Kimsey, Linda; Olaiya, Samuel; Smith, Chad; Hoburg, Andrew; Lipsitz, Stuart R; Koehlmoos, Tracey; Nguyen, Louis L; Weissman, Joel S
This study seeks to quantify variation in healthcare utilization and per capita costs using system-defined geographic regions based on enrollee residence within the Military Health System (MHS). Data for fiscal years 2007 - 2010 were obtained from the Military Health System under a data sharing agreement with the Defense Health Agency (DHA). DHA manages all aspects of the Department of Defense Military Health System, including TRICARE. Adjusted rates were calculated for per capita costs and for two procedures with high interest to the MHS- back surgery and Cesarean sections for TRICARE Prime and Plus enrollees. Coefficients of variation (CoV) and interquartile ranges (IQR) were calculated and analyzed using residence catchment area as the geographic unit. Catchment areas anchored by a Military Treatment Facility (MTF) were compared to catchment areas not anchored by a MTF. Variation, as measured by CoV, was 0.37 for back surgery and 0.13 for C-sections in FY 2010- comparable to rates documented in other healthcare systems. The 2010 CoV (and average cost) for per capita costs was 0.26 ($3,479.51). Procedure rates were generally lower and CoVs higher in regions anchored by a MTF compared with regions not anchored by a MTF, based on both system-wide comparisons and comparisons of neighboring areas. In spite of its centrally managed system and relatively healthy beneficiaries with very robust health benefits, the MHS is not immune to unexplained variation in utilization and cost of healthcare.
The military medical and health care system in the Song Dynasty manifested as two aspects, namely disease prevention and medical treatment. Disease prevention included ensuring food and drink safety, avoiding dangerous stations and enjoying regular vacations, etc. Medical treatment included sending medical officials to patrol, stationing military physicians to follow up, applying emergency programs, establishing military medical and pharmacy centers, dispensing required medicines, and accommodating and nursing sick and injured personnel, etc. Meanwhile, the imperial court also supervised the implementation of military medical mechanism, in order to check the soldiers' foods, check and restrict the military physicians' responsibilities, etc., which did play a positive role in protecting soldier's health, guaranteeing the military combat effectiveness, and maintaining national security.
Shrader, Angela; Casero, Kellie; Casper, Bethany; Kelley, Mary; Lewis, Laura; Calohan, Jess
Lesbian, gay, bisexual, and transgender (LGBT) individuals serving within the U.S. military and their beneficiaries have unique health care requirements. Department of Defense Directive 1304.26 "Don't Ask, Don't Tell" created a barrier for service members to speak candidly with their health care providers, which left specific health care needs unaddressed. There are no standardized cultural education programs to assist Military Health System (MHS) health care providers in delivering care to LGBT patients and their beneficiaries. The purpose of this project was to develop, implement, and evaluate the effectiveness of an LGBT educational program for health care providers within the MHS to increase cultural awareness in caring for this special population. This multisite educational program was conducted at Travis Air Force Base and Joint Base Lewis-McChord from November 15, 2014, to January 30, 2015. A 15-question multiple-choice questionnaire was developed based on the education program and was administered before and after the education program. A total of 51 individuals completed the program. Overall posttest scores improved compared to pretest scores. This program was designed to begin the process of educating health care providers about the unique health care issues of military LGBT Service Members and their beneficiaries. This program was the first to address the disparities in LGBT health care needs within the Department of Defense. It also provided a platform for facilitating open communication among providers regarding LGBT population health needs in the military.
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.
Do, Nhan V; Barnhill, Rick; Heermann-Do, Kimberly A; Salzman, Keith L; Gimbel, Ronald W
To design, build, implement, and evaluate a personal health record (PHR), tethered to the Military Health System, that leverages Microsoft® HealthVault and Google® Health infrastructure based on user preference. A pilot project was conducted in 2008-2009 at Madigan Army Medical Center in Tacoma, Washington. Our PHR was architected to a flexible platform that incorporated standards-based models of Continuity of Document and Continuity of Care Record to map Department of Defense-sourced health data, via a secure Veterans Administration data broker, to Microsoft® HealthVault and Google® Health based on user preference. The project design and implementation were guided by provider and patient advisory panels with formal user evaluation. The pilot project included 250 beneficiary users. Approximately 73.2% of users were < 65 years of age, and 38.4% were female. Of the users, 169 (67.6%) selected Microsoft® HealthVault, and 81 (32.4%) selected Google® Health as their PHR of preference. Sample evaluation of users reflected 100% (n = 60) satisfied with convenience of record access and 91.7% (n = 55) satisfied with overall functionality of PHR. Key lessons learned related to data-transfer decisions (push vs pull), purposeful delays in reporting sensitive information, understanding and mapping PHR use and clinical workflow, and decisions on information patients may choose to share with their provider. Currently PHRs are being viewed as empowering tools for patient activation. Design and implementation issues (eg, technical, organizational, information security) are substantial and must be thoughtfully approached. Adopting standards into design can enhance the national goal of portability and interoperability.
Barnhill, Rick; Heermann-Do, Kimberly A; Salzman, Keith L; Gimbel, Ronald W
Objective To design, build, implement, and evaluate a personal health record (PHR), tethered to the Military Health System, that leverages Microsoft® HealthVault and Google® Health infrastructure based on user preference. Materials and methods A pilot project was conducted in 2008–2009 at Madigan Army Medical Center in Tacoma, Washington. Our PHR was architected to a flexible platform that incorporated standards-based models of Continuity of Document and Continuity of Care Record to map Department of Defense-sourced health data, via a secure Veterans Administration data broker, to Microsoft® HealthVault and Google® Health based on user preference. The project design and implementation were guided by provider and patient advisory panels with formal user evaluation. Results The pilot project included 250 beneficiary users. Approximately 73.2% of users were <65 years of age, and 38.4% were female. Of the users, 169 (67.6%) selected Microsoft® HealthVault, and 81 (32.4%) selected Google® Health as their PHR of preference. Sample evaluation of users reflected 100% (n=60) satisfied with convenience of record access and 91.7% (n=55) satisfied with overall functionality of PHR. Discussion Key lessons learned related to data-transfer decisions (push vs pull), purposeful delays in reporting sensitive information, understanding and mapping PHR use and clinical workflow, and decisions on information patients may choose to share with their provider. Conclusion Currently PHRs are being viewed as empowering tools for patient activation. Design and implementation issues (eg, technical, organizational, information security) are substantial and must be thoughtfully approached. Adopting standards into design can enhance the national goal of portability and interoperability. PMID:21292705
women.5 Screening practices may also contribute to higher rates of E. coli infections among females of reproductive age, as the Infectious Disease...Annual Surveillance Summary: Escherichia coli (E. coli) Infections in the Military Health System (MHS...and prevalence among all beneficiaries seeking care within the Military Health System (MHS). This report describes demographics, clinical
incidence among all beneficiaries seeking care within the Military Health System (MHS). This report is a calendar year (CY) 2016 update to the CY...Department NMCPHC-EDC-TR-364-2017 Appendix A: Acronym and Abbreviation List Acronym/Abbreviation Definition CHCS Composite Health Care System CO...Annual Surveillance Summary: Clostridium difficile Infections in the Military Health System (MHS), 2016
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.
female OEF/OIF veteran now eligible for care in the VA system. Not listed is the need for additional Primary Care at CTVHCS in Temple which is a facility...position of the Department of the Army, Department of Defense, or the U.S. Government. MERGING THE MILITARY HEALTH SYSTEM (MHS) AND THE VETERANS HEALTH...5a. CONTRACT NUMBER Merging the Military Health System (MHS) and the Veterans Health Administration (VHA) into a Single Governance Structure 5b. GRANT
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.
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
Staphylococcus aureus (MRSA) incidence and prevalence among all beneficiaries seeking care within the Military Health System (MHS). This report...Comparison of community- and health care -associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003;290(22):2976-84. 10. Patel...community‐associated CHCS Composite Health Care System CO community‐onset CTS Contingency Tracking System CY calendar year DMDC Defense Manpower Data
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.
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.
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.
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.
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.
Jeffery, Diana D; Cohen, Martin; Brooks, Arnold; Linton, Andrea; Gromadzki, Richard; Hunter, Christine
During public health emergencies, the Military Health System experiences challenges similar to those across the U.S. public and private health systems. This study explored how 1 such event, the 2009/2010 influenza (H1N1) pandemic, impacted health care utilization and associated costs in the Military Health System. Data from the Military Data Repository were used to examine diagnoses, claims data, and dates of services with respect to military or civilian care during 2004-2009/2010 influenza seasons. Comparison analysis was conducted through two-tailed t-tests and regression models. There was a significant increase in inpatient and outpatient health care utilization during the 2009/2010 H1N1 pandemic year, most markedly for emergency department visits. The 2009/2010 H1N1 pandemic cost the Department of Defense $100 million compared to influenza-related health care costs incurred in previous influenza seasons. Highest health care utilization costs were found in children less than age 5. The greatest cost burden was attributed to immunizations for active duty personnel delivered at military facilities. Annual trend analysis of costs and health care utilization would be helpful to plan and resource emerging influenza pandemics and to identify subgroups at greatest risk for contracting influenza. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.
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
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.
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
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.
Petrov, G M; Moretskiĭ, A A
There are discussed the problems of military treatment and prophylactic institution (TPI) functioning under conditions of market reform of Russian public health. Main marketing concepts in military health are determined and some recommendations on work improvement in TPI of the Armed Forces in the system of obligatory medical insurance are presented, granting population paid medical services. It is necessary to form a new type of director--military and medical manager.
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.
Beauvais, Brad; Richter, Jason; Brezinski, Paul
The 2014 Military Health System Review calls for healthcare system leaders to implement effective strategies used by other high-performing organizations. The authors state, " the [military health system] MHS can create an optimal healthcare environment that focuses on continuous quality improvement where every patient receives safe, high-quality care at all times" (Military Health System, 2014, p. 1). Although aspirational, the document does not specify how a highly reliable health system is developed or what systemic factors are necessary to sustain highly reliable performance. Our work seeks to address this gap and provide guidance to MHS leaders regarding how high-performing organizations develop exceptional levels of performance.The authors' expectation is that military medicine will draw on these lessons to enhance leadership, develop exceptional organizational cultures, onboard and engage employees, build customer loyalty, and improve quality of care. Leaders from other segments of the healthcare field likely will find this study valuable given the size of the military healthcare system (9.6 million beneficiaries), the United States' steady progression toward population-based health, and the increasing need for highly reliable systems and performance.
Belsher, Bradley E; Jaycox, Lisa H; Freed, Michael C; Evatt, Daniel P; Liu, Xian; Novak, Laura A; Zatzick, Douglas; Bray, Robert M; Engel, Charles C
Integrated health care models aim to improve access and continuity of mental health services in general medical settings. STEPS-UP is a stepped, centrally assisted collaborative care model designed to improve posttraumatic stress disorder (PTSD) and depression care by providing the appropriate intensity and type of care based on patient characteristics and clinical complexity. STEPS-UP demonstrated improved PTSD and depression outcomes in a large effectiveness trial conducted in the Military Health System. The objective of this study was to examine differences in mental health utilization patterns between patients in the stepped, centrally assisted collaborative care model relative to patients in the collaborative care as usual-treatment arm. Patients with probable PTSD and/or depression were recruited at 6 large military treatment facilities, and 666 patients were enrolled and randomized to STEPS-UP or usual collaborative care. Utilization data acquired from Military Health System administrative datasets were analyzed to determine mental health service use and patterns. Clinical complexity and patient characteristics were based on self-report questionnaires collected at baseline. Compared with the treatment as usual arm, STEPS-UP participants received significantly more mental health services and psychiatric medications across primary and specialty care settings during the year of their participation. Patterns of service use indicated that greater clinical complexity was associated with increased service use in the STEPS-UP group, but not in the usual-care group. Results suggest that stepped, centrally assisted collaborative care models may increase the quantity of mental health services patients receive, while efficiently matching care on the basis of the clinical complexity of patients.
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.
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
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.
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.
Chandrasekera, Ruvani M; Lesho, Emil P; Chukwuma, Uzo; Cummings, James F; Waterman, Paige E
During a military public health laboratory symposium held in 1999, concerns were raised that the military health system lacked a standardized antimicrobial resistance (AMR) surveillance system that allowed comparison of data across sites, investigation of trends, and understanding of resistance mechanisms. The purpose of this review was to assess if current AMR activities in the military health system have addressed the aforementioned gaps. It was determined that much progress has already been made within the Department of Defense with respect to monitoring and understanding AMR through initiatives such as the Antimicrobial Resistance Monitoring and Research Program-a strong Department of Defense-wide surveillance program. These surveillance efforts can be made more robust through harmonization of testing and reporting structures across military treatment facilities, and by encouraging military treatment facility participation. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.
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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
echelons. I4. To guide preparation of specific urgency lists for the time -phased demands of supporting industrial resources. 5. To indicate the...AD-A270 736 ELECTE aeprlnt Incorporating Transmittal 61-2 Au-uast 17, 1955 Department of Defense Directive SUBJECT Military Production Urgencies ...Departaent of Defense Military Production Urgencies System which will provide authoritative information for guidance as to the relative urgency of desired
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…
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.
SGVU SUBJECT: Professional Presentation Approval 21 MAR2016 1. Your paper, entitled Impact of the Group Lifestyle Balance (GLB) Program on Diabetes...59th CSPG/SGVU) FWH20 I 30086H PROTOCOL TITLE A Retrospective Analysis of Outcomes from the WHASC DCOE Group Lifestyle Balance ™ Program 2009-2013 1...TITLE OF MATERIAL TO BE PUBLISHED OR PRESENTED Impact of the Group Lifestyle Balance (GLB) Program on Diabetes Prevention in the Military Health
The Department of Defense Instruction (DoDI) 6000.16 entitled Military Health Support for Stability Operations was published in 2010 and established policy that Medical Stability Operations (MSOs) would be a core military mission. The instruction set out to institutionalize how the Military Health Support (MHS) would effectively support MSOs and assist in bridging the gap with other actors operating in the same space. What is less clear is the current status of the MHS in accomplishing the responsibilities outlined in the DoDI. Even more concerning is how these efforts will support the "new" strategic guidance for the DoD published in January 2012 that states U.S. forces will no longer be sized to conduct large-scale, prolonged stability operations. In the absence of a publicly available DoDI 6000.16 implementation strategy, this article proposes the use of an organizational transformation process developed by internationally acclaimed leadership and organizational change expert Dr. John Kotter. The eight-step process is used as a framework to explore ways to effectively transform the DoD in meeting the intent of the MSOs DoDI. The past decade has transformed how service members think about MSOs. Now is the time to transform the MHS with urgency to institutionalize these thoughts.
exceed environmental, occupational, and military exposure guidelines. 8 Adverse health effects, includ- ing cardiovascular and pulmonary disease , are... 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
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
Scott, Paul; Deye, Gregory; Srinivasan, Arjun; Murray, Clinton; Moran, Kimberly; Hulten, Ed; Fishbain, Joel; Craft, David; Riddell, Scott; Lindler, Luther; Mancuso, James; Milstrey, Eric; Bautista, Christian T; Patel, Jean; Ewell, Alessa; Hamilton, Tacita; Gaddy, Charla; Tenney, Martin; Christopher, George; Petersen, Kyle; Endy, Timothy; Petruccelli, Bruno
We investigated an outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection among US service members injured in Iraq. The investigation was conducted in Iraq and Kuwait, in the 2 military hospitals where the majority of injured service members were initially treated. After initially characterizing the outbreak, we evaluated 3 potential sources of infection for the period March 2003 to December 2004. The evaluation included screening samples that were obtained from the skin of patients for the presence of colonization and assessing the soil and health care environments for the presence of A. baumanii-calcoaceticus complex organisms. Isolates obtained from samples from patients in US Military treatment facilities, as well as environmental isolates, were genotypically characterized and compared using pulsed-field gel electrophoresis. A. baumanii-calcoaceticus complex organisms were present on the skin in only 1 (0.6%) of 160 patients who were screened and in 1 (2%) of 49 soil samples. A. baumanii-calcoaceticus complex isolates were recovered from treatment areas in 7 of the 7 field hospitals sampled. Using pulsed-field gel electrophoresis, we identified 5 cluster groups in which isolates from patients were related to environmental isolates. One cluster included hospitalized patients who had not been deployed to Iraq. Among the clinical isolates, only imipenem, polymyxin B, and colistin demonstrated reliable in vitro antimicrobial activity. Generally, the environmental isolates were more drug susceptible than were the clinical isolates. Our findings suggest that environmental contamination of field hospitals and infection transmission within health care facilities played a major role in this outbreak. On the basis of these findings, maintaining infection control throughout the military health care system is essential. Novel strategies may be required to prevent the transmission of pathogens in combat field hospitals.
base and/or a large health care system, this manual tool was not tested. A system that appeared promising but was not available at the time of the...singular payment technique that could respond to the variety of conditions in these diverse settings. The primary savings gained from the use of DRGs are...frequently with the primary care and non-surgical specialties because of the nature of the CPT-4 manual . It contains more codes for surgical procedures
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
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.
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 ...
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
with critical information about the impact of military service on mental and physical health outcomes and healthcare utilization. For example...service experiences, such as deployment, and a variety of mental and physical health outcomes . Results of this study have both military and...including deployment and combat, on a variety of mental and physical health outcomes . With the 21 + year follow-up planned, this study will also
Taylor, Lockwood G; Thelus Jean, Rosenie; Gordon, Geoff; Fram, David; Coster, Trinka
The aim of this study was to develop a mother-child linked database consisting of all eligible active duty military personnel, retirees, and their dependents in order to conduct medication-related analyses to improve the safety and quality of care in the Military Health System (MHS). Eligible women of reproductive age with at least one pregnancy-related encounter between January 2005 and December 2013 receiving care in the MHS were included in the study population. Building on previously published algorithms, we used pregnancy-related diagnostic and procedure codes, parameterized temporal constraints, and data elements unique to the MHS to identify pregnancies ending in live births, stillbirth, spontaneous abortion, or ectopic pregnancy. Pregnancies ending in live births were matched to presumptive offspring using birth dates and family-based sponsorship identification. Antidepressant and antiepileptic use during pregnancy was evaluated using electronic pharmacy data. Algorithms identified 755,232 women who experienced 1,099,648 complete pregnancies with both pregnancy care encounter and pregnancy outcome. Of the 924,320 live birth pregnancies, 827,753 (90.0%) were matched to offspring. Algorithms also identified 5,663 stillbirths, 11,358 ectopic pregnancies, and 169,665 spontaneous abortions. Among the matched singleton live birth pregnancies, 7.1% of mothers were dispensed an antidepressant at any point during pregnancy, usually a selective serotonin reuptake inhibitor, (75.3%), whereas 1.3% of mothers were dispensed an antiepileptic drug. Copyright © 2015 John Wiley & Sons, Ltd.
Engel, Charles C; Bray, Robert M; Jaycox, Lisa H; Freed, Michael C; Zatzick, Doug; Lane, Marian E; Brambilla, Donald; Rae Olmsted, Kristine; Vandermaas-Peeler, Russ; Litz, Brett; Tanielian, Terri; Belsher, Bradley E; Evatt, Daniel P; Novak, Laura A; Unützer, Jürgen; Katon, Wayne J
War-related trauma, posttraumatic stress disorder (PTSD), depression and suicide are common in US military members. Often, those affected do not seek treatment due to stigma and barriers to care. When care is sought, it often fails to meet quality standards. A randomized trial is assessing whether collaborative primary care improves quality and outcomes of PTSD and depression care in the US military health system. The aim of this study is to describe the design and sample for a randomized effectiveness trial of collaborative care for PTSD and depression in military members attending primary care. The STEPS-UP Trial (STepped Enhancement of PTSD Services Using Primary Care) is a 6 installation (18 clinic) randomized effectiveness trial in the US military health system. Study rationale, design, enrollment and sample characteristics are summarized. Military members attending primary care with suspected PTSD, depression or both were referred to care management and recruited for the trial (2592), and 1041 gave permission to contact for research participation. Of those, 666 (64%) met eligibility criteria, completed baseline assessments, and were randomized to 12 months of usual collaborative primary care versus STEPS-UP collaborative care. Implementation was locally managed for usual collaborative care and centrally managed for STEPS-UP. Research reassessments occurred at 3-, 6-, and 12-months. Baseline characteristics were similar across the two intervention groups. STEPS-UP will be the first large scale randomized effectiveness trial completed in the US military health system, assessing how an implementation model affects collaborative care impact on mental health outcomes. It promises lessons for health system change. Copyright © 2014 Elsevier Inc. All rights reserved.
