care, food inspection,and the public health mission, it is still very important,and the one that many Veterinary Corps officers, civil-ian veterinarians, and technicians enjoy the most. The vast majority of veterinarians and technicians went into veterinary medicine because of a love for animals. It is fulfilling to offer guidance to a client with a new puppy or kitten, see a sick pet improve after treatment, and interact with dozens of animals and clients in a day. The services provided by the Army Veterinary Corps in car-ing for pets has expanded over the years and the standard of care has improved as well. It is truly a privilege to serve those who dedicate themselves to the protection of our Nation. The Army Veterinary Corps is indeed proud to provide care to the pets of Warfighters of the Army,Navy, Marine Corps, Air Force, and Coast Guard; their family members; and our military retirees.
The literature on gender differences related to psychological health among in-theater service members who are deployed in a combatant role is limited. Much focuses on retrospective reports of service members who have returned from deployment. Potential key factors that contribute to gender differences in psychological health among combatants are found in literature across several topic areas, but integration of findings across disciplines is lacking. A growing body of literature on gender differences related to psychological health of postdeployment military populations suggests males and females respond differently to perceived levels of social support pre-and postdeployment. One study on service members who were deployed suggested no significant gender differences related to reported psychological health symptoms, but did appear to find significant gender differences related to reported perception of unit morale. In another related area, research explores how ostracism impacts physical and psychological health of individuals and organizations, and can result in perceptions of physical pain, although research on gender differences related to the impact of ostracism is scarce. Research has also begun to focus on sex differences in pain responses, and has identified multiple biopsychosocial, genetic, and hormonal factors that may contribute as potential underlying mechanisms. In this brief review, we focus on and begin to integrate relevant findings related to the psychological health of females in combat roles, gender differences in the impact of perception of social support on psychological health, the psychological and physical impact of ostracism on individuals and organizations, and the current literature on sex differences in pain perception. We conclude with a synthesis and discussion of research gaps identified through this review, implications for clinical practice, and potential future research directions. In conclusion, there appear to be gender
Bonar, Ted C.
This chapter provides an overview of common challenges faced by military-connected students on university campuses. The characteristics, culture, and experiences of service members and veterans are described through vignettes based on military-connected students.
Duron, Sandrine; Ertzscheid, Clémence; de Laval, Franck; Manet, Ghislain; Ficko, Cécile; Velut, Guillaume; Lefèvre, François; Migliani, René; Mayet, Aurélie; Meynard, Jean-Baptiste
Rabies is one of the risks to which travelers are exposed when going abroad. During the summer of 2012, a rabid dog died in an International Military Transit Camp in Afghanistan, leading to a public health investigation briefly reported here. The lessons learned from this episode are that such investigations are complex and that information for travelers needs to be improved.
Perceptions about Psychotherapy , Medications, and Barriers to Care in the United States Military PRINCIPAL INVESTIGATOR: Steven Southwick, MD...SUBTITLE Mental Health and Resilience: Soldier’s Perceptions about 5a. CONTRACT NUMBER Psychotherapy , Medications, and Barriers to...negative beliefs about psychotherapy , were found to contribute to decreased healthcare utilization, especially in Service Members with severe PTSD
Muiser, Jorine; Sáenz, María del Rocío; Bermúdez, Juan Luis
This paper describes the health conditions in Nicaragua and discusses the characteristics of its national health system including its structure and coverage, its financial sources its physical, material and human resources the stewardship functions developed by the Ministry of Health the participation of citizens in the operation and evaluation of the system and the level of satisfaction of health care users. It also discusses the most recent policy innovations, including the new General Health Law, the decentralization of the regulation of health facilities and the design and implementation of a new health care model known as Family and Community Health Model.
Accessions Research Consortium in Fort Jackson , SC. • Allen et al. (2005) presented a poster at NAASO’s 2005 Annual Scientific Meeting: “Military...PA: Lippincott Williams & Wilkins. Bathalon, G. (2004, January). Abdominal girth and health readiness standards: Proposed changes to AR 6009. Oral...presentation given at the Accessions Research Consortium, Fort Jackson , SC. Bathalon, G. (2005, January). Weight Status as Recruits: Impact on
the Director, James Hosek. He can be reached by email at James_Hosek@rand.org; by phone at 310-393-0411, extension 7183; or by mail at the RAND...recruitment and missed recruitment targets, the military increased cash compensation levels and expanded retirement benefits ( Williams , 2004; CBO, 2007...These changes have been credited for at least part of the increased recruiting levels between 1998 and 2003 ( Williams , 2004). Studies have also found
for leadership “to recognize and react to environment change before the pain of a crisis.” Sullivan argues that this is very difficult. “Without a...open plains of Europe, the open deserts of the Middle East, or the open steppes of China. It is spine- tingling to think that the U.S. Army has...change. If a belief or sensation 165 Murray, Military Innovation in the Interwar Period, 323
Standards Organization (SISO) provides a collaborative environment for exchange of information about...19th ICCRTS “C2 Agility: Lessons Learned from Research and Operations” Advances in Systems and...Their vision is a future where military organizations can link their C2 and simulation systems without special preparation in support of coalition
Muhr, Per; Rosenhall, Ulf
The influence of military service on self-assessed hearing symptoms and measured auditory function was studied as well as the efficacy of the Hearing Conservation Program (HCP) of the Swedish Armed Forces. 839 conscripts were recruited for the study at reporting to military service. They were all exposed to noise over the risk-limits from weapons and vehicles and used earmuffs and/or earplugs. Questionnaires and pure tone screening audiometry were studied at the start and the end of the military service. Retrospective information regarding audiometry at conscription before military service was included as control. The prevalence values of tinnitus were 23% before and 32% after the service and of sensitivity to noise 16% and 19% respectively. The prevalence values of hearing impairment were 6.3% at conscription, 14.5% at reporting to military service, and 24% after the training period. The incidence values of hearing decline were 3.7% during the period with no military noise exposure and 6.6% during the military service. Acoustic accident increased the risk of worsened tinnitus and sensitivity to noise four times and for a high frequency hearing decline six times. We observed elevated prevalence values of tinnitus, sensitivity to noise and hearing impairment at discharge compared to before military service. We observed an elevated risk of hearing decline during military service. Acoustic accident increased the risk of tinnitus, noise sensitivity and hearing decline. We suggest improvements regarding inclusion criteria for military service, and for education regarding the HCP.
Power generation systems based on the Technology Management, Inc. (TMI) solid oxide fuel cell (SOFC) are an optional modality for military...integrated system using TMI’s proprietary sulfur-tolerant planar solid oxide fuel cell (SOFC) and steam reformer, integrated into a compact unit which
Ohio State Univ., Columbus. National Center for Research in Vocational Education.
This military-developed text consists of four volumes of materials for use by those studying to become apprentice heating system specialists. Covered in the individual volumes are the following topics: related subjects (basic electricity, electrical controls, pipe and copper tubing, the principles of heating, fuels, and fuel systems); heating…
instituted as standards of care within the theater trauma system, including deep venous thrombosis ( DVT ) prophylaxis, hypothermia prevention , and...for massive transfusion / damage control resuscitation, burn care, hypothermia prevention and management, wound and amputation management have been...advances in numerous components of battlefield injury care. PREVENTION Since the implementation of the military trauma system, the effect of new
Hutchins, Susan G.
People in nearly ever occupational setting can provide examples of poor system design. The focus for this paper is on an analysis of design problems found in complex military command and control systems and the ways in which these types of problems can be avoided in future system design. The source of data for this analysis was a group of case studies of sixteen U.S. military systems written by officer-students at the Naval Postgraduate School, Monterey, CA. Systems analyzed span the four military services and include aircraft systems, communications systems, the M-16 rifle, a missile defense system, a message processing system, weapon systems, and decision support systems. Documented problems with system use were categorized according to the following measures of effectiveness: Performance, Safety, Usability, Reliability, Maintainability, Time and Cost to Train, and Workload. The number of problems encountered per system ranged from one to nine; the mean number of reported problems per system was 4.9 IEEE 1220-1998 includes a revised systems engineering approach with an increased emphasis on engineering the system for the human. Adhering to a user-centered design approach should have a positive impact on system design by significantly reducing the types of system problems described in this paper.
Guerrero, Ramiro; Gallego, Ana Isabel; Becerril-Montekio, Victor; Vásquez, Johanna
This document briefly describes the health conditions of the Colombian population and, in more detail, the characteristics of the Colombian health system. The description of the system includes its structure and coverage; financing sources; expenditure in health; physical material and human resources available; monitoring and evaluation procedures; and mechanisms through which the population participates in the evaluation of the system. Salient among the most recent innovations implemented in the Colombian health system are the modification of the Compulsory Health Plan and the capitation payment unit, the vertical integration of the health promotion enterprises and the institutions in charge of the provision of services and the mobilization of additional resources to meet the objectives of universal coverage and the homologation of health benefits among health regimes.
Lucio, Ruth; Villacrés, Nilhda; Henríquez, Rodrigo
This paper describes the health conditions in Ecuador and, in more detail, the characteristics of the Ecuadorian health system, including its structure and coverage, its financial sources, the physical, material and human resources available, and the stewardship activities developed by the Ministry of Public Health. It also describes the structure and content of its health information system, and the participation of citizens in the operation and evaluation of the health system. The paper ends with a discussion of the most recent policy innovations implemented in the Ecuadorian system, including the incorporation of a chapter on health into the new Constitution which recognizes the protection of health as a human right, and the construction of the Comprehensive Public Health Network.
Alcalde-Rabanal, Jacqueline Elizabeth; Lazo-González, Oswaldo; Nigenda, Gustavo
This paper describes the health conditions in Peru and, with greater detail, the Peruvian health system, including its structure and coverage, its financial sources, its physical, material and human resources, and its stewardship functions. It also discusses the activities developed in the information and research areas, as well as the participation of citizens in the operation and evaluation of the health system. The article concludes with a discussion of the most recent innovations, including the Comprehensive Health Insurance, the Health Care Enterprises system, the decentralization process and the Local Committees for Health Administration. The main challenge confronted by the Peruvian health system is the extension of coverage to more than I0% of the population presently lacking access to basic health care.
Lester, Patricia; Stein, Judith A; Saltzman, William; Woodward, Kirsten; MacDermid, Shelley W; Milburn, Norweeta; Mogil, Catherine; Beardslee, William
Family-centered preventive interventions have been proposed as relevant to mitigating psychological health risk and promoting resilience in military families facing wartime deployment and reintegration. This study evaluates the impact of a family-centered prevention program, Families OverComing Under Stress Family Resilience Training (FOCUS), on the psychological adjustment of military children. Two primary goals include (1) understanding the relationships of distress among family members using a longitudinal path model to assess relations at the child and family level and (2) determining pathways of program impact on child adjustment. Multilevel data analysis using structural equation modeling was conducted with deidentified service delivery data from 280 families (505 children aged 3-17) in two follow-up assessments. Standardized measures included service member and civilian parental distress (Brief Symptom Inventory, PTSD Checklist-Military), child adjustment (Strengths and Difficulties Questionnaire), and family functioning (McMaster Family Assessment Device). Distress was significantly related among the service member parent, civilian parent, and children. FOCUS improved family functioning, which in turn significantly reduced child distress at follow-up. Salient components of improved family functioning in reducing child distress mirrored resilience processes targeted by FOCUS. These findings underscore the public health potential of family-centered prevention for military families and suggest areas for future research.
Treatment of persistent post-concussive symptoms after mild traumatic brain injury: a systematic review of cognitive rehabilitation and behavioral health interventions in military service members and veterans.
Cooper, Douglas B; Bunner, Anne E; Kennedy, Jan E; Balldin, Valerie; Tate, David F; Eapen, Blessen C; Jaramillo, Carlos A
Increased prevalence of traumatic brain injury (TBI) has been associated with service members and veterans who completed combat deployments in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Management of persistent post-concussive symptoms (PCS) has been a challenge to healthcare providers throughout the Military and Veterans Healthcare Systems, as well as civilian healthcare providers, due in part to the chronic nature of symptoms, co-occurrence of behavioral health disorders such as depression, Posttraumatic Stress Disorder (PTSD), and substance use disorders, and fear of a potential stigma associated with psychiatric diagnoses and behavioral health treatment(s). This systematic review examined non-pharmacologic behavioral health interventions and cognitive rehabilitation interventions for PCS in military service members and veterans with a history of mild TBI (mTBI). Six electronic databases were searched with specific term limitations, identifying 121 citations. Ultimately, 19 articles met criteria for inclusion in this systematic review. Studies were broadly categorized into four subtypes: psychoeducational interventions, cognitive rehabilitation, psychotherapeutic approaches, and integrated behavioral health interventions for PCS and PTSD. The review provides an update of the empirical evidence for these four types of interventions for PCS in active duty service members and veterans. Recommendations for future research are discussed, including the need to expand and improve the limited evidence basis on how to manage persistent post-concussive symptoms in this population.
Gómez Dantés, Octavio; Sesma, Sergio; Becerril, Victor M; Knaul, Felicia M; Arreola, Héctor; Frenk, Julio
This paper describes the Mexican health system. In part one, the health conditions of the Mexican population are discussed, with emphasis in those emerging diseases that are now the main causes of death, both in men and women: diabetes, ischaemic heart disease, cerebrovascular diseases and cancer. Part two is devoted to the description of the basic structure of the system: its main institutions, the population coverage, the health benefits of those affiliated to the different heath institutions, its financial sources, the levels of financial protection in health, the availability of physical, material and human resources for health, and the stewardship functions displayed by the Ministry of Health and other actors. This part also discusses the role of citizens in the monitorization and evaluation of the health system, as well as the levels of satisfaction with the rendered health services. In part three the most recent innovations and its impact on the performance of the health system are discussed. Salient among them are the System of Social Protection in Health and the Popular Health Insurance. The paper concludes with a brief analysis of the short- and middle-term challenges faced by the Mexican health system.
Richardson, J.; Labbe, M.; Belala, Y.; Leduc, Vincent
The requirement for improving aircraft utilization and responsiveness in airlift operations has been recognized for quite some time by the Canadian Forces. To date, the utilization of scarce airlift resources has been planned mainly through the employment of manpower-intensive manual methods in combination with the expertise of highly qualified personnel. In this paper, we address the problem of facilitating the load planning process for military aircraft cargo planes through the development of a computer-based system. We introduce TALBAS (Transport Aircraft Loading and BAlancing System), a knowledge-based system designed to assist personnel involved in preparing valid load plans for the C130 Hercules aircraft. The main features of this system which are accessible through a convivial graphical user interface, consists of the automatic generation of valid cargo arrangements given a list of items to be transported, the user-definition of load plans and the automatic validation of such load plans.
Wang, Hui; Jiang, Nan; Shao, Sicong; Zheng, Tao; Sun, Jianzhong
The objective of this study is to establish a comprehensive evaluation system for military hospitals' response capacity to bio-terrorism. Literature research and Delphi method were utilized to establish the comprehensive evaluation system for military hospitals' response capacity to bio-terrorism. Questionnaires were designed and used to survey the status quo of 134 military hospitals' response capability to bio-terrorism. Survey indicated that factor analysis method was suitable to for analyzing the comprehensive evaluation system for military hospitals' response capacity to bio-terrorism. The constructed evaluation system was consisted of five first-class and 16 second-class indexes. Among them, medical response factor was considered as the most important factor with weight coefficient of 0.660, followed in turn by the emergency management factor with weight coefficient of 0.109, emergency management consciousness factor with weight coefficient of 0.093, hardware support factor with weight coefficient of 0.078, and improvement factor with weight coefficient of 0.059. The constructed comprehensive assessment model and system are scientific and practical.
Cylus, Jonathan; Richardson, Erica; Findley, Lisa; Longley, Marcus; O'Neill, Ciaran; Steel, David
This analysis of the United Kingdom health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. It provides an overview of how the national health services operate in the four nations that make up the United Kingdom, as responsibility for organizing health financing and services was devolved from 1997. With devolution, the health systems in the United Kingdom have diverged in the details of how services are organized and paid for, but all have maintained national health services which provide universal access to a comprehensive package of services that are mostly free at the point of use. These health services are predominantly financed from general taxation and 83.5% of total health expenditure in the United Kingdom came from public sources in 2013. Life expectancy has increased steadily across the United Kingdom, but health inequalities have proved stubbornly resistant to improvement, and the gap between the most deprived and the most privileged continues to widen, rather than close. The United Kingdom faces challenges going forward, including how to cope with the needs of an ageing population, how to manage populations with poor health behaviours and associated chronic conditions, how to meet patient expectations of access to the latest available medicines and technologies, and how to adapt a system that has limited resources to expand its workforce and infrastructural capacity so it can rise to these challenges.
Centeno, José A.; Rogers, Duane A.; van der Voet, Gijsbert B.; Fornero, Elisa; Zhang, Lingsu; Mullick, Florabel G.; Chapman, Gail D.; Olabisi, Ayodele O.; Wagner, Dean J.; Stojadinovic, Alexander; Potter, Benjamin K.
Background: The majority of modern war wounds are characterized by high-energy blast injuries containing a wide range of retained foreign materials of a metallic or composite nature. Health effects of retained fragments range from local or systemic toxicities to foreign body reactions or malignancies, and dependent on the chemical composition and corrosiveness of the fragments in vivo. Information obtained by chemical analysis of excised fragments can be used to guide clinical decisions regarding the need for fragment removal, to develop therapeutic interventions, and to better anticipate future medical problems from retained fragment related injuries. In response to this need, a new U.S Department of Defense (DoD) directive has been issued requiring characterization of all removed fragments to provide a database of fragment types occurring in combat injuries. Objectives: The objective of this study is to determine the chemical composition of retained embedded fragments removed from injured military personnel, and to relate results to histological findings in tissue adjacent to fragment material. Methods: We describe an approach for the chemical analysis and characterization of retained fragments and adjacent tissues, and include case examples describing fragments containing depleted uranium (DU), tungsten (W), lead (Pb), and non-metal foreign bodies composed of natural and composite materials. Fragments obtained from four patients with penetrating blast wounds to the limbs were studied employing a wide range of chemical and microscopy techniques. Available adjacent tissues from three of the cases were histologically, microscopically, and chemically examined. The physical and compositional properties of the removed foreign material surfaces were examined with energy dispersive x-ray fluorescence spectrometry (EDXRF), scanning electron microscopy (SEM), laser ablation inductively-coupled plasma mass-spectrometry (LA-ICP-MS), and confocal laser Raman
Mattocks, Kristin; Schwarz, Eleanor Bimla; Borrero, Sonya; Skanderson, Melissa; Zephyrin, Laurie; Brandt, Cynthia; Haskell, Sally
Abstract Background: Women Veterans who suffered military sexual trauma (MST) may be at high risk for unintended pregnancy and benefit from contraceptive services. The objective of this study is to compare documented provision of contraceptives to women Veterans using the Department of Veterans Affairs (VA) health system who report or deny MST. Methods: This retrospective cohort study included women Veterans aged 18–45 years who served in Operation Enduring or Iraqi Freedom and had at least one visit to a VA medical center between 2002 and 2010. Data were obtained from VA administrative and clinical databases. Chi-squared tests and logistic regression were conducted to evaluate the association between MST, ascertained by routine clinical screening, and first documented receipt of hormonal or long-acting contraception. Results: Of 68,466 women Veterans, 13% reported, 59% denied and 28% had missing data for the MST screen. Among the entire study cohort, 30% of women had documented receipt of a contraceptive method. Women reporting MST were significantly more likely than those denying MST to receive a method of contraception (adjusted odds ratio [aOR] 1.12, 95% confidence interval [CI] 1.07–1.18) including an intrauterine device (odds ratio [OR] 1.29, 95% CI 1.17–1.41) or contraceptive injection (OR 1.17, 95% CI 1.05–1.29). Women who were younger, unmarried, seen at a women's health clinic, or who had more than one visit were more likely to receive contraception. Conclusions: A minority of women Veterans of reproductive age receive contraceptive services from the VA. Women Veterans who report MST, and particularly those who seek care at VA women's health clinics, are more likely to receive contraception. PMID:24787680
10 4.2.5 Two camera LIDAR ............................................................................................. 11 4.2.6 Dynamic Range and...System UXO Unexploded ordinance VNIR Visible to Near Infrared 1 1.0 Abstract Many active and former military installations have ranges and...features. Because REVEAL is implemented with a range -gated ICMOS (Intensified CMOS) camera , the large array size (1024 x 773) provides detailed
Williams, Stephen J.; Poss, W. Bradley; Cupp, Craig L.