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.
Lin, Jie; Gill, Abegail; Zahm, Shelia H; Carter, Corey A; Shriver, Craig D; Nations, Joel A; Anderson, William F; McGlynn, Katherine A; Zhu, Kangmin
Research suggests that metformin may be associated with improved survival in cancer patients with type II diabetes. This study assessed whether metformin use after non-small cell lung cancer (NSCLC) diagnosis is associated with overall survival among type II diabetic patients with NSCLC in the U.S. military health system (MHS). The study included 636 diabetic patients with histologically confirmed NSCLC diagnosed between 2002 and 2007, identified from the linked database from the Department of Defense's Central Cancer Registry (CCR) and the Military Health System Data Repository (MDR). Time-dependent multivariate Cox proportional hazards models were used to assess the association between metformin use and overall survival during follow-up. Among the 636 patients, 411 died during the follow-up. The median follow-up time was 14.6 months. Increased post-diagnosis cumulative use (per 1 year of use) conferred a significant reduction in mortality (adjusted hazard ratio (HR) = 0.76; 95% CI = 0.65-0.88). Further analysis by duration of use revealed that compared to non-users, the lowest risk reduction occurred among patients with the longest duration of use (i.e. use for more than 2 years) (HR = 0.19; 95% CI = 0.09-0.40). Finally, the reduced mortality was particularly observed only among patients who also used metformin before lung cancer diagnosis and among patients at early stage of diagnosis. Prolonged duration of metformin use in the study population was associated with improved survival, especially among early stage patients. Future research with a larger number of patients is warranted. © 2017 UICC.
Everett Koop , Carson E. Beadle, Paul P. Cooper, Mary Jane England, Roger F. Greaves, Jacque J. Sokolov, Daniel Wright, and the Health Project...1996. Fries, James F., C. Everett Koop , Carson E. Beadle, Paul P. Cooper, Mary Jane England, Roger F. Greaves, Jacque J. Sokolov, Daniel Wright
King, Heidi B; Kesling, Kimberly; Birk, Carmen; Walker, Theodore; Taylor, Heather; Datena, Michael; Burgess, Brittany; Bower, Lyndsay
Partnership for Patients (PfP) was a national initiative sponsored by the Department of Health and Human Services, Centers for Medicare and Medicaid Services, to reduce preventable hospital acquired conditions (HACs) by 40% and readmissions (within 30 days) by 20%, by the end of 2013 (as compared to the baseline of CY2010). Along with partners across the nation, the Assistant Secretary of Defense for Health Affairs, Dr. Jonathan Woodson, pledged to support PfP in June 2011. Participation of the Military Health System (MHS) in PfP marked the implementation of the first enterprise-wide patient safety initiative. Three phases of the MHS initiative were developed to meet the aims of the national PfP initiative: (1) Planning and Design, (2) Implementation, and (3) Monitoring and Sustainment. The Planning and Design phase focused on the identification of evidence-based practices (Table III); the development of implementation guides; the implementation of various communication, education, and improvement strategies; and the development of methods by which to track progress and share successes. The implementation phase focused on identifying roles and responsibilities across all levels of care; creating, disseminating, and implementing evidence-based practices at participating military treatment facilities; and establishing a structured learning action network. Finally, during the monitoring and sustainment phase, per the guidance of the Agency for Healthcare Research and Quality, an overall HAC rate was developed for quarterly analysis. The HAC rate per 1,000 dispositions (i.e., discharges) was an aggregate of all PfP HACs. Using the HAC rate, the improvement rate was calculated by comparing the current quarter's HAC rate to the baseline (CY2010). This allowed the MHS to track the overall progress across the enterprise. The MHS achieved a number of accomplishments, including a 15.8% cumulative reduction in HACs by the end of 2013, an 11.1% reduction in readmissions
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
Hardoff, Daniel; Halevy, Ari
Our purpose is to illuminate health perspectives of adolescents in military service, who comprise the main bulk of military personnel. Two views are emphasized: the soldier as a developing adolescent and the healthcare of adolescent soldiers. The capacity for abstract thinking and future planning, characteristic of late adolescence, opposes the military challenges of obedience, disengagement from the family, and potential threats for physical injury and mental stress, in addition to the requirement for responsibility beyond the individual's personal needs. On the other hand, at discharge from military service, the mature young adult faces questions of a 17-year-old adolescent. Health perspectives regarding adolescents in military service include physical and mental health screening before draft; recruiting adolescents with chronic illnesses; specific healthcare issues during service, including routine medical care, psychosocial problems of young people in service and approach to suicide and to risk behaviors; health aspects of adolescent women in military frameworks; and the dual commitment of physicians as military officers. Professionals who care for the well-being of young people in their late teens and early 20s in military service need to consider the service period as an additional developmental stage within late adolescence that requires attention as part of the comprehensive healthcare.
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.
Manjelievskaia, Janna; Brown, Derek; Shriver, Craig D; Zhu, Kangmin
Chronic hepatitis C virus (HCV) is the most common blood-borne infection in the United States, with an estimated 2.7 to 3.9 million cases as of 2014. In August 2012, the Centers for Disease Control and Prevention (CDC) recommended 1-time HCV testing of all baby boomers. The objectives of this study were to (1) determine the proportion of people screened for HCV in the US Department of Defense Military Health System before and after the CDC screening recommendation for baby boomers and (2) assess whether certain patient or system factors were associated with screening for HCV before and after August 2012. We used a dataset containing 5% of beneficiaries randomly selected from the Military Health System Data Repository medical claims database for the period July 2011 through September 2013. Of 108 223 people eligible for HCV screening during the first period (July 2011 through July 2012), 1812 (1.7%) were screened. Of 109 768 people eligible during the second period (September 2012 through September 2013), 2599 (2.4%) were screened. HCV screening receipt was related to benefit type (Prime before August 2012: adjusted odds ratio [aOR] = 2.16; 95% confidence interval [CI], 1.89-2.46; Prime after August 2012: aOR = 1.93; 95% CI, 1.73-2.16) and care source (direct care before August 2012: aOR = 1.80; 95% CI, 1.57-2.07; direct care after August 2012: aOR = 2.45; 95% CI, 2.18-2.75); male sex (aOR = 1.17; 95% CI, 1.06-1.29) and black race (aOR = 1.20; 95% CI, 1.05-1.37) were associated with HCV testing only before August 2012. Interventions should be implemented to increase awareness and knowledge of the current national HCV testing recommendation among baby boomers to seek out testing and health care providers to perform screening.
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…
and CivilIian Specialists........................129 II1.C.45 Beneficiary Class by Comparison of Military and Civilian Hospital Plant...98.2 .0 Physicians 13.8 54 .9 4.8 Corpsmen 4.5 93.8 .1 1.7 Nurses .7 97.7 .. Dentists 1.0 97.5 Personnel .6 99.2 - Staff .3 99.1 - .o Hospital Plant...the same pattern exists, the distribution of income groups I within regions helps to expiain previously discussed differences in dental visits. The
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.
Pavlin, Julie A; Burkom, Howard S; Elbert, Yevgeniy; Lucero-Obusan, Cynthia; Winston, Carla A; Cox, Kenneth L; Oda, Gina; Lombardo, Joseph S; Holodniy, Mark
The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) had more than 18 million healthcare beneficiaries in 2011. Both Departments conduct individual surveillance for disease events and health threats. We performed joint and separate analyses of VA and DoD outpatient visit data from October 2006 through September 2010 to demonstrate geographic and demographic coverage, timeliness of influenza epidemic awareness, and impact on spatial cluster detection achieved from a joint VA and DoD biosurveillance platform. Although VA coverage is greater, DoD visit volume is comparable or greater. Detection of outbreaks was better in DoD data for 58% and 75% of geographic areas surveyed for seasonal and pandemic influenza, respectively, and better in VA data for 34% and 15%. The VA system tended to alert earlier with a typical H3N2 seasonal influenza affecting older patients, and the DoD performed better during the H1N1 pandemic which affected younger patients more than normal influenza seasons. Retrospective analysis of known outbreaks demonstrated clustering evidence found in separate DoD and VA runs, which persisted with combined data sets. The analyses demonstrate two complementary surveillance systems with evident benefits for the national health picture. Relative timeliness of reporting could be improved in 92% of geographic areas with access to both systems, and more information provided in areas where only one type of facility exists. Combining DoD and VA data enhances geographic cluster detection capability without loss of sensitivity to events isolated in either population and has a manageable effect on customary alert rates.
Pavlin, Julie A.; Burkom, Howard S.; Elbert, Yevgeniy; Lucero-Obusan, Cynthia; Winston, Carla A.; Cox, Kenneth L.; Oda, Gina; Lombardo, Joseph S.; Holodniy, Mark
Background The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) had more than 18 million healthcare beneficiaries in 2011. Both Departments conduct individual surveillance for disease events and health threats. Methods We performed joint and separate analyses of VA and DoD outpatient visit data from October 2006 through September 2010 to demonstrate geographic and demographic coverage, timeliness of influenza epidemic awareness, and impact on spatial cluster detection achieved from a joint VA and DoD biosurveillance platform. Results Although VA coverage is greater, DoD visit volume is comparable or greater. Detection of outbreaks was better in DoD data for 58% and 75% of geographic areas surveyed for seasonal and pandemic influenza, respectively, and better in VA data for 34% and 15%. The VA system tended to alert earlier with a typical H3N2 seasonal influenza affecting older patients, and the DoD performed better during the H1N1 pandemic which affected younger patients more than normal influenza seasons. Retrospective analysis of known outbreaks demonstrated clustering evidence found in separate DoD and VA runs, which persisted with combined data sets. Conclusion The analyses demonstrate two complementary surveillance systems with evident benefits for the national health picture. Relative timeliness of reporting could be improved in 92% of geographic areas with access to both systems, and more information provided in areas where only one type of facility exists. Combining DoD and VA data enhances geographic cluster detection capability without loss of sensitivity to events isolated in either population and has a manageable effect on customary alert rates. PMID:24386335
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.
Dall, Timothy M; Zhang, Yiduo; Chen, Yaozhu J; Wagner, Rachel C Askarinam; Hogan, Paul F; Fagan, Nancy K; Olaiya, Samuel T; Tornberg, David N
To estimate medical and indirect costs to the Department of Defense (DoD) that are associated with tobacco use, being overweight or obese, and high alcohol consumption. Retrospective, quantitative research. Healthcare provided in military treatment facilities and by providers participating in the military health system. The 4.3 million beneficiaries under age 65 years who were enrolled in the military TRICARE Prime health plan option in 2006. The findings come from a cost-of-disease model developed by combining information from DoD and civilian health surveys and studies; DoD healthcare encounter data for 4.1 million beneficiaries; and epidemiology literature on the increased risk of comorbidities from unhealthy behaviors. DoD spends an estimated $2.1 billion per year for medical care associated with tobacco use ($564 million), excess weight and obesity ($1.1 billion), and high alcohol consumption ($425 million). DoD incurs nonmedical costs related to tobacco use, excess weight and obesity, and high alcohol consumption in excess of $965 million per year. Unhealthy lifestyles are significant contributors to the cost of providing healthcare services to the nation's military personnel, military retirees, and their dependents. The continued rise in healthcare costs could impact other DoD programs and could potentially affect areas related to military capability and readiness. In 2006, DoD initiated Healthy Choices for Life initiatives to address the high cost of unhealthy lifestyles and behaviors, and the DoD continues to monitor lifestyle trends through the DoD Lifestyle Assessment Program.
Eekhout, Iris; Geuze, Elbert; Vermetten, Eric
Health care providers need to be aware that stress complaints that result from deployment can emerge even after many years. This has important implications for health care policies. The main aim of this study is to investigate the relation between the development of posttraumatic stress and other mental health complaints and the burden on (mental) health care after a deployment. For this study we used data from a large prospective cohort study on stress-factors related to deployment in 1007 Dutch soldiers, who were deployed to Afghanistan. Participants were assessed at six follow up times up until five years after deployment. In a Generalized Estimated Equations model we estimated the relation between mental health complaints and the utilization of psychological treatment and a general practitioner, respectively. Moreover, we studied the relation between mental health complaints and health care costs using bootstrap techniques. The results showed that higher scores for PTSD, depression and fatigue relate to increased use of a psychologist. And lower PTSD scores and higher depression, anxiety and somatization scores relate to increased odds to visit a GP. Furthermore, mental health complaints relate to higher costs. In conclusion, monitoring soldiers is important in order to be informed on the current demand for (mental) health care to satisfy the health care need of veterans. Early treatment, which is enabled by lowering barriers to care, relates to positive results and therefore, lower health care costs. Copyright © 2016 Elsevier Ltd. All rights reserved.
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…
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…
this estimate would equate to more than six times the amount spent on health care in 1984 (Weinberger & Oddone , 1989). Compared to the Consumer Price...health care industry (Weinberger & Oddone , 1989). The allowable lengths of stay upon which the Medicare reimbursement is based have motivated physicians...Obtained from the State of Washington, Health Care Authority, 4505 Woodview Drive SE, MS: QF-31, Olympia, WA 98504. Weinberger, M., & Oddone , E. (1989
health maintenance organization in California. (Jatulis, Bundek, & Legorreta , 1997). Fear Fear encompasses many issues and may include fear of...Health Nursing, 11(3), 145-149. Jatulis, D., Bundek, N., & Legorreta , A. (1997). Identifying predictors of satisfaction with access to medical care
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
Nee, Robert; Fisher, Evan; Yuan, Christina M; Agodoa, Lawrence Y; Abbott, Kevin C
Previous reports showed an increased early mortality after chronic dialysis initiation among the end-stage renal disease (ESRD) population. We hypothesized that ESRD patients in the Military Health System (MHS) would have greater access to pre-ESRD care and hence better survival rates during this early high-risk period. In this retrospective cohort study, using the US Renal Data System database, we identified 1,256,640 patients initiated on chronic dialysis from January 2, 2004 through December 31, 2014, from which a bootstrap sample of 3,984 non-MHS incident dialysis patients were compared with 996 MHS patients. We assessed care by a nephrologist and dietitian, erythropoietin administration, and vascular access use at dialysis initiation as well as all-cause mortality as outcome variables. MHS patients were significantly more likely to have had pre-ESRD nephrology care (adjusted OR [aOR] 2.9; 95% CI 2.3-3.7) and arteriovenous fistula used at dialysis initiation (aOR 2.2; 95% CI 1.7-2.7). Crude mortality rates peaked between the 4th and the 8th week for both cohorts but were reduced among MHS patients. The baseline adjusted Cox model showed significantly lower death rates among MHS vs. non-MHS patients at 6, 9, and 12 months. This survival advantage among MHS patients was attenuated after further adjustment for pre-ESRD nephrology care and dialysis vascular access. MHS patients had improved survival within the first 12 months compared to the general ESRD population, which may be explained in part by differences in pre-ESRD nephrology care and vascular access types. © 2017 S. Karger AG, Basel.
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
rates were higher in health care regions with larger inpatient CDI reservoirs, which were estimated by the healthcare- associated infection (HAI) metrics...development of diarrhea. Historically, CDI has been known as a hospital-acquired, antibiotic- associated diarrheal infection presenting in the...causative agent in the majority of antibiotic- associated diarrhea cases.2 However, in 2000, reports of increased incidence and severity renewed interest in
Morrow, A L; Rosenthal, J; Lakkis, H D; Bowers, J C; Butterfoss, F D; Crews, R C; Sirotkin, B
Pediatric immunization rates have increased in the United States since 1990. Nevertheless, national survey data indicate that up to one third of 2-year-old children in some states and urban areas lack at least one recommended dose of diphtheria-tetanus-pertussis (DTP)-, polio-, or measles-containing vaccines. Immunization has become a key measure of preventive pediatric health care in the United States. To achieve and maintain the national immunization goal that 90% of children receive all recommended immunizations by 2 years of age, the role of the health care system in immunization delivery must be examined. Urban eastern Virginia has a diverse population that obtains immunization services from public, private, and military providers and insurers. At the time of this survey, immunization services in Virginia were available free to all children through public health clinics and to military families when using a military facility. To examine access to pediatric immunization services and health system factors associated with underimmunization in a representative sample of children at 12 and 24 months of age. We conducted a household survey in urban eastern Virginia from April through September 1993. A total of 12 770 households in Norfolk and Newport News, VA, were selected for inclusion in the study using probability-proportionate-to-size cluster sampling. Use of probability-proportionate-to-size sampling ensured that children within each city had equal probability of being included in the survey. Selected households were visited by trained interviewers to determine their eligibility, defined as having at least one child 12 to 30 months of age residing in the household. In eligible households, parents were asked to participate in a standardized, 15-minute interview. Survey respondents were asked about household demographics, and for each eligible child, the immunization history, health insurance, the name and location of all immunization providers, the usual
military medical care. Efforts to downsize the medical infrastructure are a BRAC reality, and current efforts to privatize uniformed physicians and nurses... Corporation , 2002. Federal Employees Health Benefit Program Handbook. Washington, DC: U.S Office of Personnel Management. http://www.opm.gov/insure/handbook...Elizabeth Eiseman. Placing a Value on the Health Care Benefit for Active-Duty Personnel. RAND Report MG-385. Arlington, VA: RAND Corporation , 2005. Hosek
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
at military hospitals and clinics located on military bases. Women represent a significant percentage of the population eligible for MHS services...represent a significant percentage of the population served by the Department of Defense’s (DOD) Military Health System (MHS); as of the end of fiscal year...selection, and how information is shared among different levels within the MHS. In addition, we conducted site visits to six military hospitals
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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.
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.
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.
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.
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 ...
Jeffery, Diana D; Bulathsinhala, Lakmini; Kroc, Michelle; Dorris, Joseph
We compared prevalence, health care utilization, and costs over time for nonelderly adults diagnosed with fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS) in relation to timing of federal approvals for FMS drugs. We used military health care claims from October 2006 to September 2010. Retrospective, multiple-year comparisons were conducted using trend analyses, and time series regression-based generalized linear models. Over 5 years, FMS prevalence rates increased from 0.307% to 0.522%, whereas IBS and CFS prevalence rates remained stable. The largest increase in FMS prevalence occurred between 2007 and 2008. Health care utilization was higher for FMS cases compared to IBS and CFS cases. Over 5 years, the total cost for FMS-related care increased $163.2 million, whereas IBS costs increased $14.9 million and CFS cost increased $3.7 million. Between 2006 and 2010, total pharmacy cost for FMS cases increased from $55 million ($3,641/person) to $96.3 million ($3,557/person). Although cause and effect cannot be established, the advent of federally approved drugs for FMS in concert with pharmaceutical industry marketing of these drugs coincide with the observed changes in prevalence, health care utilization, and costs of FMS relative to IBS and CFS. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.
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
Malone, Ruth E.
Smoking impairs the readiness and performance of military personnel, yet congressional opposition has thwarted military tobacco control initiatives. Involvement of civilian organizations might alter this political dynamic. We interviewed 13 leaders of national civilian public health and tobacco control organizations to explore their perspectives on military tobacco control, inductively analyzing data for themes. Leaders believed that military tobacco use was problematic but lacked specific knowledge. Most supported smoke-free policies and prohibiting smoking in uniform; however, they opposed banning tobacco use, arguing that it would violate smokers’ rights. Most leaders inappropriately applied civilian models of policy development to the military context. A tobacco-free military is unlikely to be achieved without military–civilian partnerships that include educating civilian health leaders about military policy development and implementation. PMID:23409898
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.
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.
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.