A cooperative educational program with the U.S. military is described to illustrate a unique opportunity that confronted a graduate healthcare management program. The resulting degree program supported the military's operational medical mission but also presented interesting and unexpected challenges resulting from the wars in Iraq and…
the way in performance measurement through the ORYX initiative. The ORYX initiative integrates performance measures with the accreditation Quality in...Additionally, military health care facilities must comply with the JCAHO ORYX initiative, and are incorporating HEDIS measures into various report card...of terms for performance measurement. Retrieved October 5, 2005, from http://www.j caho.org/accredited+organizations/hospitals/ oryx /glossary.htm
however, virtually all requests for early retirement are granted routinely. "The Services have found that approving early (20 years) retirement is...incentive to remain in the service. The immediate benefits payable after 20 years of service and routine approval of all requests for early retirement have...year. Evaluation of Current System Officers and enlisted members of each service were brought under the early retirement umbrella by separate pieces of
González Pier, Eduardo
Health conditions in Mexico have evolved along with socioeconomic conditions. As a result, today's health system faces several problems characterized by four overlapping transitions: demand, expectations, funding and health resources. These transitions engender significant pressures on the system itself. Additionally, fragmentation of the health system creates disparities in access to services and generates problems in terms of efficiency and use of available resources. To address these complications and to improve equity in access and efficiency, thorough analysis is required in how the right to access health care should be established at a constitutional level without differentiating across population groups. This should be followed by careful discussion about what rules of health care financing should exist, which set of interventions ought to be covered and how services must be organized to meet the health needs of the population.
Epley, L.E. )
Accessibility is today's space frontier. Our need for wide-band global communications, earth imaging an sensing, atmospheric measurements and military reconnaissance is endless but growing dependence on space-based systems raises concerns about potential vulnerability. Military commanders want space assets more accessible and under direct local control. As a result, a robust and low cost access to space-like capability has become a national priority. Buoyant vehicles, free floating in the middle stratosphere could provide the kind of cost effective access to space-like capability needed for a verity of missions. These vehicles are inexpensive, invisible and easily launched. Developments in payload electronics, atmospheric wind modeling and materials combined with ever-improving communications and navigation infrastructure are making balloon-borne concepts more attractive. The fundamental question is whether a free floating balloon, used in a pseudo-satellite role, has value in a military system. Flight tests are ongoing under NASA sponsorship. Following these tests NASA intends to use the vehicles for research in the Antarctic. The concept is being reviewed by other agencies interested in stratospheric research. We believe that LDFFF systems have applications in areas of communications, surveillance and other traditional satellite missions. Dialogue with the broader community of space users is needed to expand the applications. This report reviews the status of the recent flight tests and presents an overview of the concept of Long Duration Free Floating Flight for military applications. 12 refs., 13 figs.
Lial, J P
Over a 5 month period (October 1996 to February 1997), a rotating company of 146 servicemen belonging to the Navy Airborne 6th Regiment were assigned along the Maroni River in French Guyana. During this mission, the medical personnel treated 387 local residents. Etiologies comprised 51 malaria attacks including 46 involving Plasmodium falciparum and 4 rattlesnake envenomations. The most common cause of consultation by military personnel was mycotic and staphylococcal skin infections, but 5 cases involving poor acclimatization were treated during the hot and dry season. Seven malaria attacks involving Plasmodium falciparum including 2 that were severe occurred despite prophylaxis using chloroquine-proguanil. Treatment with halofantrine was successful in all but one case which required combined chemotherapy using quinine and doxycycline. Five cases of cutaneous leishmaniasis were observed in subjects involved in jungle training. No case of HIV infection was detected upon returning home since most personnel either followed the recommendation to abstain from sex (51 p. 100) or used a condom (90 p. 100 of personnel who had sexual relations). These data illustrate the health risks for mainland French nationals in the region of the Maroni River and underline the need for preventive measures and education.
Alexa, Jan; Recka, Lukas; Votapkova, Jana; van Ginneken, Ewout; Spranger, Anne; Wittenbecher, Friedrich
This analysis of the Czech health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. The Czech health-care system is based on compulsory statutory health insurance providing virtually universal coverage and a broad range of benefits, and doing so at 7.7 % of GDP in 2012 - well below the EU average - of which a comparatively high 85 % was publicly funded. Some important health indicators are better than the EU averages (such as mortality due to respiratory disease) or even among the best in the world (in terms of infant mortality, for example). On the other hand, mortality rates for diseases of the circulatory system and malignant neoplasms are well above the EU average, as are a range of health-care utilization rates, such as outpatient contacts and average length of stay in acute care hospitals. In short, there is substantial potential in the Czech Republic for efficiency gains and to improve health outcomes. Furthermore, the need for reform in order to financially sustain the system became evident again after the global financial crisis, but there is as yet no consensus about how to achieve this.
Greeley, M.S. Jr.; Adams, S.M.; Hinton, D.E.
Ashumet and Johns Ponds are located adjacent to the Massachusetts Military Reservation (MMR) on Cape Cod, and lie in or near the paths of several plumes of groundwater contamination flowing from the MMR. This study had the objective of documenting the present status of fish in both ponds in efforts to establish base-line conditions for any future biological monitoring activities and to determine whether evidence exists for current contaminant impacts. This objective was addressed through three complimentary approaches, including the determination of Health Assessment Index (HAI) scores for fish sampled from Ashumet and Johns Ponds and several reference ponds in the area, measurement of various biochemical and physiological indicators in fish tissues and fluids and histopathological examinations of fish organs. For each of the three primary fish species examined in this study, largemouth bass, brown bullhead catfish, and yellow perch, many similarities were noted in the physiological, biochemical and histopathological condition of fish in all the study ponds. However, mean HAIs tended to be slightly higher (indicative of poorer health) in Ashumet and Johns Ponds, due in part to pathologies related to a higher incidence of parasitic infection at these sites. The most striking differences between the ponds were very high prevalences of oral and body surface papillomas in brown bullhead catfish from Johns Pond (59%) and Ashumet Pond (34%). Although pesticides, PCBs, and other chemical contaminants were present in fish from all of ponds, there was no obvious relationship between chemical body burdens and the responses of any of the measured indicator parameters, nor was there any conclusive evidence of current impacts on fish from the contaminant plumes.
Patton, Christina L; McNally, Matthew R; Fremouw, William J
Previous studies have implicated significant differences between military members and civilians with regard to violent behavior, including suicide, domestic violence, and harm to others, but none have examined military murder-suicide. This study sought to determine whether there were meaningful differences between military and civilian murder-suicide perpetrators. Using data from the Center for Disease Control's (CDC) National Violent Death Reporting System (NVDRS), military (n = 259) and civilian (n = 259) murder-suicide perpetrators were compared on a number of demographic, psychological, and contextual factors using chi-square analyses. Logistic regression was used to determine which variables predicted membership to the military or civilian perpetrator groups. Military murder-suicide perpetrators were more likely to be older, have physical health problems, be currently or formerly married, less likely to abuse substances, and to exhibit significantly different motives than civilian perpetrators. Logistic regression revealed that membership to the military, rather than the civilian, perpetrator group was predicted by age, physical health problems, and declining heath motive-reflecting the significance of a more than 15-year difference in mean age between the two groups. Findings point to the need to tailor suicide risk assessments to include questions specific to murder-suicide, to assess attitudes toward murder-suicide, and to the importance of assessing suicide and violence risk in older adult military populations.
... Health and Human Services. More Health News on: Gay, Lesbian, Bisexual, and Transgender Health Veterans and Military Health Recent Health News Related MedlinePlus Health Topics Gay, Lesbian, Bisexual, and Transgender Health Veterans and Military ...
MIL -STD-1568, which currently exists as MIL - HDBK -1568. The information in MIL - HDBK -1568 can still be used to develop the tailored DI-MFFP-81403...requiring the delivery of the Contractor CPCP. Further, MIL - HDBK -1568 is for aerospace systems. Consider this when tailoring your Contract Data...Dissimilar Metals. MIL - HDBK -1568, Military Handbook: Materials and Processes for Corrosion Prevention and Control in Aerospace Weapons Systems (18 July
systems and directed efforts to define alternative system cosprae communication systems and configurations and protocols and to compare corporate ... communication systems for many their performance, primarily survivabilitiy and commercial clients. response time. His supervisory responribility Before his
Godfrey, Kathryn M; Mostoufi, Sheeva; Rodgers, Carie; Backhaus, Autumn; Floto, Elizabeth; Pittman, James; Afari, Niloofar
Trauma exposure (TE) and numerous deployments have been associated with negative health outcomes in veterans, many of whom have military sexual trauma (MST) and combat exposure (CE). The aims of this study were to examine the relationships between physical and mental health symptoms with MST and CE and number of deployments. Iraq and Afghanistan veterans at the Veterans Affairs San Diego Healthcare System completed self-report measures for MST, CE, number of deployments, posttraumatic stress disorder (PTSD) symptoms, depression symptoms, alcohol use, somatic symptoms, health functioning, and body mass index (BMI). Regression analyses examined main and interaction effects of CE and MST and the linear and quadratic trends of number of deployments. The sample (N = 1,294) had a mean age of 31 and was 85% male. The MST by CE interaction on BMI was significant (p = .005), such that MST was associated with lower BMI in veterans with CE and with higher BMI in veterans without CE. MST and CE were associated with higher somatic, PTSD, and depression symptoms and with lower mental health functioning (ps < .001 to .002). CE was associated with lower physical health functioning and higher alcohol use (ps < .001 to .025). Number of deployments was linearly related to higher BMI (p = .004) and had a quadratic association with alcohol use (p = .008). Findings highlight the relationship between TE and poor health outcomes and the need to further study the mechanisms of TE on physical and mental health.
contractors manufacture approved ration items for the military- Rations are made from "real foods" (commercially grown and processed). Commercial...brand name foods and military ration items are often very similar. In most cases, the manufacturers prepare the actual food product just as they would for...sweet at altitude, so foods that are too sweet at sea level may taste better at altitude Suggested snacks are raisins and other dried fruits, yogurt
Clark, Leslie L; Daniele, Denise O; O'Donnell, Francis L
This report reviews the incidence of cases of typhoidal and non-typhoidal Salmonella infections based on diagnoses recorded in healthcare records and reported through the Armed Forces reportable medical event (RME) system. During 2000-2013, there were 1,815 incident cases of non-typhoidal Salmonella and 456 incident cases of typhoidal Salmonella diagnosed in the active component force. The crude incidence rate for non-typhoidal Salmonella was 0.91 cases per 10,000 person years (p-yrs) and the rate for typhoidal Salmonella was 0.23 cases per 10,000 p-yrs. Among retirees and family members, children under 5 years of age and those aged 75 years or older comprised the greatest number of non-typhoidal Salmonella cases. Preventive measures for reducing the risk of infection with Salmonella are discussed.
MILITARY FORCES(FOREIGN), *MILITARY PSYCHOLOGY , *TEXTBOOKS, USSR, ORGANIZATIONS, COMBAT READINESS, PSYCHOMOTOR FUNCTION, REASONING, SURVEYS...TRANSLATIONS, MILITARY TRAINING, OFFICER PERSONNEL, PERCEPTION( PSYCHOLOGY ), PERSONALITY, COMMUNISM, INTERPERSONAL RELATIONS, EMOTIONS.
Roach, Dennis Patrick; Delong, Waylon Anthony; White, Scott; Yepez, Esteban; Rackow, Kirk A.; Reedy, Earl David, Jr.
An unavoidable by-product of a metallic structure's use is the appearance of crack, corrosion, erosion and other flaws. Economic barriers to the replacement of these structures have created an aging civil and military infrastructure and placed even greater demands on efficient and safe repair and inspection methods. As a result of Homeland Security issues and these aging infrastructure concerns, increased attention has been focused on the rapid repair and preemptive reinforcement of structures such as buildings and bridges. This Laboratory Directed Research and Development (LDRD) program established the viability of using bonded composite patches to repair metallic structures. High modulus fiber-reinforced polymer (FRP) material may be used in lieu of mechanically fastened metallic patches or welds to reinforce or repair damaged structures. Their use produces a wide array of engineering and economic advantages. Current techniques for strengthening steel structures have several drawbacks including requiring heavy equipment for installation, poor fatigue performance, and the need for ongoing maintenance due to continued corrosion attack or crack growth. The use of bonded composite doublers has the potential to correct the difficulties associated with current repair techniques and the ability to be applied where there are currently no rehabilitation options. Applications include such diverse structures as: buildings, bridges, railroad cars, trucks and other heavy machinery, steel power and communication towers, pipelines, factories, mining equipment, ships, tanks and other military vehicles. This LDRD also proved the concept of a living infrastructure by developing custom sensors and self-healing chemistry and linking this technology with the application of advanced composite materials. Structural Health Monitoring (SHM) systems and mountable, miniature sensors were designed to continuously or periodically assess structural integrity. Such systems are able to detect
International health is still highly dominated by equilibrium approaches. The emergence of systems thinking in international health provides a great avenue to develop innovative health interventions adapted to changing contexts. The public health community, nevertheless, has the responsibility to translate concepts related to systems thinking and complexity into concrete research methods and interventions. One possibility is to consider the properties of systems such as resilience and adaptability as entry points to better understand how health systems react to shocks. PMID:25905481
This report reviews the incidence of illness due to Campylobacter bacteria based on diagnoses recorded in healthcare records and reported through the Armed Forces reportable medical event (RME) system. During 2000-2013, incident cases of Campylobacter infection were diagnosed in 1,393 active component service members, 188 members of the reserve component, and 3,891 retirees and family members. Among members of the active component, incidence rates tended to be higher among females, those aged 40 years or older, members of the Army and Air Force, and offi cers. Incidence rates declined from 2002 through 2007 but have risen steadily since, especially from 2010 through 2013. Among retirees and family members, the highest numbers of cases were diagnosed among those aged 5 years or younger and those aged 75 years or older. Cases identifi ed through RME reports (n=2,938) showed the highest numbers of cases in May-August, especially July, and that cases reported from Fort Shafter, HI, accounted for 20% of all cases. Measures and precautions important in preventing Campylobacter infections as well as other food- and waterborne infections are discussed.
Domínguez-Alonso, Emma; Zacea, Eduardo
This paper describes the health conditions in Cuba and the general characteristics of the Cuban health system, including its structure and coverage, its financial sources, its health expenditure, its physical, material and human resources, and its stewardship functions. It also discusses the increasing importance of its research institutions and the role played by its users in the operation and evaluation of the system. Salient among the social actors involved in the health sector are the Cuban Women Federation and the Committees for the Defense of the Revolution. The paper concludes with the discussion of the most recent innovations implemented in the Cuban health system, including the cardiology networks, the Miracle Mission (Misión Milagro) and the Battle of Ideas (Batalla de Ideas).
Many calls have been made for a systems approach to public health. My response is to offer a methodology for systemic intervention that (1) emphasizes the need to explore stakeholder values and boundaries for analysis, (2) challenges marginalization, and (3) draws upon a wide range of methods (from the systems literature and beyond) to create a flexible and responsive systems practice. I present and discuss several well-tested methods with a view to identifying their potential for supporting systemic intervention for public health. PMID:16449577
degree, especially at the strategic and operational levels. One possible method of improving the DDM skills of CF personnel is the application of ’ systems ... thinking ’, in particular, the possibility that a limited number of recurring patterns (archetypes) can be used to explain all military situations and
stewardship. Units practicing doctrinaire approaches do not reinforce or nest with higher concepts, which are 5Major General (R) Robert H. Scales , “Too...Evaluation Reporting System. The ability for an officer to measure the scale of the system in which they are making decisions is possible through...in the unit system. The distinction of these systems is in their purpose and scale . The individual system is set at a scale that facilitates reason
Bonvecchio, Anabelle; Becerril-Montekio, Victor; Carriedo-Lutzenkirchen, Angela; Landaeta-Jiménez, Maritza
This paper describes the Venezuelan health system, including its structure and coverage, financial sources, human and material resources and its stewardship functions. This system comprises a public and a private sector. The public sector includes the Ministry of Popular Power for Health (MS) and several social security institutions, salient among them the Venezuelan Institute for Social Security (IVSS). The MH is financed with federal, state and county contributions. The IVSS is financed with employer, employee and government contributions. These two agencies provide services in their own facilities. The private sector includes providers offering services on an out-of-pocket basis and private insurance companies. The Venezuelan health system is undergoing a process of reform since the adoption of the 1999 Constitution which calls for the establishment of a national public health system. The reform process is now headed by the Barrio Adentro program.
Ross, Mary Candice
Competencies for military nurses are much broader in scope than their civilian counterparts. Not only must they be proficient at basic nursing skills, but they must also quickly master such military skills as protecting themselves and others during attack or threat of attack, caring for major trauma victims under austere conditions, and preparing such patients for transport through the military system of evacuation. This requires consistent and specialized training. This article describes the competencies necessary for practice by military nurses.
Ledo, Carmen; Soria, René
This paper describes the Bolivian health system, including its structure and organization, its financing sources, its health expenditure, its physical, material and humans resources, its stewardship activities and the its health research institutions. It also discusses the most recent policy innovations developed in Bolivia: the Maternal and Child Universal Insurance, the Program for the Extension of Coverage to Rural Areas, the Family, Community and Inter-Cultural Health Model and the cash-transfer program Juana Azurduy intended to strengthen maternal and child care.
Marasović Šušnjara, Ivana
Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions.
Becerril-Montekio, Víctor; López-Dávila, Luis
This paper describes the health conditions in Guatemala and, in more detail, the characteristics of the Guatemalan health system, including its structure en coverage, its financial sources, the stewardship functions developed by the Ministry of Health, as well as the generation of health information and the development of research activities. It also discusses the recent efforts to extend coverage of essential health services, mostly to poor rural areas.The most recent innovations also discussed in this paper include the Program for the Expansion of Coverage of Essential Services, the Program to Expand Access to Essential Drugs and the agreements between the Ministry of Health and several non-governmental organizations to provide essential services in rural settings.
random lead times and cannibalization R. Zhang NSERC Visiting Fellow A. Ghanmi DRDC – Centre for Operational Research and Analysis Defence Research and...Development Canada Scientific Report DRDC-RDDC-2014-R165 December 2014 Detailed maintenance planning for military systems with random lead times and...the operational level, where cannibalization operations are allowed and repair lead times are random. The study addresses the problem of maintenance
Intelligent Integrated System Health Management (ISHM) is the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system (Management: storage, distribution, sharing, maintenance, processing, reasoning, and presentation). Presentation discusses: (1) ISHM Capability Development. (1a) ISHM Knowledge Model. (1b) Standards for ISHM Implementation. (1c) ISHM Domain Models (ISHM-DM's). (1d) Intelligent Sensors and Components. (2) ISHM in Systems Design, Engineering, and Integration. (3) Intelligent Control for ISHM-Enabled Systems
dentistry or veterinary medicine after 16 October 1950 to register within five days thereafter. 3 in effect the DD Act became a separate draft system with...Physical Medicine and CliP Child Psychiatry Rehabilitation DR Disgnostic Radiology GPM General Preventive Medicine FOP Forensic Pathology PH Public Health N
Bell, David; Estabrook, Polly; Romer, Richard
A system for global inventory control of electronically tagged military hardware is achievable using a LEO satellite constellation. An equipment Tag can communicate directly to the satellite with a power of 5 watts or less at a data rate of 2400 to 50,000 bps. As examples, two proposed commercial LEO systems, IRIDIUM and ORBCOMM, are both capable of providing global coverage but with dramatically different telecom capacities. Investigation of these two LEO systems as applied to the Tag scenario provides insight into satellite design trade-offs, constellation trade-offs and signal dynamics that effect the performance of a satellite-based global inventory control system.