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…
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…
Jai, Tun-Min; McCool, Barent N; Reed, Debra B
U.S. military families are experiencing high obesity rates similar to the civilian population. The Department of Defense's Military Health System (MHS) is one of the largest healthcare providers in the United States, serving approximately 9.2 million active duty service members, retirees, spouses, and children. The annual cost to the MHS for morbidities associated with being overweight exceeds $1 billion. The preschool age has been suggested as an opportune time to intervene for the prevention of obesity. Thus, this study investigated the current level of technology usage by military service member families and assessed their needs and interests in health/nutrition information. This needs assessment is crucial for researchers/educators to design further studies and intervention programs for obesity prevention in military families with young children. In total, 288 military parents (233 Army and 55 Air Force) at two military bases whose children were enrolled in military childcare centers in the southwestern United States participated in a Technology Usage in Military Family (TUMF) survey in 2013. Overall, both bases presented similar technology usage patterns in terms of computer and mobile device usage on the Internet. Air Force base parents had a slightly higher knowledge level of nutrition/health information than Army base parents. The TUMF survey suggested practical ways such as mobile applications/Web sites, social networks, games, etc., that health educators can use to disseminate nutrition/health information for obesity prevention among military families with young children.
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.
Lin, Jie; Carter, Corey A.; McGlynn, Katherine A.; Zahm, Shelia H.; Nations, Joel A.; Anderson, William F.; Shriver, Craig D.; Zhu, Kangmin
Introduction Accurate prognosis assessment after non-small cell lung cancer (NSCLC) diagnosis is an essential step for making effective clinical decisions. This study is aimed to develop a prediction model with routinely available variables to assess prognosis in patients with NSCLC in the U.S. Military Health System. Methods We used the linked database from the Department of Defense’s Central Cancer Registry (CCR) and the Military Health System Data Repository (MDR). The dataset was randomly and equally split into a training set to guide model development and a testing set to validate the model prediction. Stepwise Cox regression was used to identify predictors of survival. Model performance was assessed by calculating area under the receiver operating curves (AUC) and construction of calibration plots. A simple risk scoring system was developed to aid quick risk score calculation and risk estimation for NSCLC clinical management. Results The study subjects were 5,054 patients diagnosed with NSCLC between 1998 and 2007. Age, sex, tobacco use, tumor stage, histology, surgery, chemotherapy, peripheral vascular disease, cerebrovascular disease and diabetes mellitus were identified as significant predictors of survival. Calibration showed high agreement between predicted and observed event rates. The AUC reached 0.841, 0.849, 0.848, and 0.838 over one, two, three and five years, respectively. Conclusions This is the first NSCLC prognosis model for quick risk assessment within the MHS. After external validation, the model can be translated into clinical use both as a web-based tool and through mobile applications easily accessible to physicians, patients and researchers. PMID:26473644
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
Himmerich, Hubertus; Willmund, G D; Wesemann, U; Jones, N; Fear, N T
Despite joint participation in international military operations, few collaborative military mental health research projects have been undertaken by European countries. From a common perspective of military mental health researchers from Germany and the UK, the lack of shared research might be related not only to the use of different languages but also the different ways in which the two militaries provide mental health and medical support to operations and differences in military institutions. One area that is suitable for military health research collaboration within UK and German forces is mental health and well-being among military personnel. This could include the study of resilience factors, the prevention of mental disorder, mental health awareness, stigma reduction and the treatment of mental disorder. Military mental health research topics, interests and the studies that have been conducted to date in the UK and Germany have considerable overlap and commonality of purpose. To undertake the investigation of the long-term consequences of operational deployment, the specific burdens placed on military families and to further the understanding of the role of factors such as biomarkers for use in military mental health research, it seems advisable to forge international research alliances across European nations, which would allow for researchers to draw transcultural and generalisable conclusions from their work. Such an enterprise is probably worthwhile given the shared research interests of Germany and the UK and the common perspectives on military mental health in particular. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Health and Traumatic Brain Injury (DCoE) asked the RAND Corporation to conduct case studies to identify the ways in which civilian health plans...we conducted a small set of case studies of health plans to describe their approaches to assessing the quality of psychological health care. These... case studies had three primary aims: 1. to describe health plans’ efforts to assess the quality of psychological health care and the extent to which
Haddock, Christopher K.; Jahnke, Sara A.; Poston, Walker S.C.; Williams, Larry N.
Tobacco use is the leading cause of preventable death in the United States (US) and has been demonstrated to significantly harm the combat readiness of military personnel. Unfortunately, recent research demonstrated that cigarettes are sold at substantial discounts in military retail outlets. In fact, the military is the only retailer which consistently loses money on tobacco. Cheap tobacco prices have been identified by enlisted personnel and Department of Defense health policy experts as promoting a culture of tobacco use in the US Military. This paper provides an analysis of why current military tobacco pricing policy has failed to eliminate cheap tobacco prices as an incentive for use. A rationale for increasing tobacco prices also is presented along with recommendations for improved military tobacco control policy. PMID:23756017
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.
Military Studies Henry A. Arnold, COL Accepted this 10th day of December 2013 by: , Director, Graduate Degree Programs Robert F. Baumann...the affected area. 105Paule Lefebvre , “Operation Unified Assistance,” (Presentation, National Defense University 2005 Pacific Symposium, Waikiki, HI...tsunami related humanitarian assistance. 111Paule Lefebvre , “Operation Unified Assistance,” (Presentation, National Defense University 2005 Pacific
Military child care has not always been a model system. The services were inconsistent, many programs had serious deficiencies thus were failing to meet basic health and safety standards, and caregivers were poorly trained and poorly paid. However, in the late 1980's, the Government Accounting Office exposed the seriousness of the situation.…
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.
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
Seelig, Amber D; Jacobson, Isabel G; Donoho, Carrie J; Trone, Daniel W; Crum-Cianflone, Nancy F; Balkin, Thomas J
Examine the relationship between self-reported sleep parameters and indicators of resilience in a US military population (n = 55,021). 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. 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. 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. A commentary on this article appears in this issue on page 963. © 2016 Associated Professional Sleep Societies, LLC.
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
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.
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.
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
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.
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
Rhon, Daniel I; Deyle, Gail D; Gill, Norman W
Physical therapists frequently make important point-of-care decisions for musculoskeletal injuries and conditions. In the Military Health System (MHS), these decisions may occur while therapists are deployed in support of combat troops, as well as in a more traditional hospital setting. Proficiency with the musculoskeletal examination, including a fundamental understanding of the diagnostic role of musculoskeletal imaging, is an important competency for physical therapists. The purpose of this article is to present 3 cases managed by physical therapists in unique MHS settings, highlighting relevant challenges and clinical decision making. Three cases are presented involving conditions where the physical therapist was significantly involved in the diagnosis and clinical management plan. The physical therapist's clinical privileges, including the ability to order appropriate musculoskeletal imaging procedures, were helpful in making clinical decisions that facilitate timely management. The cases involve patients with an ankle sprain and Maisonneuve fracture, a radial head fracture, and a pelvic neoplasm referred through medical channels as knee pain. Clinical pathways from point of care are discussed, as well as the reasoning that led to decisions affecting definitive care for each of these patients. In each case, emergent treatment and important combat evacuation decisions were based on a combination of examination and management decisions. Physical therapists can provide important contributions to the primary management of patients with musculoskeletal conditions in a variety of settings within the MHS. In the cases described, advanced clinical privileges contributed to the success in this role.
Bailey, Jeffrey A; Morrison, Jonathan J; Rasmussen, Todd E
This review focuses on development and maturation of the tactical evacuation and en route care capabilities of the military trauma system in Afghanistan and discusses hard-learned lessons that may have enduring relevance to civilian trauma systems. Implementation of an evidence-based, data-driven performance improvement programme in the tactical evacuation and en route care elements of the military trauma system in Afghanistan has delivered measured improvements in casualty care outcomes. Transfer of the lessons learned in the military trauma system operating in Afghanistan to civilian trauma systems with a comparable burden of prolonged evacuation times may be realized in improved patient outcomes in these systems.
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.
Kaura, Mary A.
Military communications requirements are discussed, and commercial communication is presented as a potential solution for increased satellite capacity. Both the Army's tactical warfighting concept and the evolution of the modern battlefield to a highly sophisticated data environment in which large databases are transferred among echelons of command have caused a need for increased satellite capacity. This need combined with technology advancements in commercial communications (small mobile satellite terminals in conjunction with narrow spot beam technology) has resulted in the potential commercial communications that can meet the increased military requirements. NASA's Advanced Communications Technology Satellite which is intended to provide greater than a gigabit throughput capacity is considered to be one of the most promising wideband systems for military use.
Waller, Michael; McGuire, Annabel C L; Dobson, Annette J
This study assessed the extent to which alcohol consumption in a military group differed from the general population, and how alcohol affected the military group's health and social functioning. A cross sectional survey of military personnel (n = 5311) collected self-reported data on alcohol use (AUDIT scale) and general health, role limitations because of physical health problems (role physical), and social functioning scores (SF36 subscales). Logistic regression was used to compare drinking behaviours between the military sample and a general population sample, using the categories risky drinkers (>2 units per day), low risk drinkers (≤2 standard drinks per day) and abstainers. Groups in the military sample with the highest levels of alcohol misuse (harmful drinking AUDIT ≥ 16, alcohol dependence AUDIT ≥ 20, and binge drinking) were also identified. Linear regression models were then used to assess the association between alcohol misuse and SF36 scores. There were fewer risky drinkers in the military sample than in the general population sample. There were also fewer abstainers, but more people who drank at a lower risk level (≤2 standard drinks per day), than in a sample of the general population. Harmful drinking and alcohol dependence were most commonly observed in men, younger age groups, non-commissioned officers and lower ranks as well as reserve and ex-serving groups. Alcohol misuse was clearly associated with poorer general health scores, more role limitations because of physical health problems, and lower social functioning. Although risky drinking was lower in the military group than in the general population, drinking was associated with poorer health, more limitations because of physical health problems, and poorer social functioning in Defence members. These results highlight the potential benefits for Defence forces in reducing alcohol use among members, in both those groups identified at highest risk, and across the military
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
36 Plucker and Beghetto., 156. 37 Csikszentmihalyi, Creativity, 42. 38 Thomas S. Kuhn, The Structure of Scientific Revolutions...Ikujiro Nonaka. Enabling Knowledge Creation. Oxford: Oxford University Press, 2000. Kuhn, Thomas. The Structure of Scientific Revolutions. 3rd. Chicago...understanding of the system that yield military creativity would enable commanders and staffs to structure their operations process to fully exploit
Trego, Lori Lyn
Developing a feasible, fundable, and sustainable program of research (POR) is an essential career goal in research. Nurse scientists can lay the foundation for a salient POR as early as during their doctoral studies. The ensuing years of postdoctoral experiences are informative as they expand their research skills and knowledge around their research area of interest. Following graduation from a doctoral research program, novice military nurse scientists (MNS) are placed in positions that are conducive to fostering a POR. Military organizational support and the rich experiences of peers and mentors facilitate early career development of MNS. The purpose of this article is to present a conceptual framework for research career development of the novice MNS. Using an exemplar POR in military women's health, the concepts are operationalized to illustrate how the military environment enhances the development of a successful POR. Copyright © 2017 Elsevier Inc. All rights reserved.
Landrum, Michael L; Neumann, Charlotte; Cook, Courtney; Chukwuma, Uzo; Ellis, Michael W; Hospenthal, Duane R; Murray, Clinton K
Rates of hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) infections are reported as decreasing, but recent rates of community-onset S. aureus infections are less known. To characterize the overall and annual incidence rates of community-onset and hospital-onset S. aureus bacteremia and skin and soft tissue infections (SSTIs) in a national health care system and to evaluate trends in the incidence rates of S. aureus bacteremia and SSTIs and the proportion due to MRSA. Observational study of all Department of Defense TRICARE beneficiaries from January 2005 through December 2010. Medical record databases were used to identify and classify all annual first-positive S. aureus blood and wound or abscess cultures as methicillin-susceptible S. aureus or MRSA, and as community-onset or hospital-onset infections (isolates collected >3 days after hospital admission). Unadjusted incidence rates per 100,000 person-years of observation, the proportion of infections that was due to MRSA, and annual trends for 2005 through 2010 (examined using the Spearman rank correlation test or the Mantel-Haenszel χ2 test for linear trend). During 56 million person-years (nonactive duty: 47 million person-years; active duty: 9 million person-years), there were 2643 blood and 80,281 wound or abscess annual first-positive S. aureus cultures. Annual incidence rates varied from 3.6 to 6.0 per 100,000 person-years for S. aureus bacteremia and 122.7 to 168.9 per 100,000 person-years for S. aureus SSTIs. The annual incidence rates for community-onset MRSA bacteremia decreased from 1.7 per 100,000 person-years (95% CI, 1.5-2.0 per 100,000 person-years) in 2005 to 1.2 per 100,000 person-years (95% CI, 0.9-1.4 per 100,000 person-years) in 2010 (P = .005 for trend). The annual incidence rates for hospital-onset MRSA bacteremia also decreased from 0.7 per 100,000 person-years (95% CI, 0.6-0.9 per 100,000 person-years) in 2005 to 0.4 per 100,000 person-years (95% CI, 0.3-0.5 per 100
Magpantay-Monroe, Edna Ruiz
The military and veteran populations in the U. S. state of Hawaii have a strong presence in the local communities. It was this substantial presence that provided the impetus to integrate military and veteran health into a Bachelor's of Science in Nursing (BSN) curriculum. This exploratory study investigated the relationship between the integration of military and veteran health into a psychiatric mental health BSN curriculum and nursing students' understanding of the many facets of military veterans' health. The concepts related to military and veterans' health was infused in didactic, seminar, simulation and clinical instruction. Examples of approaches to teaching include guest speakers from military clinical partners, inclusion of military/military families in simulation, the reading of evidence-based articles focusing on the military and veteran population, use of identification of problem based learning and clinical placements in hospital(s) and community agencies specific to servicing military and veterans and their families. Students were encouraged to record their reflections which provided some insight on the value of integration of this important segment into the curriculum. Classroom discussions and reflections were analyzed using an exploratory method of inquiry by categorizing themes which revealed some biases about the military and veteran population and how working with this population helped students to understand their health needs. Although the data is limited, it an important foundation for further exploration into the significance of the integration of military and veterans' health in a psychiatric mental health BSN nursing curriculum. The recommendation is to further include military and veterans' health across the curriculum in order to help future nursing graduates understand and evaluate their role in working with this distinctive population, recognize challenges and opportunities in working with this population and identify available
to be sociable (33.4%). The most commonly ES-8 Executive Summary to the 2011 Health Related Behaviors Survey of Active Duty Military Personnel 20...standards and current best practices in the field of survey research. Although the target population and the topics addressed in the 2011 HRB were...enlisted, active duty military personnel to identify any items or survey instructions that were unclear. It is a best practice to pretest the survey
community - level mental health outcomes . The hypotheses we tested include: 1) Relative to Community First Responders (CFRs) that do not receive military... mental health in the military, stigma associated with mental health issues, and use of appropriate referral and support practices for helping someone... mental health in the military, stigma associated with mental health issues, and accessing care and support
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. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.
Holloway, Julie; Everly, George S
Mental health services for veterans of humanitarian assistance (HA) missions is a critical and growing need within the United States military. The mental health impacts of such missions are both similar to and different from those experienced on combat missions, and may have an equally significant impact on the health and wellness of our troops. As the US military increasingly deploys humanitarian teams on both peacetime and contingency missions, this need can be expected to grow and must be addressed with more research and more attention to prevention, screening, and treatment. In this paper we will present a brief summary of the possible mental health effects of military HA missions, and propose remedies to address the adverse conditions that may arise in the pre-deployment, deployment, and redeployment settings.
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.
Wilson, Candy; Trego, Lori; Rychnovsky, Jacqueline; Steele, Nancy; Foradori, Megan
In 2008, four doctorate military nurse scientists representing the triservices (Army, Navy, and Air Force) identified a common interest in the health and care of all women in the armed forces. For 7 years, the team's shared vision to improve servicewomen's health inspired them to commit to a rigorous schedule of planning, developing, and implementing an innovative program that has the capability of advancing scientific knowledge and influencing health policy and practice through research. The ultimate goal of the Military Women's Health Research Interest Group (MWHRIG) is to support military clinicians and leaders in making evidence-based practice and policy decisions. They developed a 4-pronged approach to cultivate the science of military women's healthcare: evaluate the existing evidence, develop a research agenda that addresses gaps in knowledge, facilitate the collaboration of multidisciplinary research, and build the bench of future researchers. The MWHRIG has been a resource to key leaders; its value has been validated by multiservice and multidisciplinary consultations. However, the journey to goal attainment has only been achieved by the enduring commitment of these MWHRIG leaders and their passion to ensure the health and wellbeing of the many women who serve in the United States military. This article describes their journey of dedication.
Lehavot, Keren; Hoerster, Katherine D; Nelson, Karin M; Jakupcak, Matthew; Simpson, Tracy L
Women who have served in the military are a rapidly growing population. No previous studies have compared directly their health status to that of civilians. To provide estimates of several leading U.S. health indicators by military service status among women. Data were obtained from the 2010 Behavioral Risk Factor Surveillance Survey, a U.S. population-based study. Health outcomes were compared by military status using multivariable logistic regression among the female participants (274,399 civilians, 4221 veterans, 661 active duty, and 995 National Guard or Reserves [NG/R]). Data were analyzed in August 2011. Veterans reported poorer general health and greater incidence of health risk behaviors, mental health conditions, and chronic health conditions than civilian women. Active duty women reported better access to health care, better physical health, less engagement in health risk behaviors, and greater likelihood of having had a recent Pap than civilian women. Women from the NG/R were comparable to civilians across most health domains, although they had a greater likelihood of being overweight or obese and reporting a depressive and anxiety disorder. Compared with civilian women, NG/R women rated their health and access to health care similarly and active duty women rated theirs better on several domains, but veterans consistently reported poorer health. Published by Elsevier Inc.
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.
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
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
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.
Dobmeyer, Anne C
The rapid expansion of integrated behavioral health care in primary care medical settings introduces a number of ethical challenges faced by teams of health professionals from different disciplines. As military health care settings have increasingly implemented primary care behavioral health models of service delivery, distinct ethical dilemmas have emerged. This article examines two of these ethical issues, competence and multiple relationships, through presentation of clinical scenarios in military integrated primary care settings. Relevant professional ethical guidelines for psychologists, social workers, and physicians are examined. Recommendations for the ethical practice of primary care behavioral health, as well as suggestions for future development of professional ethical guidelines, are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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…
important information to the field of preventive medicine and public health, benefiting both military and civilian populations. Previous cohort ... studies , including the Framingham Heart Study and the Nurses’ Cohort Study, have expanded our understanding of causes of heart disease and cancer. The
objectives ut the active force. It is a major management tool for the active torce and an element of the military compensation system. Provisions for the...for the volntory retirement of re, ilar oXficers ot all branches of sevice after 40 years of duty, at the discretion of tie P’resident. Suhsequnt Acts...tiscal year and are sent to the I)efense Manpower Data Ceuiter (IIMOC) where they are ,,aintained after a series o quality tests . re passed. h, data
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.
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)
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)
Lyk-Jensen, Stéphanie Vincent; Weatherall, Cecilie Dohlmann; Jepsen, Peter Winning
Public concern about soldiers' mental health has increased over the last decade. Yet the large literature on the mental health problems of returning soldiers relies primarily on self-reported measures that may suffer from non-response bias, usually refers to older conflicts, and focuses mainly on specific diagnoses such as PTSD. Another challenge is that the differences between soldiers and non-soldiers are not necessarily causal, instead possibly reflecting an underlying propensity towards active military service. Using the objective measures of hospitalizations and the purchase of mental health medication, this paper is the first to investigate the effect of recent military deployments on a broader measure of mental health, for a full population of Danish soldiers and a comparison group of eligible men. We exploit a panel of Danish health administrative records and use propensity score matching process, using unique observables such as ability tests. Matching is helpful in both reducing the selection bias from observables and determining pre- and post-deployment period for the comparison group. Then, we estimate the effect of deployment in a difference-in-differences setting, controlling for time trends and other omitted variables affecting both groups. Overall, we find a significant and long-lasting adverse effect of military deployment on soldiers' mental health, regardless of the comparison groups and underlying assumptions. Copyright Â© 2016 Elsevier B.V. All rights reserved.
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.
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 between January 2012–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 (χ2=5.019, p=0.285). The most commonly addressed health topics were exercise/fitness (23.5%), other mental health concerns (19.7%), alcohol/DUI (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. PMID:26032388
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.
Kanesarajah, J; Waller, M; Zheng, W Y; Dobson, A J
The benefit of military unit cohesion to morale and psychological resilience is well established. But it remains unclear whether unit cohesion modifies the association between deployment-related traumatic exposure and mental health problems. To examine the association between unit cohesion, traumatic exposure and poor mental health [symptoms of post-traumatic stress disorder (PTSD), psychological distress and alcohol dependency] and assess whether the relationship between traumatic exposure and poor mental health differs by level of unit cohesion. A self-reported cross-sectional survey of Australian military personnel deployed to Iraq or Afghanistan between 2001 and 2009. Among 11411 participants, those with low levels of unit cohesion had higher odds of PTSD symptoms [aOR (95% CI): 2.54 (1.88, 3.42)], very high psychological distress [aOR (95% CI): 4.28 (3.04, 6.02)] and a high level of alcohol problems [aOR (95% CI): 1.71 (1.32, 2.22)] compared with those reporting high unit cohesion on deployment. Higher exposure to traumatic events on deployment was associated with greater risk of PTSD symptoms, very high levels of psychological distress and high levels of alcohol problems in this cohort. However, there was no evidence of a statistically significant interaction between unit cohesion and traumatic exposures in influencing poor mental health. Our findings suggest that both unit cohesion and traumatic exposure are independently associated with poor mental health. Efforts to improve military unit cohesion may help to improve the mental health resilience of military personnel, regardless of their level of traumatic exposure. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: email@example.com.
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.
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
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.
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
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.
A healthy, well-fed, educated populace is synonymous with a prospering economy. Yet, when planning their budgets, governments tend to emphasize infrastructural/industrial projects and defence rather than investing in health, education and other social programmes to eliminate the widespread poverty and high mortality of its population, which would assure a more promising future in the long-term. As citizens, nurses are responsible for initiating and supporting action to meet the health and social needs of the public. And in keeping with ICN's 1989 resolution on nuclear war, INR presents some facts on social and defence spending to show how health needs are often being deprived by emphasis on others sectors, particularly defence. The aim is "to encourage nurses to critically appraise expenditure on health and welfare at a national and global level in relation to that spent on conventional and nuclear arms and to assist nurses to develop strategies of action to contribute to international peace."
MILITARY FACILITIES, *URBAN AREAS, MILITARY OPERATIONS, INFORMATION SYSTEMS , COMPUTER APPLICATIONS, ENVIRONMENTAL MANAGEMENT, LAND AREAS, GEOGRAPHICAL INFORMATION SYSTEMS , SATELLITE IMAGERY, REGIONAL PLANNING.
Kimerling, Rachel; Gima, Kristian; Smith, Mark W.; Street, Amy; Frayne, Susan
Objectives. We examined the utility of the Veterans Health Administration (VHA) universal screening program for military sexual violence. Methods. We analyzed VHA administrative data for 185 880 women and 4139888 men who were veteran outpatients and were treated in VHA health care settings nationwide during 2003. Results. Screening was completed for 70% of patients. Positive screens were associated with greater odds of virtually all categories of mental health comorbidities, including posttraumatic stress disorder (adjusted odds ratio [AOR]=8.83; 99% confidence interval [CI] = 8.34, 9.35 for women; AOR = 3.00; 99% CI = 2.89, 3.12 for men). Associations with medical comorbidities (e.g., chronic pulmonary disease, liver disease, and for women, weight conditions) were also observed. Significant gender differences emerged. Conclusions. The VHA policies regarding military sexual trauma represent a uniquely comprehensive health care response to sexual trauma. Results attest to the feasibility of universal screening, which yields clinically significant information with particular relevance to mental health and behavioral health treatment. Women’s health literature regarding sexual trauma will be particularly important to inform health care services for both male and female veterans. PMID:17971558
Kimerling, Rachel; Gima, Kristian; Smith, Mark W; Street, Amy; Frayne, Susan
We examined the utility of the Veterans Health Administration (VHA) universal screening program for military sexual violence. We analyzed VHA administrative data for 185,880 women and 4139888 men who were veteran outpatients and were treated in VHA health care settings nationwide during 2003. Screening was completed for 70% of patients. Positive screens were associated with greater odds of virtually all categories of mental health comorbidities, including posttraumatic stress disorder (adjusted odds ratio [AOR]=8.83; 99% confidence interval [CI] = 8.34, 9.35 for women; AOR = 3.00; 99% CI = 2.89, 3.12 for men). Associations with medical comorbidities (e.g., chronic pulmonary disease, liver disease, and for women, weight conditions) were also observed. Significant gender differences emerged. The VHA policies regarding military sexual trauma represent a uniquely comprehensive health care response to sexual trauma. Results attest to the feasibility of universal screening, which yields clinically significant information with particular relevance to mental health and behavioral health treatment. Women's health literature regarding sexual trauma will be particularly important to inform health care services for both male and female veterans.
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.
Lv, Yipeng; Xue, Chen; Ge, Yang; Ye, Feng; Liu, Xu; Liu, Yuan; Zhang, Lulu
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 health system. 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. 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' satisfaction included staff categories, satisfaction with environment, and satisfaction with medical quality. 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.
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
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.
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.
Gibala, Martin J; Gagnon, Patrick J; Nindl, Bradley C
Militaries from around the globe have predominantly used endurance training as their primary mode of aerobic physical conditioning, with historical emphasis placed on the long distance run. In contrast to this traditional exercise approach to training, interval training is characterized by brief, intermittent bouts of intense exercise, separated by periods of lower intensity exercise or rest for recovery. Although hardly a novel concept, research over the past decade has shed new light on the potency of interval training to elicit physiological adaptations in a time-efficient manner. This work has largely focused on the benefits of low-volume interval training, which involves a relatively small total amount of exercise, as compared with the traditional high-volume approach to training historically favored by militaries. Studies that have directly compared interval and moderate-intensity continuous training have shown similar improvements in cardiorespiratory fitness and the capacity for aerobic energy metabolism, despite large differences in total exercise and training time commitment. Interval training can also be applied in a calisthenics manner to improve cardiorespiratory fitness and strength, and this approach could easily be incorporated into a military conditioning environment. Although interval training can elicit physiological changes in men and women, the potential for sex-specific adaptations in the adaptive response to interval training warrants further investigation. Additional work is needed to clarify adaptations occurring over the longer term; however, interval training deserves consideration from a military applicability standpoint as a time-efficient training strategy to enhance soldier health and performance. There is value for military leaders in identifying strategies that reduce the time required for exercise, but nonetheless provide an effective training stimulus.
NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Institute for Defense Analyses,4850 Mark Center...Drive,Alexandria,VA,22311-1882 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S...plans: Prime, a health maintenance organization (HMO); Standard, a fee-for-service plan (FFS); and Extra, a preferred provider organization (PPO
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
distress or impairment • Anxious or irritable • Reduced self -control • Poor focus • More severe or persistent distress or impairment • Leaves lasting...encourage continued engagement in care once the person has reached out. Most civilian approaches to overcoming self -stigma for people engaged in care ...effects on mental health (e.g., reduce self -esteem). These findings and the feedback of the expert panel guided the development of the 13 priorities
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
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.
assurance on internal controls over financial reporting. Internal Controls: Financial Management , Feeder Systems, and Reporting The Sarbanes - Oxley Act...beneficiaries; – use performance- based clinical reporting by managed care support contractors and the direct care system; – strengthen incentives to...contracts, DoD has initiated some activities to streamline acquisition management and performance- based service contracts; however, more can be done to
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
AFRL-SA-BR-SR-2011-0001 THE ASSOCIATION BETWEEN MENTAL HEALTH AND CIGARETTE SMOKING IN ACTIVE DUTY MILITARY MEMBERS Erich W...COVERED (From – To) Jul 2009 – Jun 2010 4. TITLE AND SUBTITLE The Association Between Mental Health and Cigarette Smoking in Active Duty Military...determine if a relationship exists between mental health disorders and cigarette smoking in active duty military members. If a relationship exists
Christensen, Brandon N; Yaffe, Joanne
This study contrasts the characteristics of clients using military mental health services in deployed and nondeployed settings, the communications between their mental health providers and commanders, and the impact of mental health services on their military duties. The study explored the rates of command communication and duty restrictions across settings and referral sources. The study used secondary data from two predominantly Air Force sources: (1) deployed data collected in 2005 at Al Udeid Air Base, Qatar; and (2) nondeployed data collected in 2001 at various nondeployed settings. Chi2 analyses were used to compare the demographic variables, command communication, and duty restrictions. Among self-referrals, there were higher rates of command communication and duty restrictions in the deployed setting. Further analysis found that the rate of self-referral to mental health services did not vary significantly across settings despite the barriers of increased command communications and duty restrictions in the deployed setting. This study extends the findings of Rowan and Campise's 2006 initial nondeployed study into the deployed environment.
Do shorter delays to care and mental health system renewal translate into better occupational outcome after mental disorder diagnosis in a cohort of Canadian military personnel who returned from an Afghanistan deployment?
Boulos, David; Zamorski, Mark A
Mental disorders in military personnel result in high rates of attrition. Military organisations have strengthened their mental health systems and attempted to overcome barriers to care in order to see better outcomes. This study investigated the roles of mental health services renewal and delay to care in Canadian Armed Forces (CAF) personnel diagnosed with mental disorders. Administrative data were used to identify a retrospective cohort of 30,513 CAF personnel who deployed in support of the mission in Afghanistan. Study participants included 508 individuals with a mental disorder diagnosis identified from CAF medical records of a weighted, stratified random sample of 2014 individuals selected from the study cohort. Weighted Cox proportional hazards regression assessed the association of diagnosis era and delay to care with the outcome, after controlling for a broad range of potential confounders (eg, disorder severity, comorbidity). Taylor series linearisation methods and sample design weights were applied in generating descriptive and regression analysis statistics. The outcome was release from military service for medical reasons, assessed using administrative data for the 508 individuals with a mental disorder diagnosis. 17.5% (95% CI 16.0% to 19.0%) of the cohort had a mental disorder diagnosis after an Afghanistan-related deployment, of which 21.3% (95% CI 17.2% to 25.5%) had a medical release over a median follow-up of 3.5 years. Medical release risk was elevated for individuals diagnosed before 30 April 2008 relative to those with recent diagnoses (adjusted HR (aHR)=1.77 (95% CI 1.01 to 3.11)) and for individuals with a long delay to care (>21 months after return) relative to those with intermediate delays (8-21 months, aHR 2.47=(95% CI 1.28 to 4.76)). Mental health services renewal in the CAF was associated with a better occupational outcome for those diagnosed with mental disorders. Longer delays to care were associated with a less favourable outcome
Do shorter delays to care and mental health system renewal translate into better occupational outcome after mental disorder diagnosis in a cohort of Canadian military personnel who returned from an Afghanistan deployment?
Boulos, David; Zamorski, Mark A
Objective Mental disorders in military personnel result in high rates of attrition. Military organisations have strengthened their mental health systems and attempted to overcome barriers to care in order to see better outcomes. This study investigated the roles of mental health services renewal and delay to care in Canadian Armed Forces (CAF) personnel diagnosed with mental disorders. Design Administrative data were used to identify a retrospective cohort of 30 513 CAF personnel who deployed in support of the mission in Afghanistan. Study participants included 508 individuals with a mental disorder diagnosis identified from CAF medical records of a weighted, stratified random sample of 2014 individuals selected from the study cohort. Weighted Cox proportional hazards regression assessed the association of diagnosis era and delay to care with the outcome, after controlling for a broad range of potential confounders (eg, disorder severity, comorbidity). Taylor series linearisation methods and sample design weights were applied in generating descriptive and regression analysis statistics. Primary outcome The outcome was release from military service for medical reasons, assessed using administrative data for the 508 individuals with a mental disorder diagnosis. Results 17.5% (95% CI 16.0% to 19.0%) of the cohort had a mental disorder diagnosis after an Afghanistan-related deployment, of which 21.3% (95% CI 17.2% to 25.5%) had a medical release over a median follow-up of 3.5 years. Medical release risk was elevated for individuals diagnosed before 30 April 2008 relative to those with recent diagnoses (adjusted HR (aHR)=1.77 (95% CI 1.01 to 3.11)) and for individuals with a long delay to care (>21 months after return) relative to those with intermediate delays (8–21 months, aHR 2.47=(95% CI 1.28 to 4.76)). Conclusions Mental health services renewal in the CAF was associated with a better occupational outcome for those diagnosed with mental disorders. Longer
Naito, Neal A; Higgins, Stephen T
To provide insight on the feasibility and utility of implementing a broad based incentive program for health within the Military Health System (MHS). Published studies, articles, and information on the use of financial incentives in the military setting and to promote healthy behaviors were reviewed. Health care costs in the MHS have more than doubled over the past decade. The high prevalence of modifiable risk behaviors such as tobacco abuse, physical inactivity and obesity and their associated chronic diseases are accounting for a significant percentage of the growth. One evidence-based approach to address this issue would be the implementation of a broad based incentive program for health whereby all MHS beneficiaries would be eligible to receive some type of financial remuneration for meeting positive personal health metrics (e.g. not smoking or a normal body mass index). This approach if designed appropriately has the potential to have a high level of acceptance within the current beneficiary population since financial incentives are already used widely in the military to help meet overall manpower requirements. The use of a MHS wide financial incentives program to instill healthy behaviors in beneficiaries' may be an effective means to curb rising healthcare cost. Copyright © 2012 Elsevier Inc. All rights reserved.
Miroshnichenko, Iu V; Goriachev, A B; Krasavin, K D; Golubenko, R A; Gaĭnov, V S; Tikhonov, V S; Stavila, A G; Klochkova, I V
Authors presented a historical summary about formation and development of military formulary system and quantitative and qualitative characteristics of the fifth edition of the Drug formulary. The new Drug formulary is a list of drugs developed on the basis of multi-criteria choice of optimal alternatives according clinical and pharmacoeconomic effectiveness, costs with due regard to possible pharmacological support for troops. The fifth edition of the Drug Formulary fully covers medical and social demands of military servicemen, of military retirees and members of their families for the effective drugs during the treatment of socially important and common aliments within the framework of established government guarantee.
Chizh, I M
The article is dedicated to the outstanding figure in national medicine--colonel-general MD E.I. Smirnov (1904-1989), the Hero of Socialist Labour, member of the Academy of Medical Sciences of the USSR, who was the Head of the Main Military Sanitary Department of the Red Army during the Great Patriotic war, and the Minister of Health of the USSR in the post-war period. The main attention of the author is drawn on the contribution of E.I. Smirnov to the development of military medicine. The article makes a detailed analysis of the role of E. Smirnov in the development and practical implementation of military medical doctrine and the antiepidemic support system during the years of the Great Patriotic War, as well as his contribution for organizational arrangement of field therapy as an independent scientific discipline and as a subject of study in the system of medical education; his merits in organization of specialized medical care; formation of an institution of senior medical specialists; reforms in military medical education. The article contains many concrete examples which characterize a celebrated personality of E.I. Smirnov and his leadership qualities.
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.
Chu, Carol; Stanley, Ian H.; Hom, Melanie A.; Lim, Ingrid C.; Joiner, Thomas E.
Following deployment, soldiers may struggle to cope with the after-effects of combat service and experience increased suicidality. Therefore, connection to mental health services is vital. Research regarding the relationship between deployment, suicidality, and mental health connections has been equivocal, with some studies finding a link between deployment history and mental health outcomes, and others not. The purpose of this study was to examine the effects of military deployment on mental health and service utilization outcomes using a longitudinal design. Deployment history, mental health visits, symptoms of suicidality, and various mental health outcomes were assessed in a sample of 1,566 Army recruiters at study entry and 18-months follow-up. Deployment history was positively associated with mental health visits, number of major depressive episodes, and acquired capability for suicide at baseline; however, no significant relationship between deployment, mental health visits, and any other suicide or mental health-related outcomes emerged at baseline or follow-up. Findings suggest a disconnection from mental health services among military personnel. Implications for treatment and suicide prevention efforts among military personnel are discussed. PMID:28959502
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.
Military service is associated with unique risks to women's reproductive health. As increasing numbers of women are serving in the military, and a greater proportion of United States Veterans are women, it is essential that obstetrician-gynecologists are aware of and well prepared to address the unique health care needs of this demographic group. Obstetrician-gynecologists should ask about women's military service, know the Veteran status of their patients, and be aware of high prevalence problems (eg, posttraumatic stress disorder, intimate partner violence, and military sexual trauma) that can threaten the health and well-being of these women. Additional research examining the effect of military and Veteran status on reproductive health is needed to guide the care for this population. Moreover, partnerships between academic departments of obstetrics and gynecology and local branches of the Veterans Health Administration are encouraged as a means of optimizing the provision of comprehensive health care to this unique group of women.
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
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.
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.
Weld, Konstantine Keian; Padden, Diane; Ricciardi, Richard; Bibb, Sandra C Garmon
The results reported in this article are from a larger descriptive study examining the health literacy rates in active duty military personnel receiving health care within a culture of universal access. The purpose of this article is to describe the health literacy skills among a sample of active duty military personnel with comparison to the national population. Data were collected using the shortened version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine (REALM) in a convenience sample of 155 active duty subjects at a major military hospital from January 2007 through May 2007. Results indicate that military personnel have adequate health literacy skills although variations were noted on the basis of health training and race/ethnicity. Although the S-TOFHLA was found to be a practical tool for assessing health literacy in a high-tempo health care setting, additional reliability and validity testing is needed.
higher levels of command. Except for the work of a rela- tively small number of Western mil- itary experts fluent in Russian, most of this published...laboratory research unit for re- search on turbojet engines, com- pressors, turbines , etc., and a practice airfield for modem combat and transport...include: naval tactics; scientific Communism; philosophy; celestial navigation; radioelec- tronics; a foreign language; hydro - meteorology; military
prohibited. RAND electronic documents are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of...out with the bath water . It is important to recognize that there are at least two places where talented individuals are leaving the military...generally from a particular occupational group or community) “sponsor” junior officers, who then are given specific assignments to help shape their
hybrid nature of military theaters all around the world. Operations will be held in difficult terrains and will involve many new concepts like...emphasized that uncertainty is part of the nature of war (Clausewitz, 2007). According to Clausewitz (2007), “war is the realm of uncertainty; three...can be characterized by standardization and uniformity, tactical logistics is more variable due to the unpredictable nature of battlefield (Kress
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.
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.
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.
Smith, Tyler C; Zamorski, Mark; Smith, Besa; Riddle, James R; LeardMann, Cynthia A; Wells, Timothy S; Engel, Charles C; Hoge, Charles W; Adkins, Joyce; Blaze, Dan
Background: The US military is currently involved in large, lengthy, and complex combat operations around the world. Effective military operations require optimal health of deployed service members, and both mental and physical health can be affected by military operations. Methods: Baseline data were collected from 77,047 US service members during 2001–2003 as part of a large, longitudinal, population-based military health study (the Millennium Cohort Study). The authors calculated unadjusted, adjusted, and weighted means for the Medical Outcomes Study Short Form 36-item Survey for Veterans physical (PCS) and mental component summary (MCS) scores over a variety of demographic and military characteristics at baseline. Results: The unadjusted mean PCS and MCS scores for this study were 53.4 (95% confidence interval: 53.3–53.4) and 52.8 (95% confidence interval: 52.7–52.9). Average PCS and MCS scores were slightly more favorable in this military sample compared to those of the US general population of the same age and sex. Factors independently associated with more favorable health status included male gender, being married, higher educational attainment, higher military rank, and Air Force service. Combat specialists had similar health status compared to other military occupations. Having been deployed to Southwest Asia, Bosnia, or Kosovo between 1998 and 2000 was not associated with diminished health status. Conclusion: The baseline health status of this large population-based military cohort is better than that of the US general population of the same age and sex distribution over the same time period, especially in older age groups. Deployment experiences during the period of 1998–2001 were not associated with decreased health status. These data will serve as a useful reference for other military health studies and for future longitudinal analyses. PMID:18039387
might be promising for military information systems as well. In this paper, we discuss the potentials of multi-media databases and data mining . Both...directions focus on the handling of a vague information need of a user. In general, data mining systems allow a higher degree of vagueness than multi-media
Omid—Helmand River Valley...................57 Figure 9. Operation Omid Partner Team—Kandahar City .............................................58... cycles and patterns of behavior? Perhaps we perceive our environment as a complicated system filled with complicated subsystems and parts (nodes...car got flooded with water .” Emergent causality or perhaps systemic causality. 3 execution. However, current Military Doctrine fails to fully
Telemedicine plays a critical role within the Department of Veterans Affairs (VA) Veterans Health Administration by allowing the surveillance and care of patients who are isolated by geography, poverty, and disability. In military settings, telemedicine is being widely used to identify injury and illness and aid in the treatment, rehabilitation, and recovery of combat-wounded soldiers in theater. Rapid advances in both domains are transforming the way clinicians provide care, education, and support to patients with traumatic brain injury (TBI) and their families. This article discusses the military and VA telemedicine capabilities that are supporting the care of service members and veterans with TBI. These capabilities include new technologies that enhance the identification of TBI, management of symptoms in theater, and application of proven technologies (interactive video, Internet, and World Wide Web) to improve overall care coordination throughout military and VA systems. The impact of distance learning, teleconsultation, telerehabilitation, and home telehealth programs is also described within this context.