Figueroa, Fernando; Melcher, Kevin
The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. It is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this paper, concepts, procedures, and approaches are presented as a foundation for implementing an intelligent systems ]relevant ISHM capability. The capability stresses integration of DIaK from all elements of a system. Both ground-based (remote) and on-board ISHM capabilities are compared and contrasted. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.
Belevitin, A B; Shelepov, A M; Kriuchkov, O A
E.I.Smirnov's views of the role and place of organizational aspects of the greatest Russian surgeon N.I.Pirogov in development of modern medical supply system are covered on the basis of vast historiographical data. From the perspectives of historism and objectivism a degree of realization Pirogov's ideas during creation of the consistent military-medicine doctrine and organization of medical-evacuational measures during the Great Patriotic War 1941-1945 is analyzed.
Bermúdez-Madriz, Juan Luis; Sáenz, María del Rocío; Muiser, Jorine; Acosta, Mónica
This paper describes the health system of Honduras, including its challenges, structure coverage, sources of financing, resources and stewardship activities. This system counts with a public and a private sector. The public sector includes the Ministry of Health (MH) and the Honduran Social Security Institute (HSSI). The private sector is dominated by a set of providers offering services payed mostly out-of-pocket. The National Health Plan 2010-2014 includes a set of reforms oriented towards the creation of an integrated and plural system headed by the MH in its stewardship role. It also anticipates the creation of a public health insurance for the poor population and the transformation of the HSSI into a public insurance agency which contracts services for its affiliates with public and private providers under a family medicine model.
Kristensen, Pål; Heir, Trond; Herlofsen, Pål H; Langsrud, Øyvind; Weisæth, Lars
We prospectively studied parental mental health after suddenly losing a son in a military training accident. Parents (N = 32) were interviewed at 1, 2 and 23 years after the death of their son. The General Health Questionnaire and Expanded Texas Inventory of Grief were self-reported at 1, 2, 5, and 23 years; the Inventory of Complicated Grief was self-reported at 23 years. We observed a high prevalence of psychiatric disorders at 1- and 2-year follow-ups (57% and 45%, respectively), particularly major depression (43% and 31%, respectively). Only one mental disorder was diagnosed at the 23-year follow-up. Grief and psychological distress were highest at 1- and 2-year follow-ups. Spouses exhibited a high concordance of psychological distress. Mothers reported more intense grief reactions than did fathers. The loss of a son during military service may have a substantial impact on parental mental health particularly during the first 2 years after death. Spouses' grief can be interrelated and may contribute to their psychological distress.
Johnston, David W; Shields, Michael A; Siminski, Peter
This paper estimates the long-term health effects of Vietnam-era military service using Australia's National conscription lotteries for identification. Our primary contribution is the quality and breadth of our health outcomes. We use several administrative sources, containing a near-universe of records on mortality (1994-2011), cancer diagnoses (1982-2008), and emergency hospital presentations (2005-2010). We also analyse a range of self-reported morbidity indicators (2006-2009). We find no significant long-term effects on mortality, cancer or emergency hospital visits. In contrast, we find significant detrimental effects on a number of morbidity measures. Hearing and mental health appear to be particularly affected.
Presented to the Faculty Department of Systems Engineering and Management Graduate School of Engineering and Management Air Force Institute of Technology... Engineering Kerwin Chun Seong Teong, B.Eng (Hons) Major (Military Expert 5), Republic of Singapore Air Force September 2013 DISTRIBUTION...the engine , rotor and gearbox. The HUMS will also include software to handle data processing (diagnostics) and prognostics to enhance overall
Shah, A.; Penswick, L.; Dodson, C.; Roberts, T.
High performance sensors are playing an increasingly important role in all aspects of all critical DoD missions. There is a family of sensors that operate with improved sensitivities if cooled to very low (cryogenic) temperatures. For these sensors, a healthy and reliable mechanical refrigeration system (cryocooler) is required. The ability to accurately predict the "health" or remaining useful life of the cryocooler has significant benefits from the viewpoint of ensuring that mission critical functions can be carried out with a high probability of success. The paper provides an overview and approaches used for the development of a Cryocooler Prognostic Health Management System (CPHMS) capable of assessing the cryocooler "health" from the viewpoint of the level of performance degradation and/or the potential for near term failure. Additionally, it quantifies the reliable remaining useful life of the cryocooler. While the proposed system is focused on the specific application to linear drive cryocoolers, especially for DoD, many of the attributes of the system can be applied to other specialized system hardware in both commercial and U.S. Government agency for situations where it is critical that all aspects of the hardware "health" and "remaining useful life" be fully understood. Several benefits of the health monitoring system are also described in the paper.
Substance Abuse Prevention and Early Intervention 64 Information for Outreach and Prevention Staff 64 Information to Give Families 65 O. Suicide ...Prevention and Intervention 66 DoD/Service-Specific Suicide Prevention Programs 66 Resources for Health Care Providers 67 Non-Military Suicide ... Suicide Prevention Hotline: 800-273-TALK (8255) My HealtheVet My HealtheVet is VHA’s eHealth portal which provides access to trusted
Sanchez-Bocanegra, C L; Sanchez-Laguna, F; Sevillano, J L
People are looking for appropriate health information which they are concerned about. The Internet is a great resource of this kind of information, but we have to be careful if we don't want to get harmful info. Health recommender systems are becoming a new wave for apt health information as systems suggest the best data according to the patients' needs.The main goals of health recommender systems are to retrieve trusted health information from the Internet, to analyse which is suitable for the user profile and select the best that can be recommended, to adapt their selection methods according to the knowledge domain and to learn from the best recommendations.A brief definition of recommender systems will be given and an explanation of how are they incorporated in the health sector. A description of the main elementary recommender methods as well as their most important problems will also be made. And, to finish, the state of the art will be described.
Al-Khashan, Hesham I.; Almulla, Naseem A.; Galil, Siddig A. A.; Rabbulnabi, Ashraf A.; Mishriky, Adel M.
Background and Aim: Health reforms that tend to increase the participation of clients in decision-making requires them to be health-literate; hence, the importance of health education. However, not much research has been done to investigate the differences in health education needs according to demographic characteristics of the clients. The aim of this study was to find out any possible gender differences there may be in health education needs and preferences. Subjects and Methods: This cross-sectional study was conducted at Riyadh Military Hospital, Saudi Arabia, on a convenience sample of adult Saudis attending its clinics. Data was collected from April 2009 to May 2010 using a self-administered questionnaire covering demographic data, history and needs of health education, methods, and preferred educator. Results: Of the 1300 forms distributed, 977 were returned completed (75.2% response). Most men (74.0%) and women (77.9%) had had health education, but more women reported that it had been helpful (P = 0.014). More men mentioned health education needs relating to primary prevention (P = 0.027), and unhealthy practices (P = 0.003), and considered the different language a barrier (P = 0.002) even after adjustment for age and education. The one-to-one method was the most preferred health education method for men (72.7%) and women (67.9%). More women preferred group health education (P = 0.02) after adjustment for age and education. Significantly more men preferred pharmacists and dietitians as health educators. Conclusion: The results point to a few significant differences between men and women regarding their health education needs, barriers, and preferences. These must be taken into consideration when planning health education programs. PMID:23230383
This report summarizes the activities and accomplishments of an US Army technology security project designed to identify and develop effective policy guidelines for militarily critical technologies in specific Army systems and in broad generic technology areas of military interest, Individual systems analyses are documented in separate Weapons Systems Technical Assessments (WSTAs) and the general generic technology areas are evaluated in the Advanced Technology Assessment Reports (ATARs), However, specific details of these assessments are not addressed here, only recommendations regarding aspects of the defined approach, methodology, and format are provided and discussed.
This system is designed to assist diagnosis of the plant health globally. The system is formed by portable plant health measurement devices connected to a diagnosis and analysis center through a flexible information network. A flexible network is formed so that users from the remote areas as well as internet are able to use the system. The hardware and software is designed in an open technology for easier upgrades. Portable plant health measurement instrument is a networkable leaf flash spectrophotometer capable of measuring Qa, Electrochromy, P700, Fluorescence, S Fluorescence, reflectance spectra, temperature, humidity and image of the leaf with GPS information. The network and intelligent user interface options of the system can be used by any commercially or user designed instrument.
FOR MILITARY VEHICLES Stanley Jones, PhD Science Applications International Corporation Evergreen , CO John Mendoza, PhD Science Applications...system and high temperature (HT) cooling system in succession . Ballistic grilles at both the inlet and outlet of the cooling pathway have been...the 20°C evaporator / 70°C condenser case demonstrates the lowest overall metric. This plot demonstrates the importance of reducing the heat
Becerril-Montekio, Víctor; Reyes, Juan de Dios; Manuel, Annick
This paper describes the Chilean health system, including its structure, financing, beneficiaries, and its physical, material and human resources. This system has two sectors, public and private. The public sector comprises all the organisms that constitute the National System of Health Services, which covers 70% of the population, including the rural and urban poor, the low middle-class, the retired, and the self-employed professionals and technicians.The private sector covers 17.5% of the population, mostly the upper middle-class and the high-income population. A small proportion of the population uses private health services and pays for them out-of-pocket. Around l0% of the population is covered by other public agencies, basically the Health Services for the Armed Forces. The system was recently reformed with the establishment of a Universal System of Explicit Entitlements, which operates through a Universal Plan of Explicit Entitlements (AUGE), which guarantees timely access to treatment for 56 health problems, including cancer in children, breast cancer, ischaemic heart disease, HIV/AIDS and diabetes.
breakfast is eaten. This indicates en- listed military are more prone to skip breakfast than compa- rable civilians. 64 TABLE 4.20 Number of Times per...Eating Breakfast .. *....0... ..* . 64 Consumption of Alcoholic Re Beverages ....................... 67 Research Question Two .............. 74 Research...Weight ........................ 94 Hours of Sleep ............ . .......... 95 Eating Breakfast ..................... 95 Alcohol Consumption
Feighner, Brian H; Chrétien, Jean-Paul; Murphy, Sean P; Skora, Joseph F; Coberly, Jacqueline S; Dietz, Jerrold E; Chaffee, Jennifer L; Sikes, Marvin L; Mabee, Mimms J; Russell, Bruce P; Gaydos, Joel C
The Pandemic Influenza Policy Model (PIPM) is a collaborative computer modeling effort between the U.S. Department of Defense (DoD) and the Johns Hopkins University Applied Physics Laboratory. Many helpful computer simulations exist for examining the propagation of pandemic influenza in civilian populations. We believe the mission-oriented nature and structured social composition of military installations may result in pandemic influenza intervention strategies that differ from those recommended for civilian populations. Intervention strategies may differ between military bases because of differences in mission, location, or composition of the population at risk. The PIPM is a web-accessible, user-configurable, installation-specific disease model allowing military planners to evaluate various intervention strategies. Innovations in the PIPM include expanding on the mathematics of prior stochastic models, using military-specific social network epidemiology, utilization of DoD personnel databases to more accurately characterize the population at risk, and the incorporation of possible interventions, e.g., pneumococcal vaccine, not examined in previous models.
This article addresses several issues pertinent to health systems governance for health equity. It argues the importance of health systems using measures of positive health (well-being), discriminating in favour of historically less advantaged groups and weighing the costs of health care against investments in the social determinants of health. It cautions that the concept of governance could weaken the role of government, with disequalizing effects, while emphasizing the importance of two elements of good governance (transparency and participation) in health systems decision-making. It distinguishes between participation as volunteer labour and participation as exercising political rights, and questions the assumption that decentralization in health systems is necessarily empowering. It then identifies five health system roles to address issues of equity (educator/watchdog, resource broker, community developer, partnership developer and advocate/catalyst) and the implications of these roles for practice. Drawing on preliminary findings of a global research project on comprehensive primary health care, it discusses political aspects of progressive health system reform and the implications of equity-focused health system governance on health workers' roles, noting the importance of health workers claiming their identity as citizens. The article concludes with a commentary on the inherently political nature of health reforms based on equity; the necessary confrontation with power relations politics involves; and the health systems governance challenge of managing competing health discourses of efficiency and results-based financing, on the one hand, and equity and citizen empowerment, on the other.
Thomassen, Ådne G; Hystad, Sigurd W; Johnsen, Bjørn Helge; Johnsen, Grethe E; Laberg, Jon C; Eid, Jarle
A large number of studies have shown that hardiness and cohesion are associated with mental health in a military context. However, most of them are presented without controlling for baseline mental health symptoms, which is their most significant source of error. The present study investigates the combined effect of hardiness and cohesion in a prospective design, controlling for baseline levels of symptoms among Norwegian personnel serving in a peacekeeping operation in Kosovo. Multivariate regression analyses were performed in which self-reported mental health complaints were regressed on our explanatory variables. Our findings suggest that both cohesion and hardiness contributed to increased stress resiliency, as measured by a lower level of reported mental health complaints. Our baseline measure of mental health accounted for a larger proportion of the variance than our other predictors. A significant interaction between cohesion and hardiness suggested a combined effect, over and above the individual contributions of the predictors. For individuals who scored high on hardiness, cohesion levels did not influence levels of mental health complaints. Individuals who scored low on hardiness, on the other hand, reported lower levels of mental health complaints when cohesion levels were high.
Zellman, Gail; Gates, Susan M.; Cho, Michelle; Shaw, Rebecca
The evidence presented in this paper questions whether the current U.S. Department of Defense (DoD) system of in-kind subsidies for child care is meeting DoD recruitment, readiness, and retention goals or service member needs in an optimal way. DoD appears to be reaping limited benefits from the substantial subsidies provided to families that use…
Toro-Palacio, Luis Fernando; Ochoa-Jaramillo, Francisco Luis
This article points out the enormous gap that exists between complex thinking of an intellectual nature currently present in our environment, and complex experimental thinking that has facilitated the scientific and technological advances that have radically changed the world. The article suggests that life, human beings, global society, and all that constitutes health be considered as adaptive complex systems. This idea, in turn, prioritizes the adoption of a different approach that seeks to expand understanding. When this rationale is recognized, the principal characteristics and emerging properties of health as an adaptive complex system are sustained, following a care and services delivery model. Finally, some pertinent questions from this perspective are put forward in terms of research, and a series of appraisals are expressed that will hopefully serve to help us understand all that we have become as individuals and as a species. The article proposes that the delivery of health care services be regarded as an adaptive complex system.
status of their network (s). Sensor deployment has begun at Internet access points to monitor and control access and network traffic flow. These...Einstein sensors provide monitoring of network ingress and egress through a system of mostly COTS network monitoring tools driven by the NSA-provided...Situational Awareness Sensor deployment has begun at Internet access points to monitor and control access and network traffic flow. Commercial tools have
users who are joining different networks. The design of SIT  relies on these three pillars: • native IP(v4 and v6) based system: Internet Protocol...provide real time two way communications with another H.323 terminal, GW or MCU . This communication consists of any possible combination of voice...323 terminals based on Open Source applications (open MCU from Openh323 project) modified in order to implement the new SIT services, such as Push
field ration system. MAP technology will be best used for oxygen and moisture control in shelf-stable rations, ethylene absorption in fresh produce and...packaging . To a certain degree foods packaged with absorbing materials for oxygen or moisture are also considered to be modified atmosphere...The gas mixture may change with tire depending on the type of food. Intermediate and high moisture foods must be stored in the refrigerator or freezer
intervention to recommend that actors who work to create positive emergent outcomes should examine patterns of systemic interaction and experiment with...ways of intervening. Then actors should examine the interactions and outcomes to “ improve the chance that they do not pose more dangers or 30...knowledge of the human and the physical terrain of Afghanistan. The process started a yearlong effort to get everybody on the same sheet of music
point scale was developed to assign a subjective value to the the system’s overall performance for each table 2 head- ing. The scale was as follows: O...fairly well with prevent its use in some aircraft and ve - lab tests. hides. All have logistic concerns which must be addressed Cost ranged from $250...and Equipment Ease of Use, Effectiveness, and Compatibility Scale : Very Good Good Fair Poor 4 3 2 1
Hauger, J. S.
The Department of Defense maintains an inventory of over 1,800 MW of engine-generators 15 KW and larger, with an estimated procurement rate of over 140 MW/year. Nearly the entire requirement could be met by advanced heat engines of the types being developed as point-focussing, distributed receiver power plants. A conceptual system consisting of a heat engine which efficiently burns liquid fossil or synthetic fuels, with a 'solarization kit' for conversion to hybrid solar operation could meet existing DOD requirements for new systems which are quieter, lighter, and multi-fueled. An estimated 24 percent (33 MW/year) or more could operationally benefit from the solar option. Baseline cost projections indicate levelized energy cost goals of 210 to 120 mills/KWh (15 to 1000 KW systems). Fuel cost escalation is the major factor affecting the value of the solar option. A baseline calculation for fuel at $0.59/gal in spring, 1979, escalating at 8 percent above general inflation indicates a value of $2700/KWe for a solarization kit.
average length of stay (ALOS) or occupied bed days of about three days (the exact number is 2.975 days...total hospital days or total occupied bed days is 272, divide this by total admissions will yield an average length of stay or average OBD of 2.77...per occupied bed day, $505.69, by the average length of stay , which is 2.975 days. The CHAMPUS cost on Obstetrics care per admission within the
Krewitt, W; Hurley, F; Trukenmüller, A; Friedrich, R
Health risks from fossil, renewable and nuclear reference energy systems are estimated following a detailed impact pathway approach. Using a set of appropriate air quality models and exposure-effect functions derived from the recent epidemiological literature, a methodological framework for risk assessment has been established and consistently applied across the different energy systems, including the analysis of consequences from a major nuclear accident. A wide range of health impacts resulting from increased air pollution and ionizing radiation is quantified, and the transferability of results derived from specific power plants to a more general context is discussed.
Eibert, Max; Scherbarth, Stefan
The paper reports on current advances in the development of the Dornier Obstacle Warning System (OWS) for helicopters, with particular emphasis on the Obstacle Warning Ladar (OWL). Here both segments, development and application of the 1.5 micrometer imaging laser radar (LADAR) will be represented. It will be shown how advances in the eyesafe LADAR technology resulted in Obstacle Warning Ladar optimized for wire detection leading to a system family platform covering the range from the commercial needs up to the military requirements.
Higgins, C W; Philips, B U; Bruhn, J G; Aker, L T
Public Law 93-641 provides health systems agencies (HSAs) with a broad planning preview which has enabled a number of agencies to address environmental health issues in their health systems plans. Opponents of HSA involvement in environmental health planning charge that these activities overextend agency resources, duplicate efforts of other government agencies and involve HSAs in "issues of public policy." Closer examination of these charges finds them lacking in validity. The planning activities of health systems agencies are cooperative in nature, drawing upon the planning efforts of other institutions and agencies. It is illogical to exclude environmental concerns from general health planning in light of the impact of the environment upon health. Charges that issues of public policy are inappropriate topics for health planning are seen as attempts to avoid scrutiny of inconsistant legislative policies. Cooperative planning between health systems agencies and environmental health agencies is considered both desirable and essential for the development of effective health planning. PMID:7428743
Melcher, Kevin J.; Wong, Edmond; Fulton, Christopher E.; Sowers, Thomas S.; Maul, William A.