The Role of Special and Incentive Pays in Retaining Military Mental Health Care Providers James Hosek, Shanthi Nataraj, Michael G. Mattock, Beth J...how alternative S&I pay adjust- ments affect the retention of mental health care officers, however, and as a result policymak- ers lack an analytical...of the Secre- tary of Defense, Personnel and Readiness, responds to the need for such a basis for military mental health care providers. The report
Barrett, Drue H; Boehmer, Tegan K; Boothe, Vickie L; Flanders, W Dana; Barrett, Drue H
This study evaluated the association between military service and health-related quality of life (HRQOL), using a large, population-based sample of U.S. adults. Participants in the 2000 Behavioral Risk Factor Surveillance System were characterized as active duty personnel (N = 1,163), reserves (N = 1,055], veterans (N = 22,558), or no military service (N = 141,620). HRQOL was described by sex and military status. Logistic regression was used to calculate sex-specific adjusted odds ratios. Active duty men were more likely than men without military service to report 14 or more days of activity limitation, pain, and not enough rest in the past 30 days. Reserve personnel reported better overall HRQOL than nonmilitary participants, and no difference in HRQOL was observed between veterans and persons with no military service. Recommendations are made to monitor HRQOL of active duty and reserve personnel over time and to include HRQOL measures in military-based surveys of active duty troops.
Kimerling, Rachel; Street, Amy E; Pavao, Joanne; Smith, Mark W; Cronkite, Ruth C; Holmes, Tyson H; Frayne, Susan M
We examined military-related sexual trauma among deployed Operation Enduring Freedom and Operation Iraqi Freedom veterans. Of 125 729 veterans who received Veterans Health Administration primary care or mental health services, 15.1% of the women and 0.7% of the men reported military sexual trauma when screened. Military sexual trauma was associated with increased odds of a mental disorder diagnosis, including posttraumatic stress disorder, other anxiety disorders, depression, and substance use disorders. Sexual trauma is an important postdeployment mental health issue in this population.
Street, Amy E.; Pavao, Joanne; Smith, Mark W.; Cronkite, Ruth C.; Holmes, Tyson H.; Frayne, Susan M.
We examined military-related sexual trauma among deployed Operation Enduring Freedom and Operation Iraqi Freedom veterans. Of 125 729 veterans who received Veterans Health Administration primary care or mental health services, 15.1% of the women and 0.7% of the men reported military sexual trauma when screened. Military sexual trauma was associated with increased odds of a mental disorder diagnosis, including posttraumatic stress disorder, other anxiety disorders, depression, and substance use disorders. Sexual trauma is an important postdeployment mental health issue in this population. PMID:20558808
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
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.
Woo, Chung Hee; Kim, Sun Ah
This study was done to evaluate the Military Mental Health Promotion Program. The program was an email based cognitive behavioral intervention. The research design was a quasi-experimental study with a non-equivalent control group pretest-posttest design. Participants were 32 soldiers who agreed to participate in the program. Data were collected at three different times from January 2012 to March 2012; pre-test, post-test, and a one-month follow-up test. The data were statistically analyzed using SPSS 18.0. The effectiveness of the program was tested by repeated measures ANOVA. The first hypothesis that the level of depression in the experimental group who participated in the program would decrease compared to the control group was not supported in that the difference in group-time interaction was not statistically significant (F=2.19, p=.121). The second and third hypothesis related to anxiety and self-esteem were supported in group-time interaction, respectively (F=7.41, p=.001, F=11.67, p<.001). Results indicate that the program is effective in improving soldiers' mental health status in areas of anxiety and self-esteem.
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.…
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.…
Kaplan, Jonathan D.; Sabol, Mark A.; Wisher, Robert A.; Seidel, Robert J.
Discusses the Military Language Tutor (MILT), a language-tutor authoring system, examining the development of a proof of principal version of MILT's two-dimensional Arabic microworld, which uses speech input to control an animated agent in solving an authored problem and describing an evaluation of the speech-driven microworld at Fort Campbell,…
Kaplan, Jonathan D.; Sabol, Mark A.; Wisher, Robert A.; Seidel, Robert J.
Discusses the Military Language Tutor (MILT), a language-tutor authoring system, examining the development of a proof of principal version of MILT's two-dimensional Arabic microworld, which uses speech input to control an animated agent in solving an authored problem and describing an evaluation of the speech-driven microworld at Fort Campbell,…
Hoy-Ellis, Charles P; Shiu, Chengshi; Sullivan, Kathleen M; Kim, Hyun-Jun; Sturges, Allison M; Fredriksen-Goldsen, Karen I
Converging evidence from large community-based samples, Internet studies, and Veterans Health Administration data suggest that transgender adults have high rates of U.S. military service. However, little is known about the role of prior military service in their mental health later in life, particularly in relation to identity stigma. In this article, we examine relationships between prior military service, identity stigma, and mental health among transgender older adults. We used a subsample of transgender older adults (n = 183) from the 2014 survey of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS). We employed weighted multivariate linear models to evaluate the relationships between psychological health-related quality of life (HRQOL), depressive symptomatology (Center for Epidemiological Studies Depression Scale [CES-D] scores), identity stigma, and prior military service, controlling for background characteristics. Identity stigma was significantly related with higher depressive symptomatology and lower psychological HRQOL. Having a history of prior military service significantly predicted lower depressive symptomatology and higher psychological HRQOL. The relationships between psychological HRQOL, identity stigma, and prior military service were largely explained by depressive symptomatology. Prior military service significantly attenuated the relationship between identity stigma and depressive symptomatology. By identifying the role of military service in the mental health of transgender older adults, this study provides insights into how prior military service may contribute to resilience and positive mental health outcomes. Directions for future research are discussed. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Theophanous, Christos; Kalashnikova, Mariya; Sadler, Claire; Barreras, Elizabeth; Fung, Cha-Chi; Bruning, Madeleine
Medical student education on military health topics is critical in ensuring optimal future care for military service members and their families. Keck School of Medicine of the University of Southern California (Keck SOM) students were invited to participate in an anonymous, voluntary, online survey ("Pre") rating their level of interest, awareness, exposure and comfort with military health issues on a 5-point Likert scale. A student-organized program of four voluntary lectures discussing military health-related topics was then implemented. Students were invited to re-take the survey ("Post") and also indicate which, if any, lectures they had attended. 230 students completed the "Pre" survey. A statistically significant deviation in responses was observed in all four questions, showing high interest (mean: 3.19 ± 1.20, P = 0.002), low awareness (mean: 2.52 ± 1.15, P < 0.001), low comfort (mean: 2.66 ± 1.11, P < 0.001), and low exposure (mean: 1.80 ± 0.95, P < 0.001) to military health issues. 132 students completed the "Post" survey, including 37 lecture attendees and 95 non-attendees. A statistically significant difference in the level of interest (P < 0.05) and exposure (P < 0.05) was observed between these groups. Medical schools that lack military health curricula may underprepare students to care for military-affiliated patients. Student-led programs can help introduce this topic before formalized curricula are instituted.
System (5) and the National Health and Nutrition Examination Survey; however, these surveys do not specifically sample military personnel. Data on obesity...that focus on quality sleep, activity engagement, and improved nutrition (see www.armymedi cine.mil for more information). In addition, other DoD...and body mass index: findings from the National Health and Nutrition Examination Survey, 2001- 2006. Prev Chronic Dis 2009;6:A121. 40. Heinrich KM
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.
Mancuso, James D; Garges, Eric C; Hickey, Patrick W; Coldren, Rodney L; Korman, Amy K; Keep, Lisa W; DeFraites, Robert F; Sanchez, Jose L
Since 2006, the Division of Tropical Public Health at the Uniformed Services University (USU) has sponsored the Tropical Medicine Training Program (TMTP). Despite practice guidelines stating that global health education should include the collection and evaluation of data on the impact of the training experiences, no quantitative evaluation of program outcomes had previously occurred. The objective of this report was to evaluate TMTP outcomes to guide program improvement. We developed an anonymous, web-based survey to assess program outcomes as part of routine program evaluation. The survey addressed four main areas of potential TMTP impact: (1) career engagement, (2) military service contributions, (3) scholarly activity, and (4) acquisition of knowledge and skills. In February 2016, we sent the survey electronically to 222 program participants between Fiscal Years 2006 and 2015 who had e-mails available in DoD administrative systems. Ninety-eight (44%) of these responded to the survey. TMTP demonstrated impact in several areas. Increased knowledge and skills were reported by 81% of trainees, and 70% reported increased interest in serving at military overseas medical research laboratories. Subsequent career engagement by trainees included seven assignments to overseas research laboratories, 71 military deployments, and 193 short-term military missions. The ability to achieve many of the desired outcomes was associated with time elapsed since completion of formal medical education, including 24% who were still enrolled in graduate medical education. The TMTP has improved the U.S. military's ability to perform surveillance for emerging tropical and infectious diseases and has contributed to force health protection and readiness. Although many of the outcomes, such as service in the overseas research laboratories and military deployments, are dependent on military service requirements, these results remain perhaps the most relevant ways that the TMTP meets global
Schoneboom, Bruce A; Perry, Susan M; Barnhill, William Keith; Giordano, Nicholas A; Wiltse Nicely, Kelly L; Polomano, Rosemary C
Chronic noncancer pain (CNCP) in military and veteran populations mirrors the experience of chronic pain in America; however, these two populations have unique characteristics and comorbid conditions such as traumatic brain injuries, postconcussive syndrome, posttraumatic stress disorder, and behavioral health disorders that complicate the diagnosis and treatment of chronic pain. Military members and veterans may also be stigmatized about their conditions and experience problems with integration back into healthy lifestyles and society as a whole following deployments and after military service. The military and veteran health care systems have made chronic pain a priority and have made substantial strides in addressing this condition through advances in practice, education, research, and health policy. Despite this progress, significant challenges remain in responding to the wide-spread problem of chronic pain. The purpose of this article is to: (a) examine the state of CNCP in military and veteran populations; (b) discuss progress made in pain practice, education, research, and health policy; and (c) examine research, evidence-based practice guidelines, and expert consensus reports that are foundational to advancing pain care and improving health for military service members and veterans with CNCP. In addition, recommendations are proposed to address this widespread health problem through the expanded use of advanced practice registered nurses, the implementation of models of care, and use of national resources to educate health care providers, support practice, and promote effective pain care. Copyright © 2016 Elsevier Inc. All rights reserved.
Roustaei, Narges; Jamali, Hajar; Jamali, Mohammad Reza; Nourshargh, Pegah; Jamali, Jamshid
Objectives Quality of sleep (QoS) in individuals is affected by their occupation and is one of the factors affecting the quality of life (QoL). Few studies have evaluated the relationship between QoS and QoL in military women personnel. The aim of this study was to assess QoL and QoS, and compare their relationship among military and non-military women in Tehran. Methods This cross-sectional study was carried out on 90 women working in Tehran during 2014, 30 were military forces, 30 were military staff, and 30 were civilian organizations staff. The female subjects were selected from Amin Police University and Tehran Health Insurance Organization using simple random sampling. The 36-Item Short Form Health Survey (SF-36) and Pittsburgh Sleep Quality Index (PSQI) were used to measure QoL and QoS, respectively. The relationship between QoL and QoS was assessed using Pearson’s correlation coefficient. Results The mean scores of QoL in the military forces, military staff, and civilian organizations staff were 58.94±17.71, 67.18±13.52, and 69.10±12.51, respectively. Among the study participants, 62.9% of military forces, 20.0% of military staff, and 17.1% of the civilian organizations staff had poor QoS. Mental health as one of the dimensions of QoL was significantly different between military forces and civilian organizations staff. The association between QoL and QoS was statistically significant in military forces and military staff women. Conclusions Low QoS and QoL in the army necessitates that the authorities offer programs and appropriate strategies to improve mental health of QoL and promotion of QoS. PMID:28439383
Sparrow, Katherine; Kwan, Jamie; Howard, Louise; Fear, Nicola; MacManus, Deirdre
There is growing awareness of the problem of intimate partner violence (IPV) among military populations. IPV victimisation has been shown to be associated with mental disorder. A better understanding of the link between IPV and mental disorder is needed to inform service development to meet the needs of military families. We aimed to systematically review the literature on the association between IPV victimisation and mental health disorders among military personnel. Searches of four electronic databases (Embase, Medline, PsycINFO, and Web of Science) were supplemented by reference list screening. Heterogeneity among studies precluded a meta-analysis. Thirteen studies were included. There was stronger evidence for an association between IPV and depression/alcohol problems than between IPV and PTSD. An association between IPV and mental health problems was more frequently found among veterans compared to active duty personnel. However, the link between IPV and alcohol misuse was more consistently found among active duty samples. Finally, among active duty personnel psychological IPV was more consistently associated with depression/alcohol problems than physical/sexual IPV. The review highlighted the lack of research on male IPV victimisation in the military. There is evidence that the burden of mental health need may be significant among military personnel who are victims of IPV. The influence of attitudes towards gender in the military on research in this area is discussed. Further research is needed to inform development of services and policy to reduce IPV victimisation and the mental health consequences among military personnel.
Kintzle, Sara; Schuyler, Ashley C; Ray-Letourneau, Diana; Ozuna, Sara M; Munch, Christopher; Xintarianos, Elizabeth; Hasson, Anthony M; Castro, Carl A
Sexual trauma remains a pervasive problem in the military. The deleterious mental health outcomes related to incidents of sexual assault have been well-documented in the literature, with particular attention given to the development of posttraumatic stress disorder (PTSD) and utilization of mental health services. Much effort has focused on addressing issues of sexual trauma in the military. The purpose of this study was to examine the incidences of sexual assault in female veterans, the relationship to PTSD and mental health care utilization. The research explored differences in pre- and post-9/11 veterans. Data were collected using a 6-prong recruitment strategy to reach veterans living in Southern California. A total of 2,583 veterans completed online and in-person surveys, of which 325 female veterans were identified for inclusion in the analysis. Forty percent of the sample reported experiencing sexual assault during their military service. A history of military sexual trauma was found to be a substantial contributor to symptoms of PTSD. A majority of female veterans who indicated being sexually assaulted during their military service met the cutoff for a diagnosis of PTSD. Although only a minority of participants who indicated being a victim of sexual assault reported receiving immediate care after the incident, most had received mental health counseling within the past 12 months. Findings point to the need for additional prevention programs within the military and opportunities for care for victims of military sexual assault. (c) 2015 APA, all rights reserved).
detectable negative effects on deployability or military attrition. Attention should be given to those recently divorced regarding mental health and substance abuse treatment and prevention strategies....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
Mason, Robert; Gintert, Larry; Rippen, Marc; Skelton, Don; Zunino, James; Gutmanis, Ivars
Micro electromechanical systems (MEMS) and microsystems technologies are seeing increased consideration for use in military applications. Assets ranging from aircraft and communications to munitions may soon employ MEMS. In all cases, MEMS devices must perform their required functions for the duration of the equipment's mission profile. Long-term performance in a given scenario can be assured through an understanding of the predominant MEMS failure modes. Once the failure modes have been identified, standardized tests will be developed and conducted on representative devices to detect the potential for these failures. Failure mechanisms for MEMS devices in severe environments may include wear and stiction. While corrosion is not usually a concern for commercial MEMS devices, as they are made primarily of silicon, other materials, including metallics, are being considered for MEMS to provide enhanced robustness in military applications. When these materials are exposed to aggressive military environments, corrosion may become a concern. Corrosion of metallic packaging and interconnect materials may also present issues for overall performance. Considering these corrosion and degradation issues, there is a need to implement standardized tests and requirements to ensure adequate long-term performance of MEMS devices in fielded and emerging military systems. To this end, Concurrent Technologies Corporation has been tasked by the U.S. Army to initiate efforts to standardize test methods that have been developed under previous activities. This paper presents an overview of the MEMS activities under the standardization effort and the MEMS reliability test guidelines that have been drafted as a first phase of this effort.
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
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.
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.
Lee, Jennifer; Sanders, Karen M; Cox, Malcolm
With over one million service members separating from the military over the next several years, it seems prudent to ask whether U.S. health care professionals and systems of care are prepared to evaluate and treat the obvious and more subtle injuries ascribed to military deployment and combat. The authors suggest that several systemic interventions-adding military health history sections to electronic health records, history and physical diagnosis textbooks, and licensing exams while also ensuring that this content is adequately covered in undergraduate and graduate health professional training-will enable all health care professionals to provide service members and veterans with the high-quality care that they deserve. The authors also highlight the U.S. Department of Veterans Affairs' recent innovations in education and care delivery, which are enhancing the education of thousands of students and residents, who will be better prepared to care for veterans after receiving this training.
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
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.
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
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.
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.
The VSIL system uses “ lego -like” soft building blocks that can be dragged from a component model library to easily configure a complex system for...designs easily. They do not use “soft” modular lego -like components, so that a complete system or sub-system can be quickly and easily “assembled...Physics from the University of Michigan. CHARLES COHEN has been working in the fields of modeling and simulation, image processing, robotics , human
Villagran, Melinda; Ledford, Christy J W; Canzona, Mollie Rose
As servicewomen leave behind their military rank and status to become veterans, they must learn to effectively navigate a fragmented structure of care and communicate their health care needs. This study proposes a culture-centered approach to understanding how structural changes contribute to a reduction in positive health perception and behavior as active duty servicewomen transition to a veteran status. Results suggest during the process of disengagement from military cultural norms, women veterans' health care prevention service utilization decreases, and their physical and mental health decreases through the transition. These findings highlight the need for widely available and culturally appropriate programs to meet the needs of this unique patient population.
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 re-integration periods. Despite widespread acknowledgement 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. PMID:21707172
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. (c) 2015 APA, all rights reserved).
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.
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.
IN THE MILITARY: A SYSTEMS APPROACH by James G. Alden Amber L. Hopeman Jodi A. Neff June 2007 Thesis Advisor: Erik Jansen Thesis Co...Approved by: Dr. Erik Jansen Thesis Advisor George Lober Co-Advisor Dr. Gordon McCormick Second Reader Dr. Gordon McCormick Chairman...help you answer it. We also would like to thank our other two advisors, Erik Jansen and George Lober. Erik, we couldn’t have done this without your
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
most pop - ular commercial products are bought." We should "expect the importance of applying technology to national security prob- lems to...during soldering can cause " popcorning ", the tendency for a package to crack or explode when moisture in the package expands. While evidence...using com- mercial parts in a military microwave landing system. B.4 Design and Supportability Workshop The following summary and conclusions are
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%…
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%…
Kuz'min, S A
Results of medical examination of citizens of military age living in the Orenburg region for a decade are given. Noted that over the study period in the region have been positive changes: performance fitness for military service on health increased from 62.9% in 2000 to 67.7% in 2009 and projected to the positive dynamics in 2020 also marked improvement in physical fitness and the citizens of military age, a significant reduction in the number of recruits with poor and low power.
Hoerster, Katherine D; Lehavot, Keren; Simpson, Tracy; McFall, Miles; Reiber, Gayle; Nelson, Karin M
Little is known about health and health behavior differences among military service veterans, active duty service members, National Guard/Reserve members, and civilians. Several important differences were identified among U.S. women from these subpopulations; to identify areas for targeted intervention, studies comparing men from these subpopulations are needed. To compare veteran, military, and civilian men on leading U.S. health indicators. Data were from the 2010 Behavioral Risk Factor Surveillance Survey, a U.S. population-based study. In 2011, self-reported health outcomes were compared using multivariable logistic regression across male veterans (n=53,406); active duty service members (n=2144); National Guard/Reserve service members (n=3724); and civilians (n=110,116). Multivariate logistic regression results are presented. Despite better healthcare access, veterans had poorer health and functioning than civilians and National Guard/Reserve members on several indicators. Veterans also were more likely than those on active duty to report diabetes. Veterans were more likely to report current smoking and heavy alcohol consumption than National Guard/Reserve members and civilian men, and lack of exercise compared to active duty men and National Guard/Reserve members. National Guard/Reserve men had higher levels of obesity, diabetes, and cardiovascular disease (versus active duty and veterans, active duty, and civilians, respectively). Active duty men were more likely to report current smoking and heavy alcohol consumption than civilians and National Guard/Reserve members, and reported more smokeless tobacco use than civilians. Veterans have poorer health and health behaviors; increased prevention efforts are needed from veteran-serving organizations. Despite good health, active duty men reported unhealthy lifestyles, indicating an important area for prevention efforts. Published by Elsevier Inc.
Morrison-Beedy, Dianne; Passmore, Denise; D'Aoust, Rita
To address the unique needs of our returning military and veterans, the White House initiated the Joining Forces campaign and has encouraged colleges of nursing throughout the nation to support this mission. At the University of South Florida College of Nursing, we have implemented a multifaceted approach that addresses education, research, and employment. These military-related programs have been unified under our RESTORE LIVES (Research and Education to Rehabilitate and Restore the Lives of Veterans, Services Members and their Families) initiative. To accomplish this mission, we enhanced our curriculum to include veteran health care issues, developed research that addresses veteran wellness, launched an accelerated program to enable veterans and military personnel with medical experience to obtain their baccalaureate in nursing, and encouraged a culture within the college that is supportive of military-based health care and employment needs. We have shared our experiences through webinars and presentations and by hosting a national conference. Copyright © 2015 Elsevier Inc. All rights reserved.
Kleider, Bertrand; Pabst, Jean-Yves
The nineteenth century caused significant upheavals in numerous fields like techniques, in philosophy and in politics. Military pharmacy took advantage of this transition period. Military chemists became regular soldiers and officers: their training became resolutely scientific and their assignments covered extensive fields. Heiress of an important tradition of teaching, the School of Pharmacy from Strasbourg trained numerous chemists whose held important positions in the Health Service of the armies. The creation of the imperial School of the military Health service in Strasbourg in 1856 and the integration of the chemists in this School in 1864 represented the height of the pharmaceutical teaching in the Alsatian capital city. The attendance of the military students and their sacrifices during the siege in 1870 marked the memory of their contemporaries from Strasbourg.
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
mentioned that their leader development programs went beyond the traditional classroom format to include some or all of the following: stretch...how the military will operate in the future as a joint force and provides a format for leader development, states that joint force lead- ers should...and Halpin, 2001, p. vii) Most best-practice programs go beyond the traditional classroom format to include any or all of the following: stretch
Ragel, Brian T; Klimo, Paul; Grant, Gerald A; Taggard, Derek A; Nute, David; McCafferty, Randall R; Ellenbogen, Richard G
The 4-year military Health Professions Scholarship Program (HPSP) provides funds for medical school tuition, books, and a monthly stipend in exchange for a 4-year military commitment (to receive all physician bonuses, an additional 3 months must be served). To analyze the economics of the HPSP for students with an interest in neurosurgery by comparing medical school debt and salaries of military, academic, and private practice neurosurgeons. Salary and medical school debt values from the American Association of Medical Colleges, salary data from the Medical Group Management Association, and 2009 military pay tables were obtained. Annual cash flow diagrams were created to encompass 14.25 years that spanned 4 years (medical school), 6 years (neurosurgical residency), and the first 4.25 years of practice for military, academic, and private practice neurosurgeons. A present value economic model was applied. Mean medical school loan debt was $154,607. Mean military (adjusted for tax-free portions), academic, and private practice salaries were $160,318, $451,068, and $721,458, respectively. After 14.25 years, the cumulative present value cash flow for military, academic, and private practice neurosurgeons was $1 193 323, $2 372 582, and $3 639 276, respectively. After 14.25 years, surgeons with medical student loans still owed $208 761. The difference in cumulative annual present value cash flow between military and academic and between military and private practice neurosurgeons was $1,179,259 and $2,445,953, respectively. The military neurosurgeon will have little to no medical school debt, whereas the calculated medical school debt of a nonmilitary surgeon was approximately $208,000.
Suitable for Use in Combined Military Civil Environments. Dream or Reality ? C J Skinner, S Cochrane, M Field, R Johnston AMS Ltd Lyon Way, Frimley...Suitable for Use in Combined Military Civil Environments. Dream or Reality ? 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S...Terrorism Systems Suitable for Use in Combined Military Civil Environments. Dream or Reality ? RTO-MP-SCI-158 25 - 3 UNCLASSIFIED/UNLIMITED UNCLASSIFIED
Seelig, Amber D; Jacobson, Isabel G; Smith, Besa; Hooper, Tomoko I; Gackstetter, Gary D; Ryan, Margaret A K; Wells, Timothy S; MacDermid Wadsworth, Shelley; Smith, Tyler C
Previous research has shown that military women often experience potentially severe health outcomes following deployment. Data from the Millennium Cohort Study, a 21-year longitudinal study examining the health effects of military service, were used to examine this issue. In longitudinal analyses (2001-2008) carried out among US military women (n = 17,481), the authors examined positive screens for depression, anxiety, panic, and posttraumatic stress disorder in relation to deployment in support of the operations in Iraq and Afghanistan, while adjusting for relevant baseline and time-varying covariates. Women who were deployed and reported combat-related exposures had greater odds than nondeployed women of reporting symptoms of a mental health condition (odds ratio = 1.91, 95% confidence interval: 1.65, 2.20), after adjustment for demographic, military, and behavioral covariates. In addition, higher stress, problem drinking, and a history of mental illness were significantly associated with increased risk of later mental health conditions. In contrast, women in the Reserves or National Guard and those with higher education were at decreased risk of mental health conditions (all P 's < 0.01). As the roles and responsibilities of women in the military expand and deployments continue, designing better prevention and recovery strategies specifically for women are critical for overall force health protection and readiness.
Proceedings Brandon, William T. and Strohl , Mary Jane. " A General Purpose Mili- tary Satellite Communications System Concept." Proceedings, International...SATELLITE SYSTEMS INTEROPERABILITY I by - David Martin Skiver B.S., United States Air Force Academy, 1977 Ioi t A thesis submitted to the Faculty of...Telecommunications 1DTIC -JUL 1 5 1985 C.. G. ( ,.-.. DISTRIBUTION STAThMEN A Approved for public ieleasel Distribution Unlimited 85 06 24 098 t-i . .; .... /i
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.
Michael, G L; Fear, N T; Hacker Hughes, J
To examine the pattern of out-patient mental health care referrals for military personnel deployed to the Falklands Islands, 1986-96. Data from referral books of British Military Community Mental Health Nurses based in the Falkland Islands were abstracted, entered into an electronic database and analysed. Over the period 1986-96, 538 Service personnel were referred to the mental health out-patient facility on the Falkland Islands. The majority were male (96%) and junior ranks (81%). Approximately a third of patients were referred for reasons relating to alcohol (31%) and for over two-thirds of patients no follow-up was required (68%). Differences were observed by Service with the Army having more referrals due to alcohol than the other two Services, whilst the Navy had more deliberate self-harm referrals and the RAF more referrals for anxiety. The lack of information on the total population deployed to the Falkland Islands over this period limits the interpretation of the results.
Goodman, Adam M; Katz, Jeffrey S; Dretsch, Michael N
Emotionally relevant pictorial stimuli utilized in studies to characterize both normal and pathological emotional responses do not include military scenarios. Failures to replicate consistent findings for military populations have led to speculation that these image sets do not capture personally relevant experiences. The Military Affective Picture System (MAPS) was developed consisting of 240 images depicting scenes common among military populations. A Self-Assessment Manikin was administered to a 1) U.S. Army soldiers and a 2) non-military population. Findings revealed gender differences in valence and dominance dimensions, but not arousal, for both samples. Valence scores were higher for the military. Arousal ratings decrease as a product of combat exposure. Civilian females demonstrated stronger correlations of valence and arousal when viewing positive or negative images. Given the limited power achieved in the current studies' gender comparisons; it would be difficult to draw major conclusions regarding the interaction of combat exposure or military status with gender for each of the categories. Without having included the IAPS ratings for comparison it is difficult to conclude whether effects only pertain to viewing MAPS images, or if there was unintentional selection bias. Additional ratings would provide better assessments for these effects in both males and females. The MAPS has potential as a screening instrument and clinical evaluation tool for assessing treatment outcomes for individuals with combat-related psychopathology. The MAPS is freely available for research to non-profit groups upon request at http://www.cla.auburn.edu/psychology/military-affective-picture-system/. Copyright © 2015 Elsevier Ltd. All rights reserved.
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.
controls over financial reporting. Internal Controls: Financial Management , Feeder Systems, and Reporting The Sarbanes - Oxley Act of 2002 (P.L. 107-204...service. During his career with Ford, General Smith held a number of financial and managerial positions, including Manager for Sarbanes - Oxley ...performance- based clinical reporting by managed care support contractors and the direct care system; – strengthen incentives to providers and health
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 on-campus programs to improve the health of their students. The military academies led the way, and the first of these early programs to become operational was located at the US Military Academy at West Point, New York, in 1830.
Fletcher, J.D.; Zdybel, Frank
Intelligent instructional systems can be distinguished from more conventional approaches by the automation of instructional interaction and choice of strategy. This approach promises to reduce the costs of instructional materials preparation and to increase the adaptability and individualization of the instruction delivered. Tutorial simulation…
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
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
should be aware that notwithstanding any other provision of law , no person shall be subject to a penalty for failing to comply with a collection of...ONA and SoSA to be pseudoscience . He further argues that SoSA relies on formal systems analysis and that it should be recognized as the same analyti...show its successes, the Army likely was attracted to SOD by the ability of the Israel Defense Forces (IDF) to engage the Israeli political leadership
conditions (for example, scoliosis ), B Conditions that are known to have existed before military service, and B Conditions that began after military service...example, purchases of health IT to track adherence to clinical guidelines or spending on education and training to improve compliance with safety...structure may make providing the appropriate training on the use of health IT systems easier and thereby reduce the risks that may exist when
Ross, Elliot M; Harper, Stephen A; Cunningham, Cord; Walrath, Benjamin D; DeMers, Gerard; Kharod, Chetan U
As part of a Military Emergency Medical Services (EMS) system process improvement initiative, the authors sought to objectively evaluate the U.S. military EMS system for the island of Okinawa. They applied a program evaluation tool currently utilized by the U.S. National Park Service (NPS). A comprehensive needs assessment was conducted to evaluate the current Military EMS system in Okinawa, Japan. The NPS EMS Program Audit Worksheet was used to get an overall "score" of our assessment. After all the data had been collected, a joint committee of Military EMS physicians reviewed the findings and made formal recommendations. From 2011 to 2014, U.S. military EMS on Okinawa averaged 1,345 ± 137 patient transports annually. An advanced life support (ALS) provider would have been dispatched on 558 EMS runs (38%) based on chief complaint in 2014 had they been available. Over 36,000 man-hours were expended during this period to provide National Registry Emergency Medical Technician (EMT)-accredited instruction to certify 141 Navy Corpsman as EMT Basics. The NPS EMS Program Audit Worksheet was used and the program scored a total of 31, suggesting the program is well planned and operating within standards. This evaluation of the Military EMS system on Okinawa using the NPS program assessment and audit worksheet demonstrates the NPS evaluation instruments may offer a useful assessment tool for the evaluation of Military EMS systems. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.
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
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
Voorhees, J. W.; Bucher, N. M.; Huff, E. M.; Simpson, C. A.; Williams, D. H.
The ability of military helicopters to penetrate the Forward Line of Troops (FLOT) has increased in connection with the utilization of low-level 'Nap-of-the-Earth' (NOE) flying procedures. However, the workload of the pilot engaged in the implementation of the required maneuvers is very high. Possibilities for reducing this workload are being investigated. The present study is concerned with the introduction of an integrated warning system in the cockpit. An integrated warning system simulation study is discussed, taking into account aspects of methodology, and results. Three voice types were evaluated, including male digitized, female digitized, and digitized.
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
Hagopian, Amy; Barker, Kathy
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.
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.
Hamlett-Berry, Kim; Sung, Hai-Yen; Max, Wendy
Introduction: The health effects of cigarette smoking have been estimated to account for between 6%–8% of U.S. health care expenditures. We estimated Veterans Health Administration (VHA) health care costs attributable to cigarette smoking. Methods: VHA survey and administrative data provided the number of Veteran enrollees, current and former smoking prevalence, and the cost of 4 types of care for groups defined by age, gender, and region. Cost and smoking status could not be linked at the enrollee level, so we used smoking attributable fractions estimated in sample of U.S. residents where the linkage could be made. Results: The 7.7 million Veterans enrolled in VHA received $40.2 billion in VHA provided health services in 2010. We estimated that $2.7 billion in VHA costs were attributable to the health effects of smoking. This was 7.6% of the $35.3 billion spent on the types of care for which smoking-attributable fractions could be determined. The fraction of inpatient costs that was attributable to smoking (11.4%) was greater than the fraction of ambulatory care cost attributable to smoking (5.3%). More cost was attributable to current smokers ($1.7 billion) than to former smokers ($983 million). Conclusions: The fraction of VHA costs attributable to smoking is similar to that of other health care systems. Smoking among Veterans is slowly decreasing, but prevalence remains high in Veterans with psychiatric and substance use disorders, and in younger and female Veterans. VHA has adopted a number of smoking cessation programs that have the potential for reducing future smoking-attributable costs. PMID:25239960
Booth, Brenda M; Davis, Teri D; Cheney, Ann M; Mengeling, Michelle A; Torner, James C; Sadler, Anne G
The aim of this study was to determine whether current physical health status in female veterans is associated with rape during military service and same-sex partnership. Retrospective computer-assisted telephone interviews of 1004 Midwestern US female veterans identified from Veterans Affairs electronic records were conducted. Data included rape history including rape in military, sex partnership history, demographics, and medical history including chronic pain, mental health (depression and posttraumatic stress disorder [PTSD]), and the physical health component of the Short-Form 12-item interview (PCS-12). Physical health in this sample was lower than norm values [PCS-12: mean (standard deviation) = 43 ; norm: mean (standard deviation) = 50 ). Fifty-one percent of the participants reported rape in their lifetime, 25% reported rape in military, 11% reported history of women as sex partners, and 71% reported history of chronic pain. Multiple regression analysis indicated that physical health (PCS-12) was associated with chronic pain history (β = -.40, p < .001), rape in military (β = -.09, p = .002), and current PTSD (β = .07, p = .03), adjusting for demographic data. Mediational analysis indicated that chronic pain history significantly mediated relationships of women who have sex with women, childhood rape, PTSD, depression, and current substance use disorder with PCS-12. Both rape and sex partnership are adversely associated with lower physical functioning in female veterans. Clinicians evaluating the physical health of this population should therefore consider obtaining detailed sexual histories, and a multidisciplinary team is needed to address mental health issues in female veterans.
Zheng, Wu Yi; Kanesarajah, Jeeva; Waller, Michael; McGuire, Annabel C; Treloar, Susan A; Dobson, Annette J
To examine whether the relationship between traumatic exposure on deployment and poor mental health varies by the reported level of childhood adversity experienced in Australian military veterans deployed to the Bougainville or East Timor military operations. Cross-sectional self-reported survey data were collected in 2008 from 3,564 Australian military veterans who deployed to East Timor or Bougainville on their deployment experiences, health and recall of childhood events. Multivariable logistic regression was used to investigate the association between childhood adversity, deployment exposures and mental health. The most common childhood adversity reported was 'not having a special teacher, youth worker or family friend who looked out for them while growing up'. On average, responders reported experiencing 3.5 adverse childhood experiences (SD 2.7) and averaged 5.3 (SD 4.9) traumatic exposures on deployment. Both childhood adversity and traumatic exposures on deployment were associated with higher odds of poorer mental health. However, there was no evidence that level of childhood adversity modified the association between traumatic exposure and mental health. These findings suggest that military personnel who recalled a higher level of childhood adversity may need to be monitored for poor mental health and, if required, provided with appropriate support. © 2015 Public Health Association of Australia.
Hickman, Duncan L.; Smith, Moira I.; Kim, Kyung Su; Choi, Hyun-Jin
Polarisation information within a scene can be exploited in military systems to give enhanced automatic target detection and recognition (ATD/R) performance. However, the performance gain achieved is highly dependent on factors such as the geometry, viewing conditions, and the surface finish of the target. Such performance sensitivities are highly undesirable in many tactical military systems where operational conditions can vary significantly and rapidly during a mission. Within this paper, a range of processing architectures and fusion methods is considered in terms of their practical viability and operational robustness for systems requiring ATD/R. It is shown that polarisation information can give useful performance gains but, to retained system robustness, the introduction of polarimetric processing should be done in such a way as to not compromise other discriminatory scene information in the spectral and spatial domains. The analysis concludes that polarimetric data can be effectively integrated with conventional intensity-based ATD/R by either adapting the ATD/R processing function based on the scene polarisation or else by detection-level fusion. Both of these approaches avoid the introduction of processing bottlenecks and limit the impact of processing on system latency.
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.
snuff or chewing tobacco , which has been reported to be 4-10 times lower than for smoking.12 Another reason may be the perception of decreased...Epstein JB. The oral effects of smokeless tobacco . J Can Dent Assoc. 2000;66:22-5. 5. Alguacil J, Silverman DT. Smokeless and other noncigarette ... Tobacco Cessation with Military Personnel PRINCIPAL INVESTIGATOR: Herbert Severson, Ph.D
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. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.
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
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.
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
Hernandez, Stephen H A; Morgan, Brenda J; Parshall, Mark B
The aim of this concept analysis is to clarify military service members' stigma associated with seeking mental health services (MHS). Since 2001, over 2 million military service members have been deployed for or assigned to support military operations. Many service members develop a mental health concern during or after a deployment. Although researchers have assessed perceptions of stigma associated with accessing MHS, defining stigma is difficult, and conceptual clarity regarding stigma is lagging behind studies focused on its effects. Stigma was explored using Walker and Avant's method of concept analysis. Thirty articles were found in the PsycARTICLES, PsycINFO, and PubMed databases and selected for inclusion and synthesis. Military service member stigma is a set of beliefs, based on the member's military and prior civilian enculturation, that seeking MHS would be discrediting or embarrassing, cause harm to career progression, or cause peers or superiors to have decreased confidence in the member's ability to perform assigned duties. Nurses are ideally suited and situated to play an important role in decreasing stigma inhibiting service members from seeking MHS. Healthcare providers and civilian and uniformed leaders must communicate the value of seeking MHS to ensure service members' health, unit readiness, and overall force preparedness. © 2016 Wiley Periodicals, Inc.
Zalatoris, Jeffrey J; Scheerer, Julia B; Lebeda, Frank J
from 18 extramural organizations and three other USAMRMC laboratories. Collaborators from six USAMRMC laboratories and 58 extramural organizations were identified who provided additional research expertise to these systems biology studies. At the end of fiscal year 2016, USAMRMC laboratories self-reported 66 systems biology/computational biology studies (62 of which were unique) with 25 intramural and 81 extramural collaborators. Nearly two-thirds were led by or in collaboration with the U.S. Army Telemedicine and Advanced Technology Research Center/Department of Defense Biotechnology High-Performance Computing Software Applications Institute and U.S. Army Center for Environmental Health Research. The most common study objective addressed biological mechanisms of disease. The most common types of Research Task Areas addressed infectious diseases (viral and bacterial) and chemical agents (environmental toxicant exposures, and traditional and emerging chemical threats). More than 40% of the studies (27/62) involved collaborations between the reporting USAMRMC laboratory and one other organization. Nearly half of the studies (30/62) involved collaborations between the reporting USAMRMC laboratory and at least two other organizations. These survey results indicate that USAMRMC laboratories are compliant with data-centric policy and guidance documents whose goals are to prevent redundancy and promote collaborations by sharing data and leveraging capabilities. These results also serve as a foundation to make recommendations for future systems biology research efforts. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.