A document discusses the Portable Health Algorithms Test (PHALT) System, which has been designed as a means for evolving the maturity and credibility of algorithms developed to assess the health of aerospace systems. Comprising an integrated hardware-software environment, the PHALT system allows systems health management algorithms to be developed in a graphical programming environment, to be tested and refined using system simulation or test data playback, and to be evaluated in a real-time hardware-in-the-loop mode with a live test article. The integrated hardware and software development environment provides a seamless transition from algorithm development to real-time implementation. The portability of the hardware makes it quick and easy to transport between test facilities. This hard ware/software architecture is flexible enough to support a variety of diagnostic applications and test hardware, and the GUI-based rapid prototyping capability is sufficient to support development execution, and testing of custom diagnostic algorithms. The PHALT operating system supports execution of diagnostic algorithms under real-time constraints. PHALT can perform real-time capture and playback of test rig data with the ability to augment/ modify the data stream (e.g. inject simulated faults). It performs algorithm testing using a variety of data input sources, including real-time data acquisition, test data playback, and system simulations, and also provides system feedback to evaluate closed-loop diagnostic response and mitigation control.
Montekio, Víctor Becerril; Medina, Guadalupe; Aquino, Rosana
This paper describes the Brazilian health system, which includes a public sector covering almost 75% of the population and an expanding private sector offering health services to the rest of the population. The public sector is organized around the Sistema Único de Saúde (SUS) and it is financed with general taxes and social contributions collected by the three levels of government (federal, state and municipal). SUS provides health care through a decentralized network of clinics, hospitals and other establishments, as well as through contracts with private providers. SUS is also responsible for the coordination of the public sector. The private sector includes a system of insurance schemes known as Supplementary Health which is financed by employers and/or households: group medicine (companies and households), medical cooperatives, the so called Self-Administered Plans (companies) and individual insurance plans.The private sector also includes clinics, hospitals and laboratories offering services on out-of-pocket basis mostly used by the high-income population. This paper also describes the resources of the system, the stewardship activities developed by the Ministry of Health and other actors, and the most recent policy innovations implemented in Brazil, including the programs saúde da Familia and Mais Saúde.
Gore, Rosco; Hulten, Edward; Cheezum, Michael K; Goyal, Manju; Fischer, Collin; Nguyen, Binh; Surry, Luke; Villines, Todd C
We sought to assess the prognostic value of coronary computed tomography angiography (CCTA) among military health care system beneficiaries. We identified 1,125 consecutive symptomatic patients without known coronary artery disease (CAD) referred for 64-slice CCTA (2006-2010) at a single center. CAD was assessed as none, < 50%, or > or = 50% (obstructive) coronary stenosis. A combined endpoint of major adverse events (death, myocardial infarction [MI], coronary revascularization > 90 days after CCTA) was assessed by Kaplan-Meier and Cox proportional hazards. The mean age was 50 +/- 12 years, 59% were male, and 617 (55%) had no CAD, 411 (37%) nonobstructive CAD, and 97 (9%) obstructive CAD on CCTA. During 2.0 +/- 1.1-year follow-up, there were 6 deaths, 3 MIs, and 6 revascularizations. There was 1 event in the no-CAD group (0.08%/year), 4 events in the nonobstructive group (0.5%/year), and 9 events in patients with obstructive CAD (4.5%/year) (p < 0.001). Patients with obstructive CAD had significantly increased combined adverse events. Increasing angina typicality and risk factors (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.05-1.46; p = 0.01) and obstructive CAD (HR 12.1, 95% CI 3.99-36.9; p < 0.001) were independently predictive of events. Absence of CAD was associated with very low event rates, providing military health care system patients and providers confidence in regards to cardiovascular risk, future deployments, and occupational assignments.
Egorysheva, I V
To Kozlov N.I. (1814-1889) belong numerous achievements in the organization of military medical unit during the Crimean (1853-1856) and the Russian-Turkish (1877-1878) wars, the introduction of women's medical education in Russia, establishment of an improvement system for the military doctors, edition for their medical guidelines, the organization of military health care in Russia.
Does the country's national security rely on top-quality early childhood education? Yes, say the military leaders of Mission: Readiness, an organization led by retired military commanders that promotes investment in education, child health, and parenting support. Actually, the generals are right, but for all the wrong reasons. The generals' aim is…
Understanding the state of a polar station's power system can be critical to a successful long-term deployment. Knowing how the system is functioning, prior to service, is key to proper logistics, scheduling and the service performed during a visit. A full record of power system performance is key to proper analysis of the health of the power system. The design of a power system with monitoring is a balance of components to gather information while still trying to keep complexity low. To properly incorporate a system to analyze a stations power system a firm understanding of how the power components function in polar environments as well as communication to data acquisition and / or telemetry is needed. For example designers will need to know how a station's power storage system will change in colder environments then manufactures standard design criteria. This would include the reduced available capacity, change in the mean time between failure and possible new failure modes. This understanding coupled with a system that would collect key information on the state of health of the power system will provide crucial insight in to what service is needed to keep the station functioning.
identify military, civilian, and reservist nurses. Items #86 and 87 (see Appendix C) were changed to address basic nursing education and highest degree...Scavnicky-Mylant, M. (1987). Alcoholism nursing: Toward a policy perspective. Journal of Nursing Education , 266, 294-296. Schwartz, L. S. (1987). Women and...1) 1 (2) 2 (3) 3 .(4) 4 (5) 5 or more _(6) 86. Basic nursing education : Associate degree... (1) Diploma (2) Bachelor’s (3) 87. Highest degree
Williams, Reg Arthur; Gatien, Gary; Hagerty, Bonnie M
A number of factors currently hinder the ability of researchers to conduct military-funded research studies successfully in a timely fashion, including low-risk, psychosocial and behavioral, multisite studies. Our experiences and a review of the literature highlight examples of delays and wide variations in military and civilian Institutional Review Board (IRB) approvals. This article describes the specific experiences from a program of research over a 15-year period, required documents unrelated to protection of human subjects, onsite study principal investigators, examples from other research, and participant recruitment. Concern is raised about significant resources committed to nonstudy interventions, some described as "training," which fall outside of IRB review and its human subject protections. A broad initiative for evidenced-based research, particularly psychosocial and behavioral research, could become marginalized with limited resources redirected to technology-focused quick fixes and data collection during training. Possible solutions and initiatives are proposed that emphasize the need to reform IRB oversight and associated paperwork that is required to undertake military research.
and skills about advance directives have been cited for low completion rates. Family nurse practitioners ( FNPs ), in both civilian and military settings...receive training on ethical and moral implications of advanced nursing practice. These characteristics make the FNP an ideal candidate for promoting...environment (Hunter et al., 1997). Advanced Nursing Role Family nurse practitioners ( FNPs ) are well suited to initiate conversations concerning end-of-life
Figueroa, Fernando; Melcher, Kevin
The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. Management implies storage, distribution, sharing, maintenance, processing, reasoning, and presentation. ISHM is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this chapter, concepts, procedures, and approaches are presented as a foundation for implementing an ISHM capability relevant to intelligent systems. The capability stresses integration of DIaK from all elements of a system, emphasizing an advance toward an on-board, autonomous capability. Both ground-based and on-board ISHM capabilities are addressed. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.
Homoeopathy is a therapy which involves many components and three main agents: the patient, with his or her condition and personal characteristics; the medication used, with its composition and manufacturing procedure; and the physician, with his or her approach to treatment and concepts of health. The development of research and evaluation structures, combined with a critical education in the discipline, would help to improve practices and define homoeopathy's potential role in relation to the other therapies, both conventional and unconventional, used in Western health systems. PMID:10083716
ER D C / CE R L TR -0 9 -2 0 Demonstration of Electronic Capacitor-Based Water Treatment System for Application at Military Installations...Alfred D. Beitelman, M. Michael Pitts Jr. PhD, Rodrigo F. V. Romo, and Carolyn B. Pitts July 2009 C on st ru ct io n E n gi n ee ri n g R...In addition, Oscar Rueda of Davis Monthan AFB, and Bill Stein and Sam Montanez of Fort Huachuca provided excellent base coordination. The Deputy
The US fossil synfuels program may not have significant impact on domestic fuel supplies until near the year 2000, resulting in a continuing mobility fuels vulnerability for the US military until then. But there are other mobility fuel options for both propulsion systems and stationary base-energy sources, for which the base technology is commercially available or at least demonstrated. For example, for surface propulsion systems, hydrogen-fuel-cell/battery-electric hybrids may be considered; for weapons systems these may offer some new flexibilities, standardization possibilities, and multiple military-controlled fuel-supply options. Hydrogen-fueled aircraft may provide interesting longer-term possibilities in terms of military energy self-sufficiency and multiple supply options, as well as performance specifications. These scenarios will be discussed, along with possibilities for demonstrations in the MX-system ground vehicles.
Ibrahim, Jennifer K; Burris, Scott; Hays, Scott
The importance of law in the organization and operation of public health systems has long been a matter of interest to public health lawyers and practitioners, but empirical research on law as a factor in health system performance has been limited in quantity and sophistication. The emergence of Public Health Law Research and Public Health Systems and Services Research within a coordinated effort to strengthen public health research and practice has dramatically changed matters. This article introduces Public Health Law Research as an integral part of Public Health Systems and Services Research, discusses the challenges of integrating the 2 fields, and highlights 2 examples of current research that demonstrate the benefits of an integrated approach to improve the use of law in public health practice.
reporting period. 15. SUBJECT TERMS Mental health literacy , Mental Health First Aid (MHFA), curriculum adaptation 16. SECURITY CLASSIFICATION OF...Stress First Aid and suicide prevention gatekeeper training by providing a mental health literacy component that is currently not addressed
Church, Jared; Verbyla, Matthew E; Lee, Woo Hyoung; Randall, Andrew A; Amundsen, Ted J; Zastrow, Dustin J
As the demand for reliable and safe water supplies increases, both water quality and available quantity are being challenged by population growth and climate change. Greywater reuse is becoming a common practice worldwide; however, in remote locations of limited water supply, such as those encountered in military installations, it is desirable to expand its classification to include dishwashing water to maximize the conservation of fresh water. Given that no standards for dishwashing greywater reuse by the military are currently available, the current study determined a specific set of water quality standards for dishwater recycling systems for U.S. military field operations. A tentative water reuse standard for dishwashing water was developed based on federal and state regulations and guidelines for non-potable water, and the developed standard was cross-evaluated by monitoring water quality data from a full-scale dishwashing water recycling system using an innovative electrocoagulation and ultrafiltration process. Quantitative microbial risk assessment (QMRA) was also performed based on exposure scenarios derived from literature data. As a result, a specific set of dishwashing water reuse standards for field analysis (simple, but accurate) was finalized as follows: turbidity (<1 NTU), Escherichia coli (<50 cfu mL(-1)), and pH (6-9). UV254 was recommended as a surrogate for organic contaminants (e.g., BOD5), but requires further calibration steps for validation. The developed specific water standard is the first for dishwashing water reuse and will be expected to ensure that water quality is safe for field operations, but not so stringent that design complexity, cost, and operational and maintenance requirements will not be feasible for field use. In addition the parameters can be monitored using simple equipment in a field setting with only modest training requirements and real-time or rapid sample turn-around. This standard may prove useful in future development
Runge, Catherine E.; Waller, Michael; MacKenzie, Alison; McGuire, Annabel C. L.
Introduction There are few studies on the experiences of spouses of military members, with most focused on adverse impacts of deployment. Responses to an open-ended question in a survey of spouses' health and wellbeing enabled access to perceptions and insights on a broad range of topics. The objective of this investigation was to examine how respondents used the open-ended question and what they discussed, in aim of informing support service agencies and spouses of military members. Methods Thematic analysis was conducted on responses to the open-ended question. Descriptive analysis was performed on the demographics, military member characteristics and self-reported health of respondents and non-respondents to the open-ended question. Findings Over a quarter (28.5%) of the 1,332 survey participants answered the open-ended question, with respondents having a significantly higher level of education than non–respondents. Respondents expressed negative and positive experiences and insights on military life, provided personal information, commented on the survey, and qualified their responses to closed-ended questions. Topics included ‘inadequate support’, ‘deployment impacts’, ‘suggestions for supporting agencies’, ‘appraisal of experiences’ and ‘coping strategies’. Conclusions This investigation uncovered issues of importance to spouses of military members that were not included or identified in a quantitative study. The findings provide a platform from which to explore these issues further, particularly the impact of military life on the non-serving spouse's career. The findings also provide support agencies with evidence to strengthen their services and they give spouses an opportunity to reflect on their own and others' feelings and evaluations of military life. PMID:25479135
trial to detect intervention effects. 15. SUBJECT TERMS Mental health literacy , Mental Health First Aid (MHFA), curriculum adaptation 16. SECURITY...KEYWORDS: National Guard; Mental Health First Aid; Mental Health Literacy ; Pilot Study; Veterans; Mental Health; Prevention; Access; Stigma OVERALL...gatekeeper training by providing a mental health literacy component that is currently not addressed. Despite the promise of m-MHFA to have substantial
Hooper, Tomoko I; DeBakey, Samar F; Bellis, Kimberly S; Cox, Kenneth L; Gackstetter, Gary D
The Joint Medical Work Station (JMeWS) is a theater medical surveillance system that integrates information from three separate health data collection systems for the Army, Navy, Air Force, and Marines. Our objective was to characterize JMeWS data during its first year of implementation in 2003. We conducted a descriptive analysis of health events documented in JMeWS among military personnel deployed to Operations Enduring Freedom and Iraqi Freedom. Among the 38,498 individuals (7.8%) with a JMeWS record, women, college-educated, older individuals, and Reserve/Guard personnel were over-represented. There was wide variability by service (Air Force, 25%; Army, 5.5%; Marine Corps, 1.2%; and Navy, 0.6%). The most common diagnoses were in the categories of injury and poisoning, respiratory conditions, and musculoskeletal disorders. Differences in distribution of the various patient encounter modules in theater likely resulted in variable data capture across services. System enhancements should improve future applications.
Welsh, Janet A; Olson, Jonathan; Perkins, Daniel F; Travis, Wendy J; Ormsby, LaJuana
This study examined the relations among three different types of naturally occurring social support (from romantic partners, friends and neighbors, and unit leaders) and three indices of service member well-being (self reports of depressive symptoms, satisfaction with military life, and perceptions of unit readiness) for service members who did and did not report negative experiences associated with military deployment. Data were drawn from the 2011 Community Assessment completed anonymously by more than 63,000 USAF personnel. Regression analyses revealed that higher levels of social support was associated with better outcomes regardless of negative deployment experiences. Evidence of moderation was also noted, with all forms of social support moderating the impact of negative deployment experiences on depressive symptoms and support from unit leaders moderating the impact of negative deployment experience on satisfaction with military life. No moderation was found for perceptions of unit readiness. Subgroup analyses revealed slightly different patterns for male and female service members, with support providing fewer moderation effects for women. These findings may have value for military leaders and mental health professionals working to harness the power of naturally occurring relationships to maximize the positive adjustment of service members and their families. Implications for practices related to re-integration of post-deployment military personnel are discussed.
The Professional Health Card Public interest group (Groupement d'Intérêt Public-Carte de professionnel de Santé (GIP-CPS)) was founded in 1993 as a joint initiative by the different parties involved in health care in France: the state, the representatives of the health care professions and the compulsory and complementary health insurance organizations. The CPS system enables safe exchange and electronic sharing of medical data. Via Intranet connections and Extranet hosting of medical files, databases, the CPS system enables health care professionals who access servers to be identified with certainty. For email exhanges, the CPS systems guarantees the sender's identity and capacity. The electronic signature gives legal value to the email. The system also enables confidential email. The health card system (CPS) contributes to making the health service efficient. Shared medical files, health care networks, health warning systems or electronic requests for reimbursement of health insurance expenses all use the CPS system. More than 300,000 health care professionals use it regularly. The freedom of movement of patients throughout Europe has led to the growth of exchanges and information sharing between health professionals in the States of the Union. More and more health professionals will be leaving their own countries to work in foreign countries in the future. It is essential that their freedom of movement is accompanied by the ability to prove their rights to practice.
Belló, Mariana; Becerril-Montekio, Victor M
This paper describes the health system of Argentina.This system has three sectors: public, social security and private.The public sector includes the national and provincial ministries as well as the network of public hospitals and primary health care units which provide care to the poor and uninsured population. This sector is financed with taxes and payments made by social security beneficiaries that use public health care facilities. The social security sector or Obras Sociales (OS) covers all workers of the formal economy and their families. Most OS operate through contracts with private providers and are financed with payroll contributions of employers and employees. Finally, the private sector includes all those private providers offering services to individuals, OS beneficiaries and all those with private health insurance.This sector also includes private insurance agencies called Prepaid Medicine Enterprises, financed mostly through premiums paid by families and/or employers.This paper also discusses some of the recent innovations implemented in Argentina, including the program Remediar.
Kwak, Kiho; Kwak, Dongmin; Yoon, Joohong
A design of an Instantaneous High Power Supply System (IHPSS) with a power distribution management (PDM) for portable military devices is newly addressed. The system includes a power board and a hybrid battery that can not only supply instantaneous high power but also maintain stable operation at critical low temperature (-30 °C). The power leakage and battery overcharge are effectively prevented by the optimal PDM. The performance of the proposed system under the required pulse loads and the operating conditions of a Korean Advanced Combat Rifle employed in the battlefield is modeled with simulations and verified experimentally. The system with the IHPSS charged the fuse setter with 1.7 times higher voltage (8.6 V) than the one without (5.4 V) under the pulse discharging rate (1 A at 0.5 duty, 1 ms) for 500 ms.
Ezzati, Majid; Bailis, Rob; Kammen, Daniel M.; Holloway, Tracey; Price, Lynn; Cifuentes, Luis A.; Barnes, Brendon; Chaurey, Akanksha; Dhanapala, Kiran N.