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
Hamilton, Alison B; Williams, Lindsay; Washington, Donna L
The unemployment rate is currently higher among women Veterans than among male Veterans and civilian women. Employment is a key social determinant of health, with unemployment being strongly associated with adverse health. To identify military-related and health-related characteristics associated with unemployment in women Veterans. Secondary analysis of workforce participants (n=1605) in the National Survey of Women Veterans telephone survey. Demographics, mental health conditions, health care utilization, and military experiences and effects. Unemployment was defined as being in the labor force but unemployed and looking for work. The χ analyses to identify characteristics of unemployed women Veterans; logistic regression to identify independent factors associated with unemployment. Ten percent of women Veterans were unemployed. Independent correlates of unemployment were screening positive for depression [odds ratio (OR)=4.7; 95% confidence interval [CI], 1.8-12.4], military service during wartime (OR=2.9; 95%, CI 1.1-7.3), and service in the regular military (vs. in the National Guards/Reserves only) (OR=6.8; 95% CI, 2.2-20.5). Two postactive duty perceptions related to not being respected and understood as a Veteran were each independently associated with unemployment. Whether depression underlies unemployment, is exacerbated by unemployment, or both, it is critical to identify and treat depression among women Veterans, and also to investigate women Veterans' experiences and identities in civilian life. Community-based employers may need education regarding women Veterans' unique histories and strengths. Women who served in the regular military and during wartime may benefit from job assistance before and after they leave the military. Gender-specific adaptation of employment services may be warranted.
Chou, Han-Wei; Tzeng, Wen-Chii; Chou, Yu-Ching; Yeh, Hui-Wen; Chang, Hsin-An; Kao, Yu-Cheng; Tzeng, Nian-Sheng
The mental health of military personnel varies as a result of different cultural, political, and administrative factors. The purpose of this study was to evaluate the psychological morbidity and quality of life of military personnel in Taiwan. This cross-sectional study utilized the World Health Organization Quality of Life Instrument, brief version, Taiwan version, the General Health Questionnaire-12, Chinese version, and the Visual Analog Scale (VAS) in several military units. More than half of the subjects (55.3%) identified themselves as mentally unhealthy on the General Health Questionnaire-12, Chinese version; however, a higher percentage of officers perceived themselves as healthy (57.4%) than did noncommissioned officers (38.5%) or enlisted men (42.2%). Officers also had higher total quality of life (QOL) scores (83.98) than did enlisted men (79.67). Scores on the VAS also varied: officers: 72.5; noncommissioned officers: 67.7; and enlisted men: 66.3. The VAS and QOL were positively correlated with perceived mental health among these military personnel. Our subjects had higher rates of perceiving themselves as mentally unhealthy compared to the general population. Those of higher rank perceived themselves as having better mental health and QOL. Improving mental health could result in a better QOL in the military. The VAS may be a useful tool for the rapid screening of self-reported mental health, which may be suitable in cases of stressful missions, such as in disaster rescue; however, more studies are needed to determine the optimal cut-off point of this measurement tool.
Chou, Han-Wei; Tzeng, Wen-Chii; Chou, Yu-Ching; Yeh, Hui-Wen; Chang, Hsin-An; Kao, Yu-Cheng; Tzeng, Nian-Sheng
Objective The mental health of military personnel varies as a result of different cultural, political, and administrative factors. The purpose of this study was to evaluate the psychological morbidity and quality of life of military personnel in Taiwan. Materials and methods This cross-sectional study utilized the World Health Organization Quality of Life Instrument, brief version, Taiwan version, the General Health Questionnaire-12, Chinese version, and the Visual Analog Scale (VAS) in several military units. Results More than half of the subjects (55.3%) identified themselves as mentally unhealthy on the General Health Questionnaire-12, Chinese version; however, a higher percentage of officers perceived themselves as healthy (57.4%) than did noncommissioned officers (38.5%) or enlisted men (42.2%). Officers also had higher total quality of life (QOL) scores (83.98) than did enlisted men (79.67). Scores on the VAS also varied: officers: 72.5; noncommissioned officers: 67.7; and enlisted men: 66.3. The VAS and QOL were positively correlated with perceived mental health among these military personnel. Conclusion Our subjects had higher rates of perceiving themselves as mentally unhealthy compared to the general population. Those of higher rank perceived themselves as having better mental health and QOL. Improving mental health could result in a better QOL in the military. The VAS may be a useful tool for the rapid screening of self-reported mental health, which may be suitable in cases of stressful missions, such as in disaster rescue; however, more studies are needed to determine the optimal cut-off point of this measurement tool. PMID:24570587
Soldatova, L N; Horoshilkina, F Ya; Iordanishvili, A K
The aim of the study was to estimate dental health of servicemen of young and middle age using PMA index, Schiller-Pisarev assay, iodic number of Svrakov, OHI-S. Hundred and six servicemen were enrolled in the study: control group (n=35) with no orthodontic treatment and groups 2 (n=34) and 3 (n=37) group undergoing orthodontic treatment with bracket-systems. All patients had professional oral hygiene and received standard oral care recommendations. Group 3 participants additionally used dental foam (Splat, Russia) after meal. All patients were examined at baseline and 12 months later. In the presence of orthodontic appliances standard oral care products were not enough to maintain proper oral health. Dental foam improved both periodontal condition and OHI-S.
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.
Zhang, Xuan-Ming; Zhang, Xuan; Luo, Xu; Guo, Hai-Tao; Zhang, Li-Qun; Guo, Ji-Wei
Military medicine is a research field that seeks to solve the medical problems that occur in modern war conditions based on public medicine theory. We explore the main research topics of military health and medical research in the web of science™ core collection (WoSCC) from 2007 to 2016, and the goal of this work is to serve as a reference for orientation and development in military health and medicine. Based on CiteSpace III, a reference co-citation analysis is performed for 7921 papers published in the WoSCC from 2007 to 2016. In addition, a cluster analysis of research topics is performed with a comprehensive analysis of high-yield authors, outstanding research institutions and their cooperative networks. Currently, the research topics in military health and medicine mainly focus on the following seven aspects: mental health diagnoses and interventions, an army study to assess risk and resilience in service members (STARRS), large-scale military action, brain science, veterans, soldier parents and children of wartime, and wound infection. We also observed that the annual publication rate increased with time. Wessely S, Greenberg N, Fear NT, Smith TC, Smith B, Jones N, Ryan MAK, Boyko EJ, Hull L, and Rona RJ were the top 10 authors in military health and medicine research. The top 10 institutes were the Uniformed Services University of the Health Sciences, the United States Army, the United States Navy, Kings College London, Walter Reed National Military Medical Center, Boston University, Walter Reed Army Institute of Research, Walter Reed Army Medical Center, Naval Health Research Center, and the VA Boston Healthcare System. We are able to perform a comprehensive analysis of studies in military health and medicine research and summarize the current research climate and the developmental trends in the WoSCC. However, further studies and collaborations are needed worldwide. Overall, our findings provide valuable information and new perspectives and shape
AN APPLICATION OF SOCIAL NETWORK ANALYSIS ON MILITARY STRATEGY, SYSTEM NETWORKS AND THE PHASES OF...subject to copyright protection in the United States. AFIT-ENS-MS-15-M-117 AN APPLICATION OF SOCIAL NETWORK ANALYSIS ON MILITARY STRATEGY...RELEASE; DISTRIBUTION UNLIMITED. AFIT-ENS-MS-15-M-117 AN APPLICATION OF SOCIAL NETWORK ANALYSIS ON MILITARY STRATEGY, SYSTEM NETWORKS AND THE PHASES
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.
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.
Wilson, Candy; Corrigan, Robert; Reese, Sharon; Almonte, Angelica; Simpson, Danielle; Wilson, Amber
To gain better understanding of the military medics' (Navy Independent Duty Corpsman, Air Force Independent Duty Medical Technician, and Army Health Care Specialist, experiences providing health care for women in the deployed or ship setting. The researchers used an exploratory, descriptive design informed by ethnography. A total of 86 individuals participated in the focus group and individual interviews. Three themes were identified: Training Fidelity, Advocate Leader, and The Challenges of Providing Patient Care. Experience in austere settings has convinced a number of medics they need additional women's health care topics in every facet of their training. They further suggested such training should be provided in stepwise fashion, beginning with initial, technical training courses and continuing through medical skills sustainment platforms. They were especially interested in basic women's health concerns. Topics suggested included vaginal infections, urinary tract infections, and birth control management. Although the advancement of women in the military continues to make strides-it is clear the availability of quality women's health care that women feel comfortable accessing may be its defining limitation. Medics are an excellent conduit for reinforcing these healthy messages and providing first-line treatment to deployed military women. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.
Lima, Débora R S; Bezerra, Marcio L S; Neves, Eduardo B; Moreira, Fátima R
To review the literature concerning the risks associated with the main xenobiotics contained in military ammunition and explosive residues and damage to human and environmental health. Using "ammunition", "military", "environmental", "health", "explosive", "metal", "TNT", "RDX", "pollution", and "contamination" as search terms, a large database, namely ISI Web of Knowledge and PubMed, was searched for studies on military ammunition and explosive residues from 1989 to 2010. Other sources used to conduct the search included the library of the Toxicology Laboratory of the Center for Workers' Health and Human Ecology (CESTEH) at the National School of Public Health. In total, 15 different combinations were used with the search words above and 708 papers were found. Among them, 76 papers concerned this review. More than 12 references of interest were discovered in the library of the CESTEH. The results were organized into metals, dinitrotoluene, trinitrotoluene (TNT), and royal demolition explosive (RDX), showing their main uses, occurrence in the environment, the current toxic effects to human and environmental health, and remediation possibilities. Because military activities can cause the acute and chronic exposure of human beings, the public administration must aim politics towards suitable environmental management.
Giles Iii, James T
The use of military working dogs (MWDs) in support of military operations has increased dramatically over recent years, as they have proven to be our most reliable deterrent to improvised explosive devices. Healthcare delivery for MWDs in combat presents unique challenges and requires extensive collaboration between veterinarians and human health care providers (HCPs). A successful example is the incorporation of MWD emergency care for nonveterinary HCPs into the Joint Trauma System Clinical Practice Guidelines, which has proven to be a helpful product. Additional challenges that need further solutions include MWDs as patients in human medical treatment facilities (MTFs) and the procurement of appropriate canine blood components in an operational environment. It is often necessary for MWDs to be treated as patients in human MTFs, however, there is no Department of Defense guidance to support this activity. Access to MWD blood products is limited to collection of fresh whole blood in the operational setting. Similar to humans, specific blood component therapy, such as fresh frozen plasma, is often indicated for sick or injured MWDs. Currently there is no formal system in place to deliver any blood products for MWDs or to facilitate collection in theater.
Brignone, Emily; Gundlapalli, Adi V; Blais, Rebecca K; Kimerling, Rachel; Barrett, Tyson S; Nelson, Richard E; Carter, Marjorie E; Samore, Matthew H; Fargo, Jamison D
The effects of sexual trauma on long-term health care utilization and costs are not well understood due to infrequent documentation of sexual trauma history in health care systems. The Veteran's Health Administration provides a unique opportunity to address this constraint as sexual trauma is actively screened for as part of routine care. We used a retrospective cohort design to analyze Veteran's Health Administration mental health and medical service utilization and costs as a function of a positive screen for exposure to military sexual trauma (MST) among Veterans of recent conflicts in Iraq and Afghanistan. We computed adjusted 5-year estimates of overall utilization and costs, and utilization and costs determined not to be related to MST. The cohort included 426,223 men and 59,611 women. A positive MST screen was associated with 50% higher health care utilization and costs relative to a negative screen. Overall, a positive relative to negative MST screen was associated with a 5-year incremental difference of 34.6 encounters and $10,734 among women, and 33.5 encounters and $11,484 among men. After accounting for MST-related treatment, positive MST screen was associated with 11.9 encounters and $4803 among women, and 19.5 encounters and $8001 among men. Results demonstrate significant and consistent differences in health care utilization and costs between Veterans with a positive relative to negative MST screen. Even after accounting for MST-related care, a positive screen was associated with significantly higher utilization and costs. MST-related needs may be more readily recognized in women relative to men.
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. (c) 2015 APA, all rights reserved).
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
Costa, Edilma de Oliveira; Germano, Raimunda Medeiros
The article presents an excerpt from an investigation into male military police perceptions of STD/AIDS, emphasizing RELATIONS OF POWER, identifying interventions in sexual practice and consequently, on perception and exposure to the risk of STD/AIDS contamination. Focus group meetings enabled socialization of information, showing that the majority of participants acknowledge the risk of STD/AIDS contamination, although this is not necessarily converted into prevention. It registers the inequality between men and women regarding sexual practice and its possible consequences in the growing incidence of cases of sexually transmitted disease.
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.
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. Published by Elsevier Inc.
Volkova, Svitlana; Charles, Lauren E.; Harrison, Josh; ...
Military populations present a small, unique community whose mental and physical health impacts the security of the nation. Recent literature has explored social media's ability to enhance disease surveillance and characterize distinct communities with encouraging results. We present a novel analysis of the relationships between influenza-like illnesses (ILI) clinical data and affects (i.e., emotions and sentiments) extracted from social media around military facilities. Our analyses examine (1) differences in affects expressed by military and control populations, (2) affect changes over time by users, (3) differences in affects expressed during high and low ILI seasons, and (4) correlations and cross-correlations betweenmore » ILI clinical visits and affects from an unprecedented scale –171M geo-tagged tweets across 31 global geolocations. Key findings include: Military and control populations dier in the way they express affects in social media over space and time. Control populations express more positive and less negative sentiments and less sadness, fear, disgust, and anger emotions than military. However, affects expressed in social media by both populations within the same area correlate similarly with ILI visits to military health facilities. We have identified potential responsible co-factors leading to location variability, e.g., region or state locale, military service type and/or the ratio of military to civilian populations. For most locations, ILI proportions positively correlate with sadness and neutral sentiment, which are the affects most often expressed during high ILI season. The ILI proportions negatively correlate with fear, disgust, surprise, and positive sentiment. These results are similar to the low ILI season where anger, surprise, and positive sentiment are highest. Finally, cross-correlation analysis shows that most affects lead ILI clinical visits, i.e. are predictive of ILI data, with affect-ILI leading intervals dependent on geo
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
Meynard, Jean-Baptiste; Chaudet, Herve; Green, Andrew D; Jefferson, Henry L; Texier, Gaetan; Webber, Daniel; Dupuy, Bruce; Boutin, Jean-Paul
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. 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. 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 of the process parameters
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)
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.
da Silva, Franciele Cascaes; Hernandez, Salma Stéphany Soleman; Arancibia, Beatriz Angélica Valdivia; Castro, Thiago Luis da Silva; Filho, Paulo José Barbosa Gutierres; da Silva, Rudney
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. 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. 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. 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.
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)
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
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.
Saulters, Oral S; Erickson, Larry E; Leven, Blase A; Pickrel, John A; Green, Ryan M; Jamka, Leslie; Prill, Amanda
New technologies are not only critical in supporting traditional industrial and military success but also play a pivotal role in advancing sustainability and sustainable development. With the current global economic challenges, resulting in tighter budgets and increased uncertainty, synergistic paradigms and tools that streamline the design and dissemination of key technologies are more important than ever. Accordingly, a proactive and holistic approach can facilitate efficient research, design, testing, evaluation, and fielding for novel and off-the-shelf products, thereby assisting developers, end users, and other diverse stakeholders in better understanding tradeoffs in the defense industry and beyond. By prioritizing mechanisms such as strategic life-cycle environmental assessments (LCEA); programmatic environment, safety, and occupational health evaluations (PESHE); health hazard assessments (HHA); and other innovative platforms and studies early within systems engineering, various nonlethal military technologies have been successfully developed and deployed. These efforts provide a framework for addressing complex environment, safety, and occupational health risks that affect personnel, infrastructure, property, socioeconomic, and natural/cultural resources. Moreover, integrated, comprehensive, multidisciplinary, and iterative analyses involving flexible groups of specialists/subject matter experts can be applied at various spatiotemporal scales in support of collaborations. This paper highlights the Urban Operations Laboratory process utilized for inclusive and transformative environmental analysis, which can translate into advantages and progress toward sustainable systems. (c) 2009 SETAC.
Li, Rongxia; McNeil, Michael M; Pickering, Susanne; Pemberton, Michael R; Duran, Laurie L; Collins, Limone C; Nelson, Michael R; Engler, Renata J M
We studied military health care provider (HCP) practices regarding reporting of adverse events following immunization (AEFI). A convenience sample of HCP was surveyed to assess familiarity with Vaccine Adverse Event Reporting System (VAERS), AEFI they were likely to report, methods used and preferred for reporting, and perceived barriers to reporting. We analyzed factors associated with HCP reporting AEFI to VAERS. A total of 547 surveys were distributed with 487 completed and returned for an 89% response rate. The percentage of HCP aware of VAERS (54%) varied by occupation. 47% of respondents identified knowledge of at least one AEFI with only 34% of these indicating that they had ever reported to VAERS. More serious events were more likely to be reported. Factors associated with HCP reporting AEFIs in bivariate analysis included HCP familiarity with filing a paper VAERS report, HCP familiarity with filing an electronic VAERS report, HCP familiarity with VAERS, and time spent on immunization tasks. In a multivariable analysis, only HCP familiarity with filing a paper VAERS report was statistically significant (Odds ratio = 115.3; p < 0.001). Specific educational interventions targeted to military HCP likely to see AEFIs but not currently filing VAERS reports may improve vaccine safety reporting practices. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.
implementing a shared services model within the military health system. A “ shared services model” means that the DHA will assume responsibility for... shared services , functions, and activities in the military health system, including the TRICARE program, pharmacy programs, medical education and
Eckart, Robert E; Shry, Eric A; Scoville, Stephanie L; Thompson, Christopher M; Stajduhar, Karl C; Krasuski, Richard A
In addition to psychological disorders, emotional stress can trigger a chain of neurohumoral imbalances that can manifest as cardiopulmonary complaints. No studies were identified that used objective clinical data on complaints after the terrorist attacks of September 11, 2001. The purpose of this descriptive study was to identify all cardiopulmonary and psychological diagnoses among active duty personnel seeking care at a military treatment facility and/or its ancillary facilities before and after September 11, 2001. The study population included 40,981 active duty military personnel between August 13, 2001 and October 9, 2001 (4 weeks before and 4 weeks after September 11, 2001). Demographic and diagnostic data were obtained from the Composite Health Care System for each visit during the study period. The outcomes of interest were psychological and cardiopulmonary diagnoses. There were 19,595 clinic visits before September 11, 2001 compared to 19,207 clinic visits in the 4 weeks after September 11. There was no increase in total psychological diagnoses in the postexposure period, compared with the preexposure period (risk ratio (RR), 0.97; 95% confidence interval (CI), 0.84-1.11). The only statistically significant finding was a decrease in diagnoses of psychoses (RR, 0.62; 95% confidence interval, 0.42-0.91). However, diagnoses of depressive disorders were increased in the postexposure period (RR, 1.61; 95% CI, 0.89-2.90; p = 0.11). Total cardiopulmonary diagnoses did not increase in the postexposure period, compared with the preexposure period (RR, 0.96; 95% CI, 0.91-1.02). This descriptive study failed to identify evidence that any changes in cardiopulmonary or mental health diagnoses were attributable to September 11 terrorist attacks. In the unfortunate event of another national tragedy, it is recommended that health care professionals administer a questionnaire to determine why patients are seeking care after the tragedy. These data could be linked to
Groover, Robert O.
The document covers an operational entity-simulation system designed to permit observation and selective control of a military personnel system under a variety of policy alternatives. PERSYM is modularized to facilitate conversion to different military forces and the programing and inclusion of alternative policy logic modules. The system…
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…
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…
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.
Cook, Wendy A.; Melvin, Kristal C.; Doorenbos, Ardith Z.