It is well-documented that energy and energy systems have a central role in social and economic development and human welfare at all scales, from household and community to regional and national (41). Among its various welfare effects, energy is closely linked with people s health. Some of the effects of energy on health and welfare are direct. With abundant energy, more food or more frequent meals can be prepared; food can be refrigerated, increasing the types of food items that are consumed and reducing food contamination; water pumps can provide more water and eliminate the need for water storage leading to contamination or increased exposure to disease vectors such as mosquitoes or snails; water can be disinfected by boiling or using other technologies such as radiation. Other effects of energy on public health are mediated through more proximal determinants of health and disease. Abundant energy can lead to increased irrigation, agricultural productivity, and access to food and nutrition; access to energy can also increase small-scale income generation such as processing of agricultural commodities (e.g., producing refined oil from oil seeds, roasting coffee, drying and preserving fruits and meats) and production of crafts; ability to control lighting and heating allows education or economic activities to be shielded from daily or seasonal environmental constraints such as light, temperature, rainfall, or wind; time and other economic resources spent on collecting and/or transporting fuels can be used for other household needs if access to energy is facilitated; energy availability for transportation increases access to health and education facilities and allow increased economic activity by facilitating the transportation of goods and services to and from markets; energy for telecommunication technology (radio, television, telephone, or internet) provides increased access to information useful for health, education, or economic purposes; provision of energy
AlAteeq, Mohammed; Alrashoud, Abdulaziz M; Khair, Mohammed; Salam, Mahmoud
Background Brief advice on smoking cessation from primary health care (PHC) physicians reduces smoking prevalence. However, few studies have investigated the provision of such advice by PHC physicians providing services to military communities. The aim of this study was to evaluate PHC physicians’ attitudes toward and practice of delivering smoking cessation advice to smokers in a military community in central Saudi Arabia. Methods A self-reported survey of PHC physicians was conducted in 2015 using a previously validated tool. The age, sex, educational level, job title, experience and previous smoking cessation training of each physician was recorded. Attitude (ten statements) and practice (six statements) were evaluated on a five-point Likert scale. Scoring system was applied and percentage mean scores (PMS) were calculated. Descriptive/statistical analyses were applied to identify factors that were significantly associated with a positive attitude and favorable practice (PMS >65 each). P-values <0.05 were considered to be significant. Results Response rate was 73/150 (48.6%), of which equal sex distribution (52%:48%) was observed, with a mean age of 35.3±9.6 years. General practitioners constituted 71.4%, followed by consultants (17.9%) and specialists (10.7%). Those with a postgraduate education formed 49.3%, while experience averaged 9.5±9.2 years. Approximately 56% had not attended a smoking cessation educational program in the previous year. Approximately 75% of physicians had a positive attitude (PMS =72.4±11.2), while 64.4% reported favorable practice (PMS =65.3±27.7). Higher education levels were significantly more associated with positive attitude than lower education levels (adj. odds ratio [OR] 95% confidence interval [CI] =17.9 [1.3–242.3]; adj. P=0.03). More experienced physicians (adj. OR [95% CI] =9.5 [1.6–54.6]) and those with positive attitude (adj. OR [95% CI] =6.1 [1.6–23.3]) were more likely to report a favorable practice, compared
Morlan, John E.; Lu, Mei-Yan
To determine whether professionals in business, industry, health professions, agencies, and the military are receiving the training they need to work as instructional designers and trainers, a 54-item survey was prepared based on competencies perceived necessary by a group of university professors. Items ranged from basic demographic data to the…
place to the base unit (consultation site). The transmission is performed through GSM, Satellite links or POTS . Using this device a specialist...standardized medical protocol. Keywords – Emergency Health Care Telemedicine, GSM, Satellite, POTS I. INTRODUCTION The availability of prompt and expert...of communication means (Satellite, GSM and Plain Old Telephony System - POTS ). The base unit is comprised of a set of user-friendly software
Bergeron, Michael F; Nindl, Bradley C; Deuster, Patricia A; Baumgartner, Neal; Kane, Shawn F; Kraemer, William J; Sexauer, Lisa R; Thompson, Walter R; O'Connor, Francis G
A potential emerging problem associated with increasingly popularized extreme conditioning programs (ECPs) has been identified by the military and civilian communities. That is, there is an apparent disproportionate musculoskeletal injury risk from these demanding programs, particularly for novice participants, resulting in lost duty time, medical treatment, and extensive rehabilitation. This is a significant and costly concern for the military with regard to effectively maintaining operational readiness of the Force. While there are certain recognized positive aspects of ECPs that address a perceived and/or actual unfulfilled conditioning need for many individuals and military units, these programs have limitations and should be considered carefully. Moreover, certain distinctive characteristics of ECPs appear to violate recognized accepted standards for safely and appropriately developing muscular fitness and are not uniformly aligned with established and accepted training doctrine. Accordingly, practical solutions to improve ECP prescription and implementation and reduce injury risk are of paramount importance.
Programs . . . . . . . . . . . . 11 Incidence Data . . . . . . . 11 Benefits of Health Promotion Programs . . . . . 12 DOD Health Promotion Efforts .. 14...considering such a move (21:85). Benefits of Health Promotion Programs. The benefits of having health promotion programs extend to both 12 %w the employer and
Pons, F; Rigal, S; Dupeyron, C; de Saint-Julien, J
The military health service provided a surgery antenna during the two months of the Turquoise operation in Zaire and Rwanda. During this period, the antenna functioned as a back-up station for the French troop and the local populations subjected to various conditions: Rwanda refugees who had escaped the massacres, subjects wounded by canon shots, war wounds, surgery emergencies in the refugee population. There were 315 operations performed including 33% in children and 70% for lesions of the limbs. The activity during the mission was analyzed on the basis of strategy for surgical diagnosis and treatment under local conditions (lack of complementary examinations, limited number of personnel, disrupted families in the refugee population, no possibility for transfer, major cholera and dysentery epidemic...).
Sekretaryova, Alina N; Eriksson, Mats; Turner, Anthony P F
We present a brief overview of bioelectrocatalytic devices for in vitro health applications, including food safety and environmental analysis, focusing on microelectrode- and microfluidic-based biosensors, paper-based point-of-care devices and wearable biosensors. The main hurdles and future perspectives are discussed. We then consider the role of electron transfer between a biocatalyst and an electrode in biosensor design. Brief descriptions of indirect, direct and mediated mechanisms are given. The principal strategies, as well as recent developments for modulation of electron transfer in biocatalytic systems are summarised. In conclusion, we highlight some of the challenges associated with improving these redox systems.
Frilander, Heikki; Lallukka, Tea; Viikari-Juntura, Eira; Heliövaara, Markku; Solovieva, Svetlana
Disability retirement causes a significant burden on the society and affects the well-being of individuals. Early health problems as determinants of disability retirement have received little attention. The objective was to study, whether interrupting compulsory military service is an early indicator of disability retirement among Finnish men and whether seeking medical advice during military service increases the risk of all-cause disability retirement and disability retirement due to mental disorders and musculoskeletal diseases. We also looked at secular trends in these associations. We examined a nationally representative sample of 2069 men, who had entered military service during 1967–1996. We linked military service health records with cause-specific register data on disability retirement from 1968 to 2008. Secular trends were explored in three service time strata. We used the Cox regression model to estimate proportional hazard ratios and their 95% confidence intervals. During the follow-up time altogether 140 (6.8%) men retired due to disability, mental disorders being the most common cause. The men who interrupted service had a remarkably higher cumulative incidence of disability retirement (18.9%). The associations between seeking medical advice during military service and all-cause disability retirement were similar across the three service time cohorts (overall hazard ratio 1.40 per one standard deviation of the number of visits; 95% confidence interval 1.26–1.56). Visits due to mental problems predicted disability retirement due to mental disorders in the men who served between 1987 and 1996 and a tendency for a similar cause-specific association was seen for musculoskeletal diseases in the men who served in 1967–1976. In conclusion, health problems—in particular mental problems—during late adolescence are strong determinants of disability retirement. Call-up examinations and military service provide access to the entire age cohort of men
Gill, Jessica; Lee, Hyunhwa; Barr, Taura; Baxter, Tristin; Heinzelmann, Morgan; Rak, Hannah; Mysliwiec, Vincent
Military personnel who have combat exposures are at increased risk for the service-related disorders of post-traumatic stress disorder (PTSD), depression, sleep disturbances and decreased health related quality of life (HRQOL). Those with a traumatic brain injury (TBI) are at even greater risk. Inflammation is associated with these disorders and may underlie the risk for health declines. We evaluated 110 recently deployed, military personnel presenting with sleep disturbances for service-related disorders (TBI, PTSD, and depression) as well as HRQOL. ANOVA models were used to examine differences among military personnel with two or more service-related disorders (high comorbid group), or one or no disorders (low comorbid group). Logistic regression models were used to determine associations among interleukin-6 (IL-6) to HRQOL and service-related disorders. Approximately one-third of the sample had two or more service-related disorders. HRQOL was lower and IL-6 concentrations were higher in military personnel with PTSD or depression, with the most profound differences in those with more service-related disorders, regardless of sleep disorder. Having symptoms of depression and PTSD resulted in a 3.5-fold risk to be in the lower quartile of HRQOL and the highest quartile of IL-6. In a linear regression model, 41% of the relationship between HRQOL and IL-6 concentrations was mediated by PTSD and depression. Military personnel with PTSD and depression are at high risk for lower HRQOL, and higher IL-6 concentrations. Comprehensive treatment is required to address co-occurring service-related disorders in military personnel to promote health and well-being.
0Michael Zubkoff and David Dunlop, " Consumer Behavior in Preventive Health Services," in Consumer Incentives for Health Care, ed. Selma J. Mushkin (New...78 Sorkin, Alan L. Health Economics. Lexington, Mass.: D.C. Heath, 1975. Zubkoff, Michael, and Dunlop, David. " Consumer Behavior in Preventive Health
Blasko, Kelly A
Military children often present with psychological health concerns related to their experience of deployments, reintegration, and frequent moves common in military life. MilitaryKidsConnect is a Department of Defense (DoD) Web site designed to enhance the coping of military children in the context of their military life experience. The purpose of this paper is to describe the development of the Web site as a resource that provides psychoeducation, coping strategies, and peer support to military children.
Maul, William A.; Kopasakis, George; Santi, Louis M.; Sowers, Thomas S.; Chicatelli, Amy
Aerospace systems are developed similarly to other large-scale systems through a series of reviews, where designs are modified as system requirements are refined. For space-based systems few are built and placed into service these research vehicles have limited historical experience to draw from and formidable reliability and safety requirements, due to the remote and severe environment of space. Aeronautical systems have similar reliability and safety requirements, and while these systems may have historical information to access, commercial and military systems require longevity under a range of operational conditions and applied loads. Historically, the design of aerospace systems, particularly the selection of sensors, is based on the requirements for control and performance rather than on health assessment needs. Furthermore, the safety and reliability requirements are met through sensor suite augmentation in an ad hoc, heuristic manner, rather than any systematic approach. A review of the current sensor selection practice within and outside of the aerospace community was conducted and a sensor selection architecture is proposed that will provide a justifiable, defendable sensor suite to address system health assessment requirements.
Maul, William A.; Kopasakis, George; Santi, Louis M.; Sowers, Thomas S.; Chicatelli, Amy
Aerospace systems are developed similarly to other large-scale systems through a series of reviews, where designs are modified as system requirements are refined. For space-based systems few are built and placed into service. These research vehicles have limited historical experience to draw from and formidable reliability and safety requirements, due to the remote and severe environment of space. Aeronautical systems have similar reliability and safety requirements, and while these systems may have historical information to access, commercial and military systems require longevity under a range of operational conditions and applied loads. Historically, the design of aerospace systems, particularly the selection of sensors, is based on the requirements for control and performance rather than on health assessment needs. Furthermore, the safety and reliability requirements are met through sensor suite augmentation in an ad hoc, heuristic manner, rather than any systematic approach. A review of the current sensor selection practice within and outside of the aerospace community was conducted and a sensor selection architecture is proposed that will provide a justifiable, dependable sensor suite to address system health assessment requirements.
Nguyen, Binh N.
The Choctaw Tribe is the first and only tribe to develop a health delivery system to take over an existing Indian Health Service inpatient facility. The takeover was accomplished in January 1984 under the Indian Self-Determination Act through a contract with the Indian Health Service. The Choctaw Health Delivery System includes a 35-bed general…
Lane, Marian E.; Hourani, Laurel L.; Bray, Robert M.; Williams, Jason
Objectives. We examined stress levels and other indicators of mental health in reservists and active-duty military personnel by deployment status. Methods. We used data from the Department of Defense Health-Related Behaviors surveys, which collect comprehensive, population-based data for reserve and active-duty forces. Data were collected from 18 342 reservists and 16 146 active-duty personnel. Results. Overall, with adjustment for sociodemographic and service differences, reservists reported similar or less work and family stress, depression, and anxiety symptoms than did active-duty personnel. However, reservists who had been deployed reported higher rates of suicidal ideation and attempts than did active-duty personnel who had been deployed and higher rates of post-traumatic stress disorder symptomatology than did any active-duty personnel and reservists who had not been deployed. The highest rates of suicidal ideation and attempts were among reservists who had served in theaters other than Iraq and Afghanistan. Conclusions. Our results suggest that deployment has a greater impact on reservists than on active-duty members, thus highlighting the urgent need for services addressing reservists’ unique postdeployment mental health issues. Also, deployment to any theater, not only Iraq or Afghanistan, represents unique threats to all service members’ mental well-being. PMID:22571709
Health Questionnaire. JAMA 1999;282: 1737–44. 30 Ware JE Jr. SF - 36 health survey update . Spine 2000;25: 3130–39. 31...Outcomes Study Short Form 36 -Item Health Survey for Veterans.30 Broad comparison between the GHQ and PHQ may be pos- sible28 via comparison of baseline...administered Primary Care Evalua- tion of Mental Disorders, PRIME-MD)29 Medical Outcomes Study Short Form 36 -Item Health Survey for Veterans30 BMI
Payne, Samuel E; Hill, Jeffrey V; Johnson, David E
Military mental health care professionals have, for decades, recommended that commanders implement a unit watch (now called a "command interest profile" at most Army posts) as a tool for enhancing the safety of personnel in the unit when a soldier presents with suicidal or homicidal ideation. Although these procedures are used extensively in garrison and in operational settings, there exists no specific body of literature or Army publication to offer either a rationale or a set of guidelines for their use. We have successfully used unit watch protocols for years both in the deployment setting and in garrison. This article provides both a rationale and a set of guidelines for their use based on fundamental military psychiatric principles, review of the relevant literature, and anecdotal experience with this intervention. Although further research is indicated, this article provides support for the use of unit watch in military settings.
Dezaire, J. P.
The project A90KM616, Orientatie SATCOM, is being performed on behalf of the Royal Netherlands Navy (RNLN) to assist the Navy on the subject of satellite communications. An overview is given of the phenomenon satellite communication. The result is a general overview of satellite communications for both civil and military applications. Some examples of applications are; international telephony, television broadcasting, small private business networks, and mobile (at the moment still principally maritime) communications. In these applications satellite communication systems provide a global coverage and a high flexibility. The scientific articles have not been considered because in this stage it was the intention to study on a specialist level the broad area of techniques. Magazines, books, and a number of reports of universities and research institutes have been the main sources of information. They provided afforded an understanding of the existing systems and insight in the future developments.
Beardslee, William R; Klosinski, Lee E; Saltzman, William; Mogil, Catherine; Pangelinan, Susan; McKnight, Carl P; Lester, Patricia
In response to the needs of military families confronting the challenges of prolonged war, we developed Families OverComing Under Stress (FOCUS), a multi-session intervention for families facing multiple deployments and combat stress injuries adapted from existing evidence-based family prevention interventions (Lester et al. in Mil Med 176(1): 19-25, 2011). In an implementation of this intervention contracted by the US Navy Bureau of Medicine and Surgery (BUMED), FOCUS teams were deployed to military bases in the United States and the Pacific Rim to deliver a suite of family-centered preventive services based on the FOCUS model (Beardslee et al. in Prev Sci 12(4): 339-348, 2011). Given the number of families affected by wartime service and the changing circumstances they faced in active duty and veteran settings, it rapidly became evident that adaptations of this approach for families in other contexts were needed. We identified the core elements of FOCUS that are essential across all adaptations: (1) Family Psychological Health Check-in; (2) family-specific psychoeducation; (3) family narrative timeline; and (4) family-level resilience skills (e.g., problem solving). In this report, we describe the iterative process of adapting the intervention for different groups of families: wounded, ill, and injured warriors, families with young children, couples, and parents. We also describe the process of adopting this intervention for use in different ecological contexts to serve National Guard, Reserve and veterans, and utilization of technology-enhanced platforms to reach geographically dispersed families. We highlight the lessons learned when faced with the need to rapidly deploy interventions, adapt them to the changing, growing needs of families under real-world circumstances, and conduct rigorous evaluation procedures when long-term, randomized trial designs are not feasible to meet an emergent public health need.
Rathe, Magdalena; Moliné, Alejandro
This paper describes the health conditions in Dominican Republic and the characteristics of the Dominican health system, including its structure and coverage, its financial sources, the health expenditure, the physical, material and human resources available, the stewardship functions developed by the Ministry of Public Health and the generation of health information. The participation of health care users in the operation and evaluation of the system and the most recent policy innovations, including the new General Health Law, the new Social Security Law and the Decennial Health Plan are also discussed.
Acosta, Mónica; Sáenz, María del Rocío; Gutiérrez, Blanca; Bermúdez, Juan Luis
This paper describes the health conditions in El Salvador and the main característics of the Salvadoran health system, including its structure and coverage, its financial sources, the physical, material and human resources available, the stewardship functions developed by the Ministry of Public Health, and the participation of health care users in the evaluation of the system. It also discusses the most recent policy innovations including the approval of the Law for the Creation of the National Health System, which intends to expand coverage, reduce health inequalities and improve the coordination of public health institutions.
1998;4(2):211–9. 16.Smith TC, Gray GC, Knoke JD. Is systemic lupus erythematosus , amyotrophic lateral sclerosis, or fibromyalgia associated with Per... systematic surveillance of DoD family births. These projects will enable the US military to better assess reproductive health outcomes in the military and may
Zhou, Wei; Xiao, Shuiyuan
Mental health is a challenging public health issue worldwide and surveillance is crucial for it. However, mental health surveillance has not been developed until recently in certain developed countries; many other countries, especially developing countries, have poor or even no health information systems. This paper presents surveillance related to mental health in China, a developing country with a large population of patients with mental disorders. Detailed information of seven relevant surveillance systems is introduced respectively. From the perspective of utilization, problems including accessibility, comprehensiveness and data quality are discussed. Suggestions for future development are proposed.
Bryan, Craig J; Jennings, Keith W; Jobes, David A; Bradley, John C
The continual rise in the U.S. military's suicide rate since 2004 is one of the most vexing issues currently facing military leaders, mental health professionals, and suicide experts. Despite considerable efforts to address this problem, however, suicide rates have not decreased. The authors consider possible reasons for this frustrating reality, and question common assumptions and approaches to military suicide prevention. They further argue that suicide prevention efforts that more explicitly embrace the military culture and implement evidence-based strategies across the full spectrum of prevention and treatment could improve success. Several recommendations for augmenting current efforts to prevent military suicide are proposed.
McGuire, Annabel C L; Kanesarajah, Jeeva; Runge, Catherine E; Ireland, Renee; Waller, Michael; Dobson, Annette J
This study explored the impact of multiple deployments on the health and well-being of the partners (married or de facto) and children of Australian military personnel who have deployed frequently. Permission to contact military partners was sought from a sample of Australian Defence Force (ADF) members. Partners provided data on deployment history, physical health, mental health, and their children's emotions, and behaviors. Associations between multiple deployments and health and well-being of partners and children were assessed using logistic regression. Data were collected from 1,332 Australian Defence Force partners (response rate 36%) with 1,095 children aged between 4 and 17 years. Almost half (47%) of partners had experienced more than one deployment, mainly to Timor-Leste, Iraq, and Afghanistan. There was little evidence of associations between numbers of deployments and the health of the partner. In contrast, more behavioral problems were reported for children who experienced two or more deployments with odds ratios generally greater than 2 and significant trends with increasing numbers of deployment. Although military families who experience multiple deployments may, by selection, be more resilient than those who have fewer deployments, these results suggest that adverse impacts on the children may accrue with increasing parental absences because of deployment.
Huang, Philip M.; Knuth, Andrew A.; Krueger, Robert O.; Garrison-Darrin, Margaret A.
The Multi Mission Bus Demonstrator (MBD) is a successful demonstration of agile program management and system engineering in a high risk technology application where utilizing and implementing new, untraditional development strategies were necessary. MBD produced two fully functioning spacecraft for a military/DOD application in a record breaking time frame and at dramatically reduced costs. This paper discloses the adaptation and application of concepts developed in agile software engineering to hardware product and system development for critical military applications. This challenging spacecraft did not use existing key technology (heritage hardware) and created a large paradigm shift from traditional spacecraft development. The insertion of new technologies and methods in space hardware has long been a problem due to long build times, the desire to use heritage hardware, and lack of effective process. The role of momentum in the innovative process can be exploited to tackle ongoing technology disruptions and allowing risk interactions to be mitigated in a disciplined manner. Examples of how these concepts were used during the MBD program will be delineated. Maintaining project momentum was essential to assess the constant non recurring technological challenges which needed to be retired rapidly from the engineering risk liens. Development never slowed due to tactical assessment of the hardware with the adoption of the SCRUM technique. We adapted this concept as a representation of mitigation of technical risk while allowing for design freeze later in the program's development cycle. By using Agile Systems Engineering and Management techniques which enabled decisive action, the product development momentum effectively was used to produce two novel space vehicles in a fraction of time with dramatically reduced cost.
Zakurdaev, V V; Rezvantsev, M V
Health authorities and executives of medical organisations focused on improvement of quality index and access to health care in the process of realisation of the state policy of the Russian Federation in the healthcare field. But the figures currently used and recorded on the official statistical books don't allow to make an objective evaluation of the health status of the population and therefore to evaluate an effectiveness of medical arrangements. Thereby it is necessary to find new indicators for objective individual and public health evaluation. Performed comparative-analytical study of currently used methods and figures for public health evaluation showed that the integral health indicators obtained by the evaluation of heart rate variability are the most efficient.
In this article, the author suggests that if there is one thing that can be said about nontraditional superintendents--the men and women of business, government and the military who leave those fields to become school system leaders--it is that they never take the easy job. "School districts tend to look outside for a superintendent only when…
Ohio State Univ., Columbus. National Center for Research in Vocational Education.
This publication contains a teaching guide and student instructional materials for conducting a high school or adult vocational education course to train persons to perform duties as an aircraft environmental systems mechanic. Course content has been adapted from a military course. The instructional design for this course is self-paced and/or…
Bara, Debra; McPhillips-Tangum, Carol; Wild, Ellen L; Mann, Marie Y
Public health agencies at state and local levels are integrating information systems to improve health outcomes for children. An assessment was conducted to describe the extent to which public health agencies are currently integrating child health information systems (CHIS). Using online technology information was collected, to assess completed and planned activities related to integration of CHIS, maturity of these systems, and factors that influence decisions by public health agencies to pursue integration activities. Of the 39 public health agencies that participated, 18 (46%) reported already integrating some or all of their CHIS, and 13 (33%) reported to be planning to integrate during the next 3 years. Information systems most commonly integrated include Early Hearing Detection and Intervention (EHDI), immunization, vital records, and Newborn Dried Bloodspot Screening (NDBS). Given the high priority that has been placed on using technology to improve health status in the United States, the emphasis on expanding the capability for the electronic exchange of health information, and federal support for electronic health records by 2014, public health agencies should be encouraged and supported in their efforts to develop, implement, and maintain integrated CHIS to facilitate the electronic exchange of health information with the clinical healthcare sector.
Sen, Gita; Govender, Veloshnee
Sexual and reproductive health and rights (SRHR) are centrally important to health. However, there have been significant shortcomings in implementing SRHR to date. In the context of health systems reform and universal health coverage/care (UHC), this paper explores the following questions. What do these changes in health systems thinking mean for SRHR and gender equity in health in the context of renewed calls for increased investments in the health of women and girls? Can SRHR be integrated usefully into the call for UHC, and if so how? Can health systems reforms address the continuing sexual and reproductive ill health and violations of sexual and reproductive rights (SRR)? Conversely, can the attention to individual human rights that is intrinsic to the SRHR agenda and its continuing concerns about equality, quality and accountability provide impetus for strengthening the health system? The paper argues that achieving equity on the UHC path will require a combination of system improvements and services that benefit all, together with special attention to those whose needs are great and who are likely to fall behind in the politics of choice and voice (i.e., progressive universalism paying particular attention to gender inequalities). PMID:25536851
Enns, Russell; Mossman, David C.
In the face of shrinking defense budgets, survival of the United States rotorcraft industry is becoming increasingly dependent on increased sales in a highly competitive civil helicopter market. As a result, only the most competitive rotorcraft manufacturers are likely to survive. A key ingredient in improving our competitive position is the ability to produce more versatile, high performance, high quality, and low cost of ownership helicopters. Fiber optic technology offers a path of achieving these objectives. Also, adopting common components and architectures for different helicopter models (while maintaining each models' uniqueness) will further decrease design and production costs. Funds saved (or generated) by exploiting this commonality can be applied to R&D used to further improve the product. In this paper, we define a fiber optics based avionics architecture which provides the pilot a fly-by-light / digital flight control system which can be implemented in both civilian and military helicopters. We then discuss the advantages of such an architecture.
This report results from a contract tasking OPTOPAL Panoramic Metrology Consulting as follows: This investigation will consist of adaptation of a Hungarian-developed single-piece imaging block, the Panoramic Annular Lens (PAL) and the CNN chip for a few military applications. A polar beam splitter will be placed immediately after the relay lens to obtain two image planes, one will be used by the existing 64X64 CNN-UM focal plane array processor chip. The other image plane will be projected on the space-variant CMOS retina-like digital camera GIOTTO. Using this configuration enables us to compensate for the relatively low pixel number of the CNN-UM array processor; further it will allow a real time switching from log-polar imaging to regular imaging and allow for the design of the humanoid PAL optical system.
Cieslak, Roman; Anderson, Valerie; Bock, Judith; Moore, Bret A; Peterson, Alan L; Benight, Charles C
Our research assessed the prevalence of secondary traumatic stress (STS) among mental health providers working with military patients. We also investigated personal, work-related, and exposure-related correlates of STS. Finally, using meta-analysis, the mean level of STS symptoms in this population was compared with the mean level of these symptoms in other groups. Participants (N = 224) completed measures of indirect exposure to trauma (i.e., diversity, volume, frequency, ratio), appraisal of secondary exposure impact, direct exposure to trauma, STS, and work characteristics. The prevalence of STS was 19.2%. Personal history of trauma, complaints about having too many patients, and more negative appraisals of the impact caused by an indirect exposure to trauma were associated with higher frequency of STS symptoms. A meta-analysis showed that the severity of intrusion, avoidance, and arousal symptoms of STS was similar across various groups of professionals indirectly exposed to trauma (e.g., mental health providers, rescue workers, social workers).
The economic and social crises affecting Latin America have had a profound social and political effect on its structures. This paper analyzes this impact from 2 perspectives: 1) the impact on the apparatus of the state, in particular on its health infra-structures; and 2) the direction of the democratic process in the continent and the participatory processes of civil societies. The institutionalization of the Local Health Systems (SILOS) is an effort to analyze the problem from within the health sector and propose solutions. This paper discusses the issues of human resource development in health systems; training in human resource development and human resource development in local health care systems. There are 3 strategies used to change health systems: 1) The judicial-political system: The state's apparatus 2) The political-administrative system: the national health care system; and 3) the political-operative system: local health care systems. To assure implementation of SILOS there are 4 steps to be followed: 1) create political conditions that allow the transformation and development of local health systems; 2) development of high-level institutional and political initiatives to develop health care networks; 3) offer key players institutional space and social action to develop the SILOS process; 4) rapidly develop SILOS in regions to assure its integration with other development efforts. The labor force in the health sector and organized communities play critical roles in proposing and institutionalizing health programs.
Today's students can come from a larger area than just high school. With the entire world's conflicts and today's society, more and more of our present day students may have come from the military ranks. Though we have not come to an actual draft system, more and more modern day students have served their time in the military, to keep America…
Millegan, Jeffrey; Wang, Lawrence; LeardMann, Cynthia A; Miletich, Derek; Street, Amy E
Although absolute counts of U.S. service men who experience sexual trauma are comparable to service women, little is known about the impact of sexual trauma on men. The association of recent sexual trauma (last 3 years) with health and occupational outcomes was investigated using longitudinal data (2004-2013) from the Millennium Cohort Study. Of 37,711 service men, 391 (1.0%) reported recent sexual harassment and 76 (0.2%) sexual assault. In multivariable models, sexual harassment or assault, respectively, was associated with poorer mental health: AOR = 1.60, 95% CI [1.22, 2.12], AOR = 4.39, 95% CI [2.40, 8.05]; posttraumatic stress disorder: AOR = 2.50, 95% CI [1.87, 3.33], AOR = 6.63, 95% CI [3.65, 12.06]; depression: AOR = 2.37, 95% CI [1.69, 3.33], AOR = 5.60, 95% CI [2.83, 11.09]; and multiple physical symptoms: AOR = 2.22, 95% CI [1.69, 2.92]; AOR = 3.57, 95% CI [1.98, 6.42], after adjustment for relevant covariates. Sexual harassment was also associated with poorer physical health: AOR = 1.68, 95% CI [1.27, 2.22]. Men who reported sexual trauma were more likely to have left military service: AOR = 1.60, 95% CI [1.14, 2.24], and be disabled/unemployed postservice: AOR = 1.76, 95% CI [1.02, 3.02]. Results suggest that sexual trauma was significantly associated with adverse health and functionality extending to postmilitary life. Findings support the need for developing better prevention strategies and services to reduce the burden of sexual trauma on service men.
less, some college or a bachelor’s degree, more than a bachelor’s degree), marital status (married, never married, divorced/ other), pay grade ...Smith TC, Ritchie EC, Brix KA, Romano J. PTSD Prevalence, Exposure, and Health 101 Public Health Reports / January–February 2009 / Volume 124
Christmas, William A.
Over the past 70 years a legend has evolved that the first college health program in the United States was established at Amherst College in 1861. Although the program at Amherst was innovative in its day and served as a model for the field of college health, several other institutions prior to 1860 appropriated funds, hired staff, and established…
Qouta, Samir; Punamaki, Raija-Leena; El Sarraj, Eyad
The article reviews developmental research among Palestinians living in Gaza. The aims are, first, to analyze how exposure to traumatic events associates with children's mental health and their cognitive, emotional and social development. Second, we aimed to model familial and symbolic processes that can either harm or protect the mental health of…
Kutschera, P. C.; Caputi, Marie A.; Pelayo, Jose Maria G., III
Virtually no formal treatment protocol exists for the health/mental health care of biracial Filipino Amerasians in the Philippines. Today this large group comprises a mostly socioeconomically at risk diaspora. A recent 3-year study found depression, elevated anxiety, joblessness, social isolation, substance and alcohol abuse, and housing…
Shewale, Swapnil V; Anstadt, Mark P; Horenziak, Michael; Izu, Brent; Morgan, Eric E; Lucot, James B; Morris, Mariana
Sarin, a lethal chemical nerve agent, may be a causative factor in multifactorial syndrome implicated in the Gulf War and Tokyo terrorist attacks. Although a high dose results in seizure and death, low-dose exposure may lead to autonomic imbalance and chronic cardiac pathologies. In this study, echocardiography and electrocardiography were used to examine the late-onset effects of a low-dose sarin on cardiac structure and function in mice. Adrenal corticosterone and tyrosine hydroxylase mRNA levels were measured. Stress responsiveness of the hypothalamic-pituitary-adrenal (HPA) axis was also tested. Findings demonstrate changes consistent with a dilated cardiomyopathy, including left ventricular dilatation, reduced contractility, and altered electrophysiological and inotropic responses to β-adrenergic stimulation. Results also indicate reduced adrenal tyrosine hydroxylase mRNA, corticosterone and altered stress responsiveness of HPA indicating autonomic imbalance. The role of low-dose sarin/organophosphate exposure needs to be considered in the military and civilian populations that suffer from autonomic imbalance and/or cardiomyopathies of indeterminate origin.
An Integrated Survey System for Addressing Abuse and Misconduct Toward Air Force Trainees During Basic Military Training Kirsten M. Keller, Laura...00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE An Integrated Survey System for Addressing Abuse and Misconduct Toward Air Force Trainees During...RAND Project AIR FORCE to help develop an integrated survey system to help address abuse and misconduct toward trainees in the BMT environment. This
Carlozzi, Noelle E.; Brickell, Tracey A.; Psych, D.; French, Louis M.; Sander, Angelle; Kratz, Anna L.; Tulsky, David S.; Chiaravalloti, Nancy D.; Hahn, Elizabeth A.; Kallen, Michael; Austin, Amy M.; Miner, Jennifer A.; Lange, Rael T.
Objective To develop a conceptual framework that captures aspects of health-related quality of life (HRQOL) for caregivers of individuals with military-related traumatic brain injury (TBI). Design Qualitative data from nine focus groups composed of caregivers of wounded warriors with a medically documented TBI were analyzed. Setting Focus group participants were recruited through Walter Reed National Military Medical Center (WRNMMC), community outreach and support groups. Participants 45 caregivers of wounded warriors who had sustained a mild, moderate, severe, or penetrating TBI. Results Qualitative frequency analysis indicated that caregivers most frequently discussed social health (44% of comments), followed by emotional (40%) and physical health (12%). Areas of discussion that were specific to this population included: anger regarding barriers to health services (for caregivers and service members), emotional suppression (putting on a brave face for others, even when things are not going well), and hypervigilance (controlling one’s behavior/environment to prevent upsetting the service member). Conclusion Caring for wounded warriors with TBI is a complex experience that positively and negatively affects HRQOL. While some aspects of HRQOL can be evaluated with existing measures, evaluation of other important components does not exist. The development of military-specific measures would help facilitate better care for these individuals. PMID:27997672
Carlozzi, Noelle E; Brickell, Tracey A; French, Louis M; Sander, Angelle; Kratz, Anna L; Tulsky, David S; Chiaravalloti, Nancy D; Hahn, Elizabeth A; Kallen, Michael; Austin, Amy M; Miner, Jennifer A; Lange, Rael T
The purpose of this study was to develop a conceptual framework that captures aspects of health-related quality of life (HRQOL) for caregivers of individuals with military-related traumatic brain injury (TBI). We analyzed qualitative data from nine focus groups composed of caregivers of wounded warriors with a medically documented TBI. Focus group participants were recruited through hospital-based and/or community outreach efforts at the Walter Reed National Military Medical Center, the University of Michigan, and Hearts of Valor support groups (Tennessee and Washington). Participants were the caregivers (n = 45) of wounded warriors who had sustained a mild, moderate, severe, or penetrating TBI. Qualitative frequency analysis indicated that caregivers most frequently discussed social health (44% of comments), followed by emotional (40%) and physical health (12%). Areas of discussion that were specific to this population included anger regarding barriers to health services (for caregivers and servicemembers), emotional suppression (putting on a brave face for others even when things are not going well), and hypervigilance (controlling one's behavior/environment to prevent upsetting the servicemember). Caring for wounded warriors with TBI is a complex experience that positively and negatively affects HRQOL. While some aspects of HRQOL can be evaluated with existing measures, evaluation tools for other important components do not exist. The development of military-specific measures would help facilitate better care for these individuals.
Brinkerhoff, Derick W; Bossert, Thomas J
Governance is increasingly recognized as an important factor in health system performance, yet conceptually and practically it remains poorly understood and subject to often vague and competing notions of both what its role is and how to address its weaknesses. This overview article for the symposium on health governance presents a model of health governance that focuses on the multiplicity of societal actors in health systems, the distribution of roles and responsibilities among them and their ability and willingness to fulfil these roles and responsibilities. This focus highlights the principal-agent linkages among actors and the resulting incentives for good governance and health system performance. The discussion identifies three disconnects that constitute challenges for health system strengthening interventions that target improving governance: (1) the gap between the good governance agenda and existing capacities, (2) the discrepancy between formal and informal governance and (3) the inattention to sociopolitical power dynamics. The article summarizes the three country cases in the symposium and highlights their governance findings: health sector reform in China, financial management of health resources in Brazilian municipalities and budget reform in hospitals in Lesotho. The concluding sections clarify how the three cases apply the model's principal-agent linkages and highlight the importance of filling the gaps remaining between problem diagnosis and the development of practical guidance that supports 'best fit' solutions and accommodates political realities in health systems strengthening.
Gorbachenko, A V; Shalimov, P M
One hundred and sixty-six young military man with mitral valve prolapse (MVP) aged 19.2+/-0.8 years were examined. Complex system approach to health status was applied to study clinico-functional features of this condition in young military men. The study found that clinico-functional manifestations of MVP in young military men reflected a multifocal character of dysadaptation during the first stages of military service. Conditions of professional military activity potentiate permanent progress of crisp prolapse as well as the severity of mitral regurgitation, structural and functional myocardial alterations, and myocardial electric instability increasing in the presence of abnormal cardiac chords under the influence of a prominent vegetative dysfunction. The reserve of the cardiorespiratory system and the entire organism in military men with MVP was lowered. The study registered inadequate hemodynamic responses to functional orthostatic test and physical load test, typical for hyperventilation syndrome.
Rizzo, Albert; Hartholt, Arno; Rothbaum, Barbara; Difede, Joann; Reist, Chris; Kwok, David; Leeds, Andrew; Spitalnick, Josh; Talbot, Thomas; Adamson, Todd; Buckwalter, J Galen
The stressful experiences that have been characteristic of the combat environments in Iraq and Afghanistan have produced significant numbers of returning service members at risk for developing posttraumatic stress disorder and other psychosocial/behavioral health conditions. This paper describes a set of projects that are expanding the content for inclusion in a newly updated "Virtual Iraq/Afghanistan" Virtual Reality system for the delivery of exposure therapy (VRET) for PTSD with Service Members and Veterans. In addition to the complete rebuilding of this VRET system using the latest version of the Unity Game Engine, the system's content and functionality has been expanded to now support the use of VRET with combat medics/corpsmen and persons who have experienced military sexual trauma (MST). The focus of this paper is to present the rationale and general overview of the progress on these projects that will provide new relevant and customizable options for conducting VRET with a wider range of trauma experiences.
Pamphile, Murielle F.
Military veterans preparing for new careers in the civilian world are pursuing higher educational degrees to fulfill career goals. The real-life experiences of veterans in the military are beneficial tools that can effectively enhance student veterans' academic performance and success. As veterans' enrollment continues to rise, veteran's academic…
rebutting information that may arise ( Mynatt , Doherty, and Tweney, 1978). Some maintain that senior military commanders and politico-military leaders...Defense Adaptive Red Team (DART) Report, 2002. Mynatt , Clifford R., Michael E. Doherty, and Ryan D. Tweney, "Conse- quences of Confirmation and
of Suicidal ideation was also assessed with an item taken from association were used to evaluate the gender differences in ex- the Army’s Health Risk...past 2 differences in types of exposures, and associations between years. Recency of suicidal ideation was assessed by affirmative outcome variables...depression, mental health visit, role limitation due to As shown in Table 1I, 30% of the men and 23% of the women emotional problems, suicidal ideation , feelings
radiation sources to the crew, passengers , and maintainers to the maximum extent feasible during design , manufacture and installation of commercial...engineering controls/ design features are available to reduce or control Soldier exposures to WBV (e.g. seat padding/suspension, vehicle suspension...materiel developers. It determined that ergonomic -related health hazards are not the most common health hazard type evaluated. 15. SUBJECT TERMS 16
assessments, database accuracy, and consistency of health hazard communication to materiel developers. It determined that ergonomic -related health hazards...caused by the physical properties of the blast wave following firing. Limiting the number of rounds fired in a designated time period controlled... passengers to high levels of steady-state noise. Crewmembers were instructed to wear two forms of protective devices to combat hearing loss, which then
overall increase in hospitalizations among Gulf War veterans or birth defects among their children (8,18). In response to health questions following the...A records-based evaluation of the risk of birth defects among children of Gulf War veterans. N Engl J Med 1997; 336:1650-6. 9. Daubert v. Merrel Dow... Aspartame and the internet. Lancet 1999; 354:78. From the Office of the Assistant Secretary of Defense for Health Affairs, Department of Defense, The
asleep, and difficulty staying asleep. The survey also measured mental health symptoms, including post-traumatic stress symptoms, anxiety, and...disruption were at substantially elevated risk of meeting criteria for post-traumatic stress disorder, generalized anxiety disorder, and major depressive...respect to behavioral health, sleep disruption is also consistently linked to psychiatric sym ptom s,7 post- traum atic stress disorder (PTSD),8
Stetz, Melba C; Folen, Raymond A; Yamanuha, Bronson K
The purpose of this article is to provide a short narrative on the ways that behavioral health professionals and their patients are currently benefitting from the use of technology. Examples stem from applications of technology to patients/research participants at the Tripler Army Medical Center. The paper also discusses how current use of this technology has made it possible to serve individuals in their own cultural environment, providing a cost-effective means of providing mental health services.
This article presents a structured survey of the German health care and health insurance system, and analyzes major developments of current German health policy. The German statutory health insurance system has been known as a system that provides all citizens with ready access to comprehensive high quality medical care at a cost the country considered socially acceptable. However, an increasing concern for rapidly rising health care expenditure led to a number of cost-containment measures since 1977. The aim was to bring the growth of health care expenditure in line with the growth of wages and salaries of the sickness fund members. The recent health care reforms of 1989 and 1993 yielded only short-term reductions of health care expenditure, with increases in the subsequent years. 'Stability of the contribution rate' is the uppermost political objective of current health care reform initiatives. Options under discussion include reductions in the benefit package and increases of patients' co-payments. The article concludes with the possible consequences of the 1997 health care reform of which the major part became effective 1 July 1997.
has also compared the out-of-pocket health costs of families who use its preferred-provider organization ( PPO ) or fee-for-service options with those...comparison controlled for demographic differ- ences between military and civilian families. EVALUATING MILITARY COMPENSATION 17using PPO plans. In 2005...governments would have to absorb the difference. A PP E N D IX A Total Compensation for the Median Enlisted MemberUsing a different approach from
Hospital Care Is Questioned; Next Reprisals,” The New York Times, Dec. 20, 2014; S. LaFraniere, “Service Members Are Left in Dark on Health Errors,” The...23MHS officials told us that subject matter experts...of whom are officially appointed as subject matter experts (or consultants), in clinical areas related to women’s health care services, such as
Teyhen, Deydre; Bergeron, Michael F; Deuster, Patricia; Baumgartner, Neal; Beutler, Anthony I; de la Motte, Sarah J; Jones, Bruce H; Lisman, Peter; Padua, Darin A; Pendergrass, Timothy L; Pyne, Scott W; Schoomaker, Eric; Sell, Timothy C; O'Connor, Francis
Prevention of musculoskeletal injuries (MSKI) is critical in both civilian and military populations to enhance physical performance, optimize health, and minimize health care expenses. Developing a more unified approach through addressing identified movement impairments could result in improved dynamic balance, trunk stability, and functional movement quality while potentially minimizing the risk of incurring such injuries. Although the evidence supporting the utility of injury prediction and return-to-activity readiness screening tools is encouraging, considerable additional research is needed regarding improving sensitivity, specificity, and outcomes, and especially the implementation challenges and barriers in a military setting. If selected current functional movement assessments can be administered in an efficient and cost-effective manner, utilization of the existing tools may be a beneficial first step in decreasing the burden of MSKI, with a subsequent focus on secondary and tertiary prevention via further assessments on those with prior injury history.
Monkman, Helen; Kushniruk, Andre W
Derived from overlapping concepts in consumer health, a consumer health information system refers to any of the broad range of applications, tools, and educational resources developed to empower consumers with knowledge, techniques, and strategies, to manage their own health. As consumer health information systems become increasingly popular, it is important to explore the factors that impact their adoption and success. Accumulating evidence indicates a relationship between usability and consumers' eHealth Literacy skills and the demands consumer HISs place on their skills. Here, we present a new model called the Consumer Health Information System Adoption Model, which depicts both consumer eHealth literacy skills and system demands on eHealth literacy as moderators with the potential to affect the strength of relationship between usefulness and usability (predictors of usage) and adoption, value, and successful use (actual usage outcomes). Strategies for aligning these two moderating factors are described.
Health is a continuum of an optimized state of a biologic system, an outcome of positive relationships with the self and others. A healthy system follows the principles of systems science derived from observations of nature, highlighting the character of relationships as the key determinant. Relationships evolve from our decisions, which are consequential to the function of our own biologic system on all levels, including the genome, where epigenetics impact our morphology. In healthy systems, decisions emanate from the reciprocal collaboration of hippocampal memory and the executive prefrontal cortex. We can decide to change relationships through choices. What is selected, however, only represents the cognitive interpretation of our limited sensory perception; it strongly reflects inherent biases toward either optimizing state, making a biologic system healthy, or not. Health or its absence is then the outcome; there is no inconsequential choice. Public health effort should not focus on punitive steps (e.g. taxation of unhealthy products or behaviors) in order to achieve a higher level of public’s health. It should teach people the process of making healthy decisions; otherwise, people will just migrate/shift from one unhealthy product/behavior to another, and well-intended punitive steps will not make much difference. Physical activity, accompanied by nutrition and stress management, have the greatest impact on fashioning health and simultaneously are the most cost-effective measures. Moderate-to-vigorous exercise not only improves aerobic fitness but also positively influences cognition, including memory and senses. Collective, rational societal decisions can then be anticipated. Health care is a business system principally governed by self-maximizing decisions of its components; uneven and contradictory outcomes are the consequences within such a non-optimized system. Health is not health care. We are biologic systems subject to the laws of biology in spite
Kruchten, Robert J.; Todd, Wayne
Existing satellite concepts of operation depend on readily available experts and are extremely manpower intensive. Areas of expertise required include mission planning, mission data interpretation, telemetry monitoring, and anomaly resolution. The concepts of operation have envolved to their current state in part because space systems have tended to be treated more as research and development assets rather than as operational assets. These methods of satellite command and control will be inadequate in the future because of the availability, survivability, and capability of human experts. Because space systems have extremely high reliability and limited access, they offer challenges not found in other military systems. Thus, automation techniques used elsewhere are not necessarily applicable to space systems. A program to make satellites much more autonomous has been developed, using a variety of advanced software techniques. The problem the program is addressing, some possible solutions, the goals of the Rome Air Development Center (RADC) program, the rationale as to why the goals are reasonable, and the current program status are discussed. Also presented are some of the concepts used in the program and how they differ from more traditional approaches.
Pashkovskiĭ, R D
Military-medical examination is a part of medical service of the Armed Forces of the Russian Federation and plays a significant role in recruiting military troops with healthy, physically vigorous soldiers, in saving and improving of health of military personnel, in undertaking prophylaxis and therapeutic measures, in solving social problems of servicemen and their families. Military-medical examination board of Eastern Command plays a significant role in the system of military-medical examination of the Armed Forces of the Russian Federation. The article is devoted to the history of formation and development of military-medical examination in the Far East depending on aims and goals of military-medical service at different stages of military formation. Eastern Command dated back to the Civil War, has changed its organization, boundaries, structure and name many times. According these changes many new military-medical departments, including military-medical examination board, were reorganized, disbanded and created. Various military-medical commissions alternating or working simultaneously at different military units were created in the Far East.
Schneider, H; Lehmann, U
One of the consequences of massive investment in antiretroviral access and other AIDS programmes has been the rapid emergence of large numbers of lay workers in the health systems of developing countries. In South Africa, government estimates are 65,000, mostly HIV/TB care-related lay workers contribute their labour in the public health sector, outnumbering the main front-line primary health care providers and professional nurses. The phenomenon has grown organically and incrementally, playing a wide variety of care-giving, support and advocacy roles. Using South Africa as a case, this paper discusses the different forms, traditions and contradictory orientations taken by lay health work and the system-wide effects of a large lay worker presence. As pressures to regularise and formalize the status of lay health workers grow, important questions are raised as to their place in health systems, and more broadly what they represent as a new intermediary layer between state and citizen. It argues for a research agenda that seeks to better characterise types of lay involvement in the health system, particularly in an era of antiretroviral therapy, and which takes a wider perspective on the meanings of this recent re-emergence of an old concept in health systems heavily affected by HIV/AIDS.
Maksimov, I B; Krylov, N L
In October 2014 we celebrate the 110th anniversary of the birth of Chief of the Main Military Medical Administration of the People's Commissariat of Defense, Minister of Health of the USSR, Hero of Socialist Labor, Member of the Academy of Medical Sciences of the USSR, Colonel-General of the Medical Service Efim Smirnov (1904-1989). The article highlights biographical information about him.
biostatistician,1 Timothy S Wells, medical chief epidemiologist,2 Margaret A K Ryan, occupational and preventive medicine physician3 for the Millennium Cohort...behavioural and occupational characteristics related to military service that might be associated with adverse health.20 21 The invited cohort was ran...tary occupation (combat specialist, healthcare specia- list, functional support, and others). As service members exposed to combat are at the highest
Hanney, Stephen R; González Block, Miguel A
Health research systems can link knowledge generation with practical concerns to improve health and health equity. Interest in health research, and in how health research systems should best be organised, is moving up the agenda of bodies such as the World Health Organisation. Pioneering health research systems, for example those in Canada and the UK, show that progress is possible. However, radical steps are required to achieve this. Such steps should be based on evidence not anecdotes. Health Research Policy and Systems (HARPS) provides a vehicle for the publication of research, and informed opinion, on a range of topics related to the organisation of health research systems and the enormous benefits that can be achieved. Following the Mexico ministerial summit on health research, WHO has been identifying ways in which it could itself improve the use of research evidence. The results from this activity are soon to be published as a series of articles in HARPS. This editorial provides an account of some of these recent key developments in health research systems but places them in the context of a distinguished tradition of debate about the role of science in society. It also identifies some of the main issues on which 'research on health research' has already been conducted and published, in some cases in HARPS. Finding and retaining adequate financial and human resources to conduct health research is a major problem, especially in low and middle income countries where the need is often greatest. Research ethics and agenda-setting that responds to the demands of the public are issues of growing concern. Innovative and collaborative ways are being found to organise the conduct and utilisation of research so as to inform policy, and improve health and health equity. This is crucial, not least to achieve the health-related Millennium Development Goals. But much more progress is needed. The editorial ends by listing a wide range of topics related to the above
Perspectives of development of the Tunisian health system are presented, in reference to the conceptual framework recommended by the World Health Organization, while a project of health insurance reform of the social security regimes is submitted to a dialogue with the different concerned parts. Recommended orientations articulate around five axes: 1. The promotion of care provision by improving the accessibility to services, notably in zones under served, by introducing new modes of dispensation, organization and management of care provision in the framework of a continuous quality assurance strategy. 2. The financing of health care, with the implementation of the health insurance reform, has to allow an improvement of the financial accessibility of the population to health care, while supervising the evolution of total health expenditures and by developing the system's management capacities. 3. Proposals relative to the mobilization of resources are advanced in areas of medicine, training of health professionals and research on the health system. 4. Adaptation of the health system governance to the new context is necessary and would have to be developed around evolving standards for the health system, on evaluation of its performances and on information and communication with its users. 5. The health system responsiveness, new motion whose contours are again blurred, would have to be analysed and adapted to the specific context of the country.
McCown, Michael E; Opel, Taylor; Grzeszak, Benjamin
Vector-borne diseases (VBDs) make up a large number of emerging infectious and zoonotic diseases. Vectors such as ticks, fleas, and mosquitoes parasitize dogs, thus making canine populations adequate reservoirs for infectious disease and zoonoses. The U.S. military deploys its personnel and Military Working Dogs (MWDs) throughout the world with possible risk of exposure to VBDs. Canine VBDs continue to have veterinary and public health significance for the host nations as well as for deployed U.S. personnel and MWDs. Thus, ongoing and consistent disease surveillance is an essential component to preserve health. The purpose of this study was to survey dogs from multiple cities and varying regions throughout Puerto Rico to determine the prevalence of ehrlichiosis (Ehrlichia canis), anaplasmosis (Anaplasma phagocytophilum), Lyme disease (Borrelia burgdorferi), and heartworm disease (Dirofilaria immitis) from May to July 2012. Canine blood samples (1?3 ml) from the cities of San Juan (n = 629), Guaynabo (n = 50), Ponce (n = 20) and Vieques Island (n = 53) were obtained and tested on-site using an IDEXX SNAP? 4Dx? (enzyme-linked immunosorbent assay) test kit. Prevalence for single or multiple disease status was calculated for each site. The overall period prevalence of VBD in Puerto Rico in the shelter population was 57.7% (71/123). In Guaynabo, the VBD prevalence was 30% (15/50); 2 (13%) of these positive dogs had VBD co-infection. In the coastal port city of Ponce, it was 60% (12/20); 6 (50%) dogs were infected by two or more VBDs. On Vieques Island, it was 83% (44/53); 27 (61%) dogs were coinfected. Conversely, samples collected at the Fort Buchanan Veterinary Clinic in the capitol city of San Juan resulted in a VBD prevalence of 8.9% (56/629). Lyme disease was not detected in any sample. This study showed the presence of D. immitis, E. canis, and A. phagocytophilum in all four sites of Puerto Rico, emphasizing the value of surveillance for VBDs to determine disease
CGSC MG MILITARY GOVERNMENT LIBHARY ARI\\’IY WAR COLLEGE CJ\\RLISLE BARRACKS, PAa This text is approved for resident and extension-course...and functions · of ’ military government . It conforms ·substantially to the subject matter , of Field Manual 27-5, Civil Affairs/ Military Government ...Teaching experience at the Command and General Staff College has ···--·demonstrated the need for a military government text which brings to- gether
The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable.
Cardile, Anthony P; Murray, Clinton K; Littell, Christopher T; Shah, Neel J; Fandre, Matthew N; Drinkwater, Dennis C; Markelz, Brian P; Vento, Todd J
In response to the unprecedented Ebola virus disease (Ebola) outbreak in West Africa, the U.S. government deployed approximately 2,500 military personnel to support the government of Liberia. Their primary missions were to construct Ebola treatment units (ETUs), train health care workers to staff ETUs, and provide laboratory testing capacity for Ebola. Service members were explicitly prohibited from engaging in activities that could result in close contact with an Ebola-infected patient or coming in contact with the remains of persons who had died from unknown causes. Military units performed twice-daily monitoring of temperature and review of exposures and symptoms ("unit monitoring") on all persons throughout deployment, exit screening at the time of departure from Liberia, and post-deployment monitoring for 21 days at segregated, controlled monitoring areas on U.S. military installations. A total of 32 persons developed a fever during deployment from October 25, 2014, through February 27, 2015; none had a known Ebola exposure or developed Ebola infection. Monitoring of all deployed service members revealed no Ebola exposures or infections. Given their activity restrictions and comprehensive monitoring while deployed to Liberia, U.S. military personnel constitute a unique population with a lower risk for Ebola exposure compared with those working in the country without such measures.
AbouZahr, Carla; Boerma, Ties
Public health decision-making is critically dependent on the timely availability of sound data. The role of health information systems is to generate, analyse and disseminate such data. In practice, health information systems rarely function systematically. The products of historical, social and economic forces, they are complex, fragmented and unresponsive to needs. International donors in health are largely responsible for the problem, having prioritized urgent needs for data over longer-term country capacity-building. The result is painfully apparent in the inability of most countries to generate the data needed to monitor progress towards the Millennium Development Goals. Solutions to the problem must be comprehensive; money alone is likely to be insufficient unless accompanied by sustained support to country systems development coupled with greater donor accountability and allocation of responsibilities. The Health Metrics Network, a global collaboration in the making, is intended to help bring such solutions to the countries most in need. PMID:16184276
Neff, Roni A.; Palmer, Anne M.; Mckenzie, Shawn E.; Lawrence, Robert S.
The United States has set a national goal to eliminate health disparities. This article emphasizes the importance of food systems in generating and exacerbating health disparities in the United States and suggests avenues for reducing them. It presents a conceptual model showing how broad food system conditions interplay with community food environments—and how these relationships are filtered and refracted through prisms of social disparities to generate and exacerbate health disparities. Interactions with demand factors in the social environment are described. The article also highlights the separate food systems pathway to health disparities via environmental and occupational health effects of agriculture. PMID:23173027
Woodart, Stanley E.; Woodman, Keith L.; Coffey, Neil C.; Taylor, Bryant D.
Aircraft and other vehicles are often kept in service beyond their original design lives. As they age, they become susceptible to system malfunctions and fatigue. Unlike future aircraft that will include health-monitoring capabilities as integral parts in their designs, older aircraft have not been so equipped. The Adaptable Vehicle Health and Usage Monitoring System is designed to be retrofitted into a preexisting fleet of military and commercial aircraft, ships, or ground vehicles to provide them with state-of-the-art health- and usage-monitoring capabilities. The monitoring system is self-contained, and the integration of it into existing systems entails limited intrusion. In essence, it has bolt-on/ bolt-off simplicity that makes it easy to install on any preexisting vehicle or structure. Because the system is completely independent of the vehicle, it can be certified for airworthiness as an independent system. The purpose served by the health-monitoring system is to reduce vehicle operating costs and to increase safety and reliability. The monitoring system is a means to identify damage to, or deterioration of, vehicle subsystems, before such damage or deterioration becomes costly and/or disastrous. Frequent monitoring of a vehicle enables identification of the embryonic stages of damage or deterioration. The knowledge thus gained can be used to correct anomalies while they are still somewhat minor. Maintenance can be performed as needed, instead of having the need for maintenance identified during cyclic inspections that take vehicles off duty even when there are no maintenance problems. Measurements and analyses acquired by the health-monitoring system also can be used to analyze mishaps. Overall, vehicles can be made more reliable and kept on duty for longer times. Figure 1 schematically depicts the system as applied to a fleet of n vehicles. The system has three operational levels. All communication between system components is by use of wireless
Beckett, Maj Andrew; Fowler, Robert; Adhikari, Neil; Hawryluck, Laura; Razek, Tarek; Tien, Col Homer
Background Previous work has been published on the experiences of high-resource setting physicians mentoring in low-resource environments. However, not much is known about what mentees think about their First World mentors. We had the opportunity to explore this question in an Afghan Army Hospital, and we believe this is the first time this has been studied. Methods We conducted a pilot cross-sectional survey of Afghan health care providers evaluating their Canadian mentors. We created a culturally appropriate 19-question survey with 5-point Likert scores that was then translated into the local Afghan language. The survey questions were based on domains of Royal College of Physicians and Surgeons of Canada’s CanMEDS criteria. Results The survey response rate was 90% (36 of 40). The respondents included 13 physicians, 21 nurses and 2 other health care professionals. Overall, most of the Afghan health care workers felt that working with mentors from high-resource settings was a positive experience (median 4.0, interquartile range [IQR] 4–4), according to CanMEDS domains. However, respondents indicated that the mentors were reliant on medical technology for diagnosis (median 5.0, IQR 4–5) and failed to consider the limited resources available in Afghanistan. Conclusion The overall impression of Afghan health care providers was that mentors are appropriate and helpful. CanMEDS can be used as a framework to evaluate mentors in low-resource conflict environments. PMID:26100785
the Naval Health Research Center (protocol NHRC.2000.0007). Data Sources In addition to our longitudinal survey instrument , other data sources...megavitamin therapy, homeopathic remedies, hypnosis , massage therapy, relaxation, and spiritual healing. For the purposes of these analyses...acupuncture, biofeedback, chiropractic care, energy healing, folk medicine, hypnosis , and massage therapy were grouped together as practitioner-assisted
significance of retirement health care costs to both DoD and irivate industry . The cost of labor includes the cost of retirement benefits. Thus...Etheridge, Jr. 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) S. PERFORMING ORGANIZATION Logistica Management Institute REPORT NUMBER 6400 Goldsboro
... the underlying mechanisms of Post-Traumatic Stress Disorder (PTSD), other mental health conditions..., Veterans Affairs, and Homeland Security to expand suicide prevention strategies and take steps to meet the... members, and their families. Sec. 2. Suicide Prevention. (a) By December 31, 2012, the Department...
Luke, Douglas A.; Stamatakis, Katherine A.
Complex systems abound in public health. Complex systems are made up of heterogeneous elements that interact with one another, have emergent properties that are not explained by understanding the individual elements of the system, persist over time and adapt to changing circumstances. Public health is starting to use results from systems science studies to shape practice and policy, for example in preparing for global pandemics. However, systems science study designs and analytic methods remain underutilized and are not widely featured in public health curricula or training. In this review we present an argument for the utility of systems science methods in public health, introduce three important systems science methods (system dynamics, network analysis, and agent-based modeling), and provide three case studies where these methods have been used to answer important public health science questions in the areas of infectious disease, tobacco control, and obesity. PMID:22224885
normative population. Qual Life Res 2006, 15(3):527-536. 47. Hemingway H, Nicholson A, Stafford M, Roberts R, Marmot M: The impact of socioeconomic...Stafford M, Stansfeld S, Shipley M, Marmot M: Is the SF-36 a valid measure of change in population health? Results from the Whitehall II Study. BMJ 1997
RD-RI54 682 EXCELLENCE WiTHIN THE NAVY HEALTH CARE SYSTEM (U) NAVAL I. POSTGRADUATE SCHOOL MONTEREY CA J A NORTON DEC 84 UNCLRSSIFIED F/G 6/12...STANDAROS-1963-A -J% * .NAVAL POSTGRADUATE SCHOOL Monterey, California DTIC THESIS EXCELLENCE WITHIN THE NAVY HEALTH CARE SYSTEM by JAMES ALFRED NORTON...Within the Navy Health Care December 1984 System S. PERFORMING ORG. REPORT NUMBER 7. AUTHOR(s) I. CONTRACT OR GRANT NUMBER(@) James Alfred Norton S
Mukhametzhanov, A M; Smagulov, N K
Military service activity appeared to influence health state of military personnel. Body strain at initial stages of the service, connected with stress situation, affects general body resistance and manifests in higher general morbidity level with transitory disablement that decreases with adaptation. Based on normalized intensity parameters, the equation enables to ease a procedure of evaluation and forecast of transitory disablement morbidity in draft military personnel.
Missiles guided using optoelectronic methods, optoelectronic imaging systems (thermal imaging systems, night vision devices, LLLTV cameras, TV cameras), and optoelectronic countermeasures (smoke screens, camouflage paints and nets, IR flares, decoys, jamming systems, warning systems) are one of the most important components of modern military armament. There are numerous military standards, some of them secret, that precise radiometric parameters to be measured and the testing methods to be used. There is also much literature on the subject of testing of the systems mentioned above, although mostly on subject of testing of the thermal imaging systems. In spite of this apparently numerous literature, there still significant confusion in this area due to secrecy of some parameters and testing methods, differences in recommendations of different military standards, fast progress in military optoelectronics, and also due to enormous number of different types of optoelectronics systems used in the military armament. A review of testing methods of the three basic groups of optoelectronics systems used in modern military armament: the missiles guided using optoelectronics methods, the optoelectronic imaging systems, and the optoelectronic countermeasures is presented in this paper. Trends in the measuring sets.
Klein, David A; Adelman, William P; Thompson, Amy M; Shoemaker, Richard G; Shen-Gunther, Jane
Data examining sexuality and substance use among active duty and military-dependent youth is limited; however, these psychosocial factors have military implications. Adolescents and young adults aged 12-23 were recruited from an active-duty trainee clinic (n = 225) and a military pediatric clinic (n = 223). Active duty participants were more likely to be older, male, White, previous tobacco users, and report a history of sexual activity and less contraception use at their most recent intercourse, compared to the dependent group. Over 10% of all participants indicated attraction to members of the same gender or both genders. In logistic regression analysis, non-White participants were less likely to use contraception compared to White participants. Adolescents and young adults seen in military clinics frequently engage in high-risk behavior. Clinicians who care for military youth should assess their patient's psychosocial history. Further study of this population is warranted to identify factors that may influence risk and resilience.
measurements of body weight/ fatness across time, 2)development of an environmental/Internet-based intervention to promote healthy weight through proper...physical fitness, Soldiers, health, weight, body fat 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a...H.E.A.L.T.H.)”. Soldiers who failed to meet Army requirements for body fat defined by AR 600-9, the Army weight Control Program (AWCP), and fitness
the results of the Army Physical Fitness tests and measurements of body weight/ fatness across time, 2) development of an environmental/Internet-based...Internet activity on the website. 15. SUBJECT TERMS Nutrition, physical fitness, Soldiers, health, weight, body fat 16. SECURITY CLASSIFICATION OF...Activity, Lifestyle Training Headquarters (H.E.A.L.T.H.)”. Soldiers who fail to meet Army requirements for body fat defined by AR 600-9, the Army weight
effects . Indeed, a multitude of different stressors may manifest during the course of the assessment center (e.g., role stressors). Stressors, of...course, are not without their consequences in terms of adverse health effects , psychological and physical (e.g., Beehr, 1995; Jex, 1998). As such...applied researchers are always searching for the often-elusive buffer effect (Cohen & Wills, 1985). In the present study, the Advanced Camp assessment
Flakoll, Paul J; Judy, Tom; Flinn, Kim; Carr, Christopher; Flinn, Scott
Elevated postexercise amino acid availability has been demonstrated to enhance muscle protein synthesis acutely, but the long-term impact of postexercise protein supplementation on variables such as health, muscle soreness, and function are unclear. Healthy male US Marine recruits from six platoons (US Marine Corps Base, Parris Island, SC; n = 387; 18.9 +/- 0.1 yr, 74.7 +/- 1.1 kg, 13.8 +/- 0.4% body fat) were randomly assigned to three treatments within each platoon. Nutrients supplemented immediately postexercise during the 54-day basic training were either placebo (0 g carbohydrate, 0 g protein, 0 g fat), control (8, 0, 3), or protein supplement (8, 10, 3). Subjects and observers making measurements and data analysis were blinded to subject groupings. Compared with placebo and control groups, the protein-supplemented group had an average of 33% fewer total medical visits, 28% fewer visits due to bacterial/viral infections, 37% fewer visits due to muscle/joint problems, and 83% fewer visits due to heat exhaustion. Recruits experiencing heat exhaustion had greater body mass, lean, fat, and water losses. Muscle soreness immediately postexercise was reduced by protein supplementation vs. placebo and control groups on both days 34 and 54. Postexercise protein supplementation may not only enhance muscle protein deposition but it also has significant potential to positively impact health, muscle soreness, and tissue hydration during prolonged intense exercise training, suggesting a potential therapeutic approach for the prevention of health problems in severely stressed exercising populations.
Abstract International collaborative health research is justifiably expected to help reduce global health inequities. Investment in health policy and systems research in developing countries is essential to this process but, currently, funding for international research is mainly channelled towards the development of new medical interventions. This imbalance is largely due to research legislation and policies used in high-income countries. These policies have increasingly led these countries to invest in health research aimed at boosting national economic competitiveness rather than reducing health inequities. In the United States of America and the United Kingdom of Great Britain and Northern Ireland, the regulation of research has encouraged a model that: leads to products that can be commercialized; targets health needs that can be met by profitable, high-technology products; has the licensing of new products as its endpoint; and does not entail significant research capacity strengthening in other countries. Accordingly, investment in international research is directed towards pharmaceutical trials and product development public–private partnerships for neglected diseases. This diverts funding away from research that is needed to implement existing interventions and to strengthen health systems, i.e. health policy and systems research. Governments must restructure their research laws and policies to increase this essential research in developing countries. PMID:22271965
Sun, Yuelian; Gregersen, Hans; Yuan, Wei
China has gone through a comprehensive health care insurance reform since 2003 and achieved universal health insurance coverage in 2011. The new health care insurance system provides China with a huge opportunity for the development of health care and medical research when its rich medical resources are fully unfolded. In this study, we review the Chinese health care system and its implication for medical research, especially within clinical epidemiology. First, we briefly review the population register system, the distribution of the urban and rural population in China, and the development of the Chinese health care system after 1949. In the following sections, we describe the current Chinese health care delivery system and the current health insurance system. We then focus on the construction of the Chinese health information system as well as several existing registers and research projects on health data. Finally, we discuss the opportunities and challenges of the health care system in regard to clinical epidemiology research. China now has three main insurance schemes. The Urban Employee Basic Medical Insurance (UEBMI) covers urban employees and retired employees. The Urban Residence Basic Medical Insurance (URBMI) covers urban residents, including children, students, elderly people without previous employment, and unemployed people. The New Rural Cooperative Medical Scheme (NRCMS) covers rural residents. The Chinese Government has made efforts to build up health information data, including electronic medical records. The establishment of universal health care insurance with linkage to medical records will provide potentially huge research opportunities in the future. However, constructing a complete register system at a nationwide level is challenging. In the future, China will demand increased capacity of researchers and data managers, in particular within clinical epidemiology, to explore the rich resources. PMID:28356772
Sun, Yuelian; Gregersen, Hans; Yuan, Wei
China has gone through a comprehensive health care insurance reform since 2003 and achieved universal health insurance coverage in 2011. The new health care insurance system provides China with a huge opportunity for the development of health care and medical research when its rich medical resources are fully unfolded. In this study, we review the Chinese health care system and its implication for medical research, especially within clinical epidemiology. First, we briefly review the population register system, the distribution of the urban and rural population in China, and the development of the Chinese health care system after 1949. In the following sections, we describe the current Chinese health care delivery system and the current health insurance system. We then focus on the construction of the Chinese health information system as well as several existing registers and research projects on health data. Finally, we discuss the opportunities and challenges of the health care system in regard to clinical epidemiology research. China now has three main insurance schemes. The Urban Employee Basic Medical Insurance (UEBMI) covers urban employees and retired employees. The Urban Residence Basic Medical Insurance (URBMI) covers urban residents, including children, students, elderly people without previous employment, and unemployed people. The New Rural Cooperative Medical Scheme (NRCMS) covers rural residents. The Chinese Government has made efforts to build up health information data, including electronic medical records. The establishment of universal health care insurance with linkage to medical records will provide potentially huge research opportunities in the future. However, constructing a complete register system at a nationwide level is challenging. In the future, China will demand increased capacity of researchers and data managers, in particular within clinical epidemiology, to explore the rich resources.
Petrochuk, M A; Javalgi, R G
Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.
Burgio, Alessandra; Crialesi, Roberta; Loghi, Marzia
The Health for All - Italia information system collects health data from several sources. It is intended to be a cornerstone for the achievement of an overview about health in Italy. Health is analyzed at different levels, ranging from health services, health needs, lifestyles, demographic, social, economic and environmental contexts. The database associated software allows to pin down statistical data into graphs and tables, and to carry out simple statistical analysis. It is therefore possible to view the indicators' time series, make simple projections and compare the various indicators over the years for each territorial unit. This is possible by means of tables, graphs (histograms, line graphs, frequencies, linear regression with calculation of correlation coefficients, etc) and maps. These charts can be exported to other programs (i.e. Word, Excel, Power Point), or they can be directly printed in color or black and white.
physician visits, number of different health care providers (e.g. specialists, chiropractors , other healers, etc.) and number of medical treatments in the...compare delay in treatment seeking behaviors as related to knowledge of disease among African American, Hispanic American, and Caucasian active duty...272) = .19, p = .83) symptoms among the racial groups. Also, there were no differences in treatment experience in the medical setting among the racial
of different health care providers (e.g. specialists, chiropractors , other healers, etc.) and number of medical treatments in the last year (e.g. drugs...compare delay in treatment seeking behaviors as related to knowledge of disease among African American, Hispanic American, and Caucasian active duty...diabetes (F (2, 272) = .19, p = .83) symptoms among the racial groups. Also, there were no differences in treatment experience in the medical setting among
Toniolo, Franco; Mantoan, Domenico; Maresso, Anna
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. This HiT is one of the first to be written on a subnational level of government and focuses on the Veneto Region of northern Italy. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Veneto Region is one of Italy's richest regions and the health of its resident population compares favourably with other regions in Italy. Life expectancy for both men and women, now at 79.1 and 85.2 years, respectively, is slightly higher than the national average, while mortality rates are comparable to national ones. The major causes of death are tumours and cardiovascular diseases. Under Italy's National Health Service, the organization and provision of health care is a regional responsibility and regions must provide a nationally defined (with regional input) basic health benefit package to all of their citizens; extra services may be provided if budgets allow. Health care is mainly financed by earmarked central and regional taxes, with regions receiving their allocated share of resources from the National Health Fund. Historically, health budget deficits have been a major problem in most Italian regions, but since the early 2000s the introduction of efficiency measures and tighter procedures on financial management have contributed to a significant decrease in the Veneto Regions health budget deficit.The health system is governed by the Veneto Region government (Giunta) via the Departments of Health and Social Services, which receive technical support from a single General Management Secretariat. Health care is
Chung-Park, Min S
The purpose of this study was to explore the experiences of women in the military related to the prevention of pregnancy. Ten single women, ages 19 to 24, volunteered to be participants. They were interviewed over a 12-week period in a private setting at a military clinic. The results of the study were that their decision to use contraception was influenced by their personal goals, family values, perceived support system, and effectiveness of the birth control. These women used contraceptive methods that they felt were right for them. The conclusion of the study was that women in active military duty are in need of reproductive health education, career counseling, and support. Nurses are in a good position to provide these needed services.
Vail, David J.
The guidebook is introduced by general observations on the Scandinavian countries concerning history, social policy, medicine, mental health, and psychiatric diagnosis. Discussed individually for Norway, Sweden, and Denmark are the following areas: mental health programs and statistics; mental illness programs, regional, hospital, aftercare,…
Pathology/Diagnosis 3107 Oral Maxillofacial Surgery 3108 Orthodontics 3109 Pedodontics 3110 Periodontics 3111 Public Health Dentistry 3112 Prosthodontics...Maxillofacial Surgery 3108 Orthodontics 3109 Pedodontics 3110 Periodontics 3111 Public Health Dentistry 3112 Prosthodontics 3113 Comprehensive...Executive Dentistry 3103 Endodontics 3102 Oral Pathology/Diagnosis 3107 Oral Maxillofacial Surgery 3108 Orthodontics 3109 Pedodontics 3110 Periodontics 3111
disease to bioterrorist threat. Obstet Gynecol 2002;100(1):87-93 4. Levine MM. Live-virus vaccines in pregnancy: risks and recommendations. Lancet 1974;2...vaccination and outcome of pregnancy. AJPH Nations Health 1968;58(10)1910-21. 12. Luisi M. Smallpox vaccination and pregnancy. Am J Obstet Gynecol 1977;128...Valero J, Luna S, Dominguez-Rojas V. Risk factors in miscarriage: a review. Eur J Obstet Gynecol Reprod Biol 2002;102(2):111-9 14. Ellish NJ, Saboda K
3436% Increase Budgeted to Cut CHAMPUS Deficits," Navy - Times, 14 February 1983, 4. 19 Martha Lynn Craver, "The Stopgap Bill," Navy Times, 3 January...1983, 1. 20 Smith, ൬% Increase...,". 21 Martha Lynn Craver, "’Clinic Fee’ Rebuffed as CHAMPUS Tonic," Navy Times, 4 October 1982, 30. 22 Martha Lynn ...787-806. 42 Jay Wolfson, et al, "Effects of Cost-Sharing on Users of a State’s Health Service Program," Medical Care, 20, December 1982, 1178-1187. 43
Jay Carney, Timothy; Kong, Amanda Y
Informaticians are challenged to design health IT solutions for complex problems like health disparities but are only achieving mixed results in demonstrating a direct impact on health outcomes. This presentation of collective intelligence and the corresponding terms of smart health, knowledge ecosystem, enhanced health disparities informatics capacities, knowledge exchange, big-data, and situational awareness are means of demonstrating the complex challenges informatics professional face in trying to model, measure, and manage an intelligence and a smart systems response to health disparities. A critical piece in our understanding of collective intelligence for public and population health rests in our understanding of any public and population health as a living and evolving network of individuals, organizations, and resources. This discussion represents a step in advancing the conversation of what a smart response to health disparities should represent and how informatics can drive the design of intelligent systems to assist in eliminating health disparities and achieving health equity.
the more convinced we became that the crisis there is real, and acute; that the United States must act to meet it, and act boldly; that the stakes are...is hampered by high levels of national unemployment. The Telecommunications Health System (ANTEL) and the Teachers Health Program ( Bienestar ...now is a question of what might become. Whatever its roots in the past, the crisis in Central America exists urgently in the present, and its
Saltzman, William R.; Lester, Patricia; Beardslee, William R.; Layne, Christopher M.; Woodward, Kirsten; Nash, William P.
Recent studies have confirmed that repeated wartime deployment of a parent exacts a toll on military children and families and that the quality and functionality of familial relations is linked to force preservation and readiness. As a result, family-centered care has increasingly become a priority across the military health system. FOCUS…
Ramchand, Rajeev; Rudavsky, Rena; Grant, Sean; Tanielian, Terri; Jaycox, Lisa
This review summarizes the epidemiology of posttraumatic stress disorder (PTSD) and related mental health problems among persons who served in the armed forces during the Iraq and Afghanistan conflicts, as reflected in the literature published between 2009 and 2014. One-hundred and sixteen research studies are reviewed, most of which are among non-treatment-seeking US service members or treatment-seeking US veterans. Evidence is provided for demographic, military, and deployment-related risk factors for PTSD, though most derive from cross-sectional studies and few control for combat exposure, which is a primary risk factor for mental health problems in this cohort. Evidence is also provided linking PTSD with outcomes in the following domains: physical health, suicide, housing and homelessness, employment and economic well-being, social well-being, and aggression, violence, and criminality. Also included is evidence about the prevalence of mental health service use in this cohort. In many instances, the current suite of studies replicates findings observed in civilian samples, but new findings emerge of relevance to both military and civilian populations, such as the link between PTSD and suicide. Future research should make effort to control for combat exposure and use longitudinal study designs; promising areas for investigation are in non-treatment-seeking samples of US veterans and the role of social support in preventing or mitigating mental health problems in this group.
Liaropoulos, Lycourgos; Goranitis, Ilias
The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to "traditional" issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a globalized economy, as the share of labor decreases relative to that of capital, wage income is increasingly insufficient to cover the rising cost of care. At the same time, as the cost of Social Health Insurance through employment contributions rises with medical costs, it imperils the competitiveness of the economy. These reasons explain why spreading health care cost to all factors of production through comprehensive National Health Insurance financed by progressive taxation of income from all sources, instead of employer-employee contributions, protects health system objectives, especially during economic recessions, and ensures health system sustainability.
Sarma, Kalluri R.; Roush, Jerry; Chanley, Charles
While initial AM OLED products have been introduced in the market about a decade ago, truly successful commercialization of OLEDs has started only a couple of years ago, by Samsung Mobile Display (SMD), with small high performance displays for smart phone applications. This success by Samsung has catalyzed significant interest in AM OLED technology advancement and commercialization by other display manufacturers. Currently, significant manufacturing capacity for AM OLED displays is being established by the industry to serve the growing demand for these displays. The current development in the AM OLED industry are now focused on the development and commercialization of medium size (~10") AM OLED panels for Tablet PC applications and large size (~55") panels for TV applications. This significant progress in commercialization of AM OLED technology is enabled by major advances in various enabling technologies that include TFT backplanes, OLED materials and device structures and manufacturing know-how. In this paper we will discuss these recent advances, particularly as they relate to supporting high performance applications such as aerospace and military systems, and then discuss the results of the OLED testing for aerospace applications.
Fulop, Tamas; Roemer, Milton I.
This guide is intended to assist countries contemplating a comprehensive, action-oriented review of health labor force development to improve their national health systems. Various aspects of the health system infrastructure are examined (major components, organizational structure, coordinating mechanisms, sources of information, and…