Researchers have reported challenges in recruiting US military service members as research participants. We explored their reasons for participating. Eighteen US military service members who had participated in at least one health-related research study within the previous 3 years completed semi-structured individual interviews in person or by telephone, focused on the service members’ past decisions regarding research participation. Service members described participation decisions for 34 individual research experiences in 27 separate studies. Service members’ reasons for participation in research clustered in three themes: others-, self-, and fit-focused. Each decision included reasons characterized by at least two themes. Reasons from all three themes were apparent in two-thirds of individual participation decisions. Reasons described by at least half of the service members included a desire to make things better for others, to improve an organization, to help researchers, and to improve one’s health; understanding how they fit in studies; and convenience of participation. Findings may help researchers, study sponsors, ethicists, military leaders, and military decision-makers better understand service members’ reasons for participating in research and improve future recruitment of service members in health research. PMID:28185285
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
Cook, Wendy A; Melvin, Kristal C; Doorenbos, Ardith Z
Researchers have reported challenges in recruiting US military service members as research participants. We explored their reasons for participating. Eighteen US military service members who had participated in at least one health-related research study within the previous 3 years completed semi-structured individual interviews in person or by telephone, focused on the service members' past decisions regarding research participation. Service members described participation decisions for 34 individual research experiences in 27 separate studies. Service members' reasons for participation in research clustered in three themes: others-, self-, and fit-focused. Each decision included reasons characterized by at least two themes. Reasons from all three themes were apparent in two-thirds of individual participation decisions. Reasons described by at least half of the service members included a desire to make things better for others, to improve an organization, to help researchers, and to improve one's health; understanding how they fit in studies; and convenience of participation. Findings may help researchers, study sponsors, ethicists, military leaders, and military decision-makers better understand service members' reasons for participating in research and improve future recruitment of service members in health research. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.
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
panacea, these models are useful for planning responses to respiratory pandemics. Public health interventions used during a pandemic often have...MEDICINE, 174, 6:557, 2009 The Pandemic Infl uenza Policy Model: A Planning Tool for Military Public Health Offi cials COL Brian H. Feighner...Jerrold E. Dietz, MS * ; Jennifer L. Chaffee, MS * ; LT Marvin L. Sikes , MSC USN (Ret.) * ; COL Mimms J. Mabee , MC USA ‡ ; SGM Bruce
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.
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. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.
Luxton, David D; Pruitt, Larry D; O'Brien, Karen; Kramer, Gregory
Although home-based telemental health options have the potential to greatly expand the range of services available to U.S. military service members, there remains a need to demonstrate that home-based care is technically feasible, safe, and effective and meets the military health system's standards of care before widespread implementation can be achieved. The purpose of this preliminary study was to evaluate the feasibility and safety of providing U.S. military service members with a behavioral health treatment delivered directly to the home using videoconferencing. Ten previously deployed soldiers volunteered to complete eight sessions of a novel behavioral activation treatment for posttraumatic stress disorder. The primary clinical outcomes assessed included symptoms of posttraumatic stress and depression. Patient safety data and attitudes about seeking mental health services, treatment satisfaction, treatment adherence, and treatment compliance were also assessed. Clinically significant reductions in posttraumatic stress symptom severity and depression symptoms were observed. Soldiers indicated high levels of satisfaction with the treatment, and there were no adverse events requiring activation of emergency safety procedures. Technical problems associated with the network were observed but successfully mitigated. The results provide initial support for the feasibility and safety of telemental health treatments delivered by videoconferencing to the homes of soldiers. The optimal technical infrastructure needs to be determined to support expansion of synchronous videoconferencing capabilities to the home. The findings provide preliminary evidence of the feasibility, safety, and high user satisfaction with home-based telemental health in the military setting.
Lekhan, Valery; Rudiy, Volodymyr; Richardson, Erica
The 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 Ukrainian health system has preserved the fundamental features of the Soviet Semashko system against a background of other changes, which are developed on market economic principles. The transition from centralized financing to its extreme decentralization is the main difference in the health system in comparison with the classic Soviet model. Health facilities are now functionally subordinate to the Ministry of Health, but managerially and financially answerable to the regional and local self-government, which has constrained the implementation of health policy and fragmented health financing. Health care expenditure in Ukraine is low by regional standards and has not increased significantly as a proportion of gross domestic product (GDP) since the mid 1990s; expenditure cannot match the constitutional guarantees of access to unlimited care. Although prepaid schemes such as sickness funds are growing in importance, out-of-pocket payments account for 37.4% of total health expenditure. The core challenges for Ukrainian health care therefore remain the ineffective protection of the population from the risk of catastrophic health care costs and the structural inefficiency of the health system, which is caused by the inefficient system of health care financing. Health system weaknesses are highlighted by increasing rates of avoidable mortality. Recent political impasse has complicated health system reforms and policy-makers face significant challenges in overcoming popular distrust and
Jones, Norman; Campion, Ben; Keeling, Mary; Greenberg, Neil
Military research suggests a significant association between leadership, cohesion, mental health stigmatisation and perceived barriers to care (stigma/BTC). Most studies are cross sectional, therefore longitudinal data were used to examine the association of leadership and cohesion with stigma/BTC. Military personnel provided measures of leadership, cohesion, stigma/BTC, mental health awareness and willingness to discuss mental health following deployment (n = 2510) and 4-6 months later (n = 1636). At follow-up, baseline leadership and cohesion were significantly associated with stigma/BTC; baseline cohesion alone was significantly associated with awareness of and willingness to discuss mental health at follow-up. Over time, changes in perceived leadership and cohesion were significantly associated with corresponding changes in stigma/BTC levels. Stigma/BTC content was similar in both surveys; fear of being viewed as weak and being treated differently by leaders was most frequently endorsed while thinking less of a help-seeking team member and unawareness of potential help sources were least common. Effective leadership and cohesion building may help to reduce stigma/BTC in military personnel. Mental health awareness and promoting the discussion of mental health matters may represent core elements of supportive leader behaviour. Perceptions of weakness and fears of being treated differently represent a focus for stigma/BTC reduction.
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.
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
Weeks, Murray; Zamorski, Mark A; Rusu, Corneliu; Colman, Ian
This study sought to compare the prevalence and impacts of mental illness-related stigma among Canadian Armed Forces personnel and Canadian civilians. Data were from two highly comparable, population-based, cross-sectional surveys of Canadian military personnel and Canadian civilians: the 2013 Canadian Forces Mental Health Survey (N=6,696) and the 2012 Canadian Community Health Survey-Mental Health (N=25,113), respectively. Perceived stigma was assessed among those who reported care seeking for a mental health problem in the past 12 months. Follow-up questions assessed the impact of stigma in various domains. Modified Poisson regression and linear regression were used to examine population differences (military versus civilian) in terms of care seeking, stigma, and stigma impact, with adjustments for sociodemographic characteristics and the need for care. Military personnel were significantly more likely than civilians to have perceived stigma (adjusted prevalence ratio [PR]=1.70, 95% confidence interval [CI]=1.11-2.60). Stigma had a greater impact on military personnel, particularly in terms of work or school life (b=1.01, CI=.57-1.47). However, military personnel were also significantly more likely than civilians to have sought care (PR=1.86, CI=1.53-2.25). Military personnel reported a disproportionate amount of mental illness-related stigma, compared with Canadian civilians, and a greater impact of stigma. Nevertheless, military personnel were more likely to seek care, pointing to a complex relationship between stigma and care seeking in the military.
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.
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
ANTISOCIAL PERSONALITY R60 failed to support children R38 moved to avoid paying rent 5.) Failure to plan ahead, or impulsive behavior R57...Abuse and Health Behaviors Among Military Personnel (7) , the 1992 DoD Survey of Military Medical Care Beneficiaries (8), and the 1989 Department of...their appropriation of health-related behaviors . Women’s health-risk and behavior issues are particularly salient in the U.S. Navy and Marine Corps
Sivashchenko, P P; Kushnirchuk, I I; Sorokin, S I
Analysis of health status of military personnel is carried out in the interests of optimizing medical support personnel, maintaining a high level of health of servicemen, reducing morbidity. To perform this analysis it is necessary to compile materials about health status and morbidity in servicemen received from medical records. Selected data from medical records produced by mechanical summation of homogeneous diagnoses and time consuming. Today we have an opportunity to use common software for registration and result indices. So, by using the Excel program of Microsoft Office 2010, it is possible to implement the procedure for obtaining summary data from the electronic versions of documents medical records. By using the proposed algorithms allow authors to link the troop significantly optimize the process of accumulation, storage and use for analysis of the military - medical information, make the whole process of analysis of morbidity faster and more efficiently.
Cardona, Robert Andrew; Ritchie, Elspeth Cameron
Through the stimulus of war and concerns about neuropsychiatric disability, the U.S. military developed methods to rapidly screen the mental health of World War I and II draftees. Intelligence testing and brief psychiatric screening expanded the accession physical examination and underwent revision to identify only gross mental health disability. Supplemental psychiatric evaluations and written psychological screening tools were abandoned after postwar assessments; they demonstrated poor predictive power in evaluating recruit service capacity for combat environments. Currently, only three mental health accession tools are used to screen applicants before their entrance into military service, namely, educational achievement, cognitive testing, and a cursory psychiatric evaluation. The Navy and Air Force use a fourth screening measure during entry-level training. Educational attainment with high school graduation has been the strongest predictor of finishing a service term. The purpose of this article is to provide both a historical review and a review of testing efforts.
Mitenbergs, Uldis; Taube, Maris; Misins, Janis; Mikitis, Eriks; Martinsons, Atis; Rurane, Aiga; Quentin, Wilm
This analysis of the Latvian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health-system performance. Latvia has been constantly reforming its health system for over two decades. After independence in 1991, Latvia initially moved to create a social health insurance type system. However, problems with decentralized planning and fragmented and inefficient financing led to this being gradually reversed, and ultimately the establishment in 2011 of a National Health Service type system. These constant changes have taken place against a backdrop of relatively poor health and limited funding, with a heavy burden for individuals; Latvia has one of the highest rates of out-of-pocket expenditure on health in the European Union (EU). The lack of financial resources resulting from the financial crisis has posed an enormous challenge to the government, which struggled to ensure the availability of necessary health care services for the population and to prevent deterioration of health status. Yet this also provided momentum for reforms: previous efforts to centralise the system and to shift from hospital to outpatient care were drastically accelerated, while at the same time a social safety net strategy was implemented (with financial support from the World Bank) to protect the poor from the negative consequences of user charges. However, as in any health system, a number of challenges remain. They include: reducing smoking and cardiovascular deaths; increasing coverage of prescription pharmaceuticals; reducing the excessive reliance on out-of-pocket payments for financing the health system; reducing inequities in access and health status; improving efficiency of hospitals through implementation of DRG-based financing; and monitoring and improving quality. In the face of these challenges at a time of financial crisis, one further challenge emerges: ensuring adequate funding for the health
Wang, Lawrence; Seelig, Amber; Wadsworth, Shelley MacDermid; McMaster, Hope; Alcaraz, John E; Crum-Cianflone, Nancy F
Divorce has been linked with poor physical and mental health outcomes among civilians. Given the unique stressors experienced by U.S. service members, including lengthy and/or multiple deployments, this study aimed to examine the associations of recent divorce on health and military outcomes among a cohort of U.S. service members. Millennium Cohort participants from the first enrollment panel, married at baseline (2001-2003), and married or divorced at follow-up (2004-2006), (N = 29,314). Those divorced were compared to those who remained married for mental, behavioral, physical health, and military outcomes using logistic regression models. Compared to those who remained married, recently divorced participants were significantly more likely to screen positive for new-onset posttraumatic stress disorder, depression, smoking initiation, binge drinking, alcohol-related problems, and experience moderate weight gain. However, they were also more likely be in the highest 15(th) percentile of physical functioning, and be able to deploy within the subsequent 3-year period after divorce. Recent divorce among military members was associated with adverse mental health outcomes and risky behaviors, but was also associated with higher odds of subsequent deployment. Attention should be given to those recently divorced regarding mental health and substance abuse treatment and prevention strategies.
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.
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
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.
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…
Sundin, Josefin; Herrell, Richard K; Hoge, Charles W; Fear, Nicola T; Adler, Amy B; Greenberg, Neil; Riviere, Lyndon A; Thomas, Jeffrey L; Wessely, Simon; Bliese, Paul D
Research of military personnel who deployed to the conflicts in Iraq or Afghanistan has suggested that there are differences in mental health outcomes between UK and US military personnel. To compare the prevalence of post-traumatic stress disorder (PTSD), hazardous alcohol consumption, aggressive behaviour and multiple physical symptoms in US and UK military personnel deployed to Iraq. Data were from one US (n = 1560) and one UK (n = 313) study of post-deployment military health of army personnel who had deployed to Iraq during 2007-2008. Analyses were stratified by high- and low-combat exposure. Significant differences in combat exposure and sociodemographics were observed between US and UK personnel; controlling for these variables accounted for the difference in prevalence of PTSD, but not in the total symptom level scores. Levels of hazardous alcohol consumption (low-combat exposure: odds ratio (OR) = 0.13, 95% CI 0.07-0.21; high-combat exposure: OR = 0.23, 95% CI 0.14-0.39) and aggression (low-combat exposure: OR = 0.36, 95% CI 0.19-0.68) were significantly lower in US compared with UK personnel. There was no difference in multiple physical symptoms. Differences in self-reported combat exposures explain most of the differences in reported prevalence of PTSD. Adjusting for self-reported combat exposures and sociodemographics did not explain differences in hazardous alcohol consumption or aggression.
Schreiber, Michael; McEnany, Geoffry Phillips
Since 2001, more than 2.5 million United States military personnel have been deployed for combat. Over one million have served multiple deployments. Combat generally involved repeated exposure to highly traumatic events. Personnel were also victims of military sexual trauma (MST), a major risk factor for psychiatric illness. Most survivors do not seek or receive mental health care. Stigma is one of the main barriers to that care. To explore the impact of stigma on personnel with psychiatric illness, and suggest some innovative ways to potentially reduce stigma and improve care. Cinahl and PubMed databases were searched from 2001 to 2014. Anonymity, the use of non-stigmatizing language, peer-to-peer, and stigma-reduction programs help military personnel receive mental health care. Technology offers the opportunity for effective and appropriate education and treatment. Although stigma is formidable, several innovative services are available or being developed for military victims of trauma. Commitment of resources for program development and further research to explore which interventions offer the best clinical outcomes are needed to increase efforts to combat stigma and ensure quality care.
Lindstrom, Krista E; Smith, Tyler C; Wells, Timothy S; Wang, Linda Z; Smith, Besa; Reed, Robert J; Goldfinger, Wendy E; Ryan, Margaret A K
The proportion of women in the U.S. military is increasing, and they are being selected into jobs that are more combat related. However, the mental health effects of working in combat support occupations among military women have not been previously evaluated. Active-duty enlisted Navy and Marine Corps women in combat support (n = 10,299) and noncombat support (n = 63,478) occupations were followed for 2 years between January 1, 1994, and August 31, 2001. Hospitalization diagnoses were examined and organized into eight categories of mental disorders; Cox proportional hazards modeling was used to describe these outcomes. Women in combat support occupations were found to be significantly less likely to be hospitalized for a mental disorder than women in all other military occupations. These results are reassuring but may be confounded by a healthy worker selection effect. Further studies are needed to assess how service in combat support occupations affects the long-term health of U.S. military women.
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
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. …
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. …
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.
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.
Although military personnel are at high risk of mental health problems, research findings indicate that many military personnel and veterans do not seek needed mental health care. Thus it is critical to identify factors that interfere with the use of mental health services for this population, and where possible, intervene to reduce barriers to care. The overarching goal of this review was to examine what is known with regard to concerns about public stigma and personal beliefs about mental illness and mental health treatment as potential barriers to service use in military and veteran populations and to provide recommendations for future research on this topic. Fifteen empirical articles on mental health beliefs and service use were identified via a review of the military and veteran literature included in PsycINFO and PubMed databases. Although results suggest that mental health beliefs may be an important predictor of service use for this population, several gaps were identified in the current literature. Limitations include a lack of attention to the association between mental health beliefs and service use, a limited focus on personal beliefs about mental illness and mental health treatment, and the application of measures of mental health beliefs with questionable or undocumented psychometric properties. Studies that attend to these important issues and that examine mental health beliefs in the broader context within which decisions about seeking health care are made can be used to best target resources to engage military personnel and veterans in health care.
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.
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.
Iversen, Amy C; Fear, Nicola T; Simonoff, Emily; Hull, Lisa; Horn, Oded; Greenberg, Neil; Hotopf, Matthew; Rona, Roberto; Wessely, Simon
Exposure to childhood adversity may explain why only a minority of combatants exposed to trauma develop psychological problems. To examine the association between self-reported childhood vulnerability and later health outcomes in a large randomly selected male military cohort. Data are derived from the first stage of a cohort study comparing Iraq veterans and non-deployed UK military personnel. We describe data collected by questionnaire from males in the regular UK armed forces (n=7937). Pre-enlistment vulnerability is associated with being single, of lower rank, having low educational attainment and serving in the Army. Pre-enlistment vulnerability is associated with a variety of negative health outcomes. Two main factors emerge as important predictors of ill health: a 'family relationships' factor reflecting the home environment and an 'externalising behaviour' factor reflecting behavioural disturbance. Pre-enlistment vulnerability is an important individual risk factor for ill health in military men. Awareness of such factors is important in understanding post-combat psychiatric disorder.
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. World Health Organization 2015 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).
Wong, Eunice C; Jaycox, Lisa H; Ayer, Lynsay; Batka, Caroline; Harris, Racine; Naftel, Scott; Paddock, Susan M
A RAND team conducted an independent implementation evaluation of the Re-Engineering Systems of Primary Care Treatment in the Military (RESPECT-Mil) Program, a system of care designed to screen, assess, and treat posttraumatic stress disorder and depression among active duty service members in the Army's primary care settings. Evaluating the Implementation of the Re-Engineering Systems of Primary Care Treatment in the Military (RESPECT-Mil) presents the results from RAND's assessment of the implementation of RESPECT-Mil in military treatment facilities and makes recommendations to improve the delivery of mental health care in these settings. Analyses were based on existing program data used to monitor fidelity to RESPECT-Mil across the Army's primary care clinics, as well as discussions with key stakeholders. During the time of the evaluation, efforts were under way to implement the Patient Centered Medical Home, and uncertainties remained about the implications for the RESPECT-Mil program. Consideration of this transition was made in designing the evaluation and applying its findings more broadly to the implementation of collaborative care within military primary care settings.
Wong, Eunice C.; Jaycox, Lisa H.; Ayer, Lynsay; Batka, Caroline; Harris, Racine; Naftel, Scott; Paddock, Susan M.
Abstract A RAND team conducted an independent implementation evaluation of the Re-Engineering Systems of Primary Care Treatment in the Military (RESPECT-Mil) Program, a system of care designed to screen, assess, and treat posttraumatic stress disorder and depression among active duty service members in the Army's primary care settings. Evaluating the Implementation of the Re-Engineering Systems of Primary Care Treatment in the Military (RESPECT-Mil) presents the results from RAND's assessment of the implementation of RESPECT-Mil in military treatment facilities and makes recommendations to improve the delivery of mental health care in these settings. Analyses were based on existing program data used to monitor fidelity to RESPECT-Mil across the Army's primary care clinics, as well as discussions with key stakeholders. During the time of the evaluation, efforts were under way to implement the Patient Centered Medical Home, and uncertainties remained about the implications for the RESPECT-Mil program. Consideration of this transition was made in designing the evaluation and applying its findings more broadly to the implementation of collaborative care within military primary care settings. PMID:28083389
Ashwick, R L; Murphy, D
Little is known about the mental and physical health differences of treatment-seeking military veterans across the different nations that make up the UK. The aim of this research was to explore potential health differences in order to support better service planning. A random cross-sectional sample of treatment-seeking veterans residing in England, Scotland, Wales and Northern Ireland was identified from a national mental health charity. 403 veterans completed a questionnaire highlighting their demographics, mental health and physical health difficulties. The data were analysed using a multinomial logistic regression with England as the baseline comparison. Help-seeking veterans residing in Northern Ireland tended to be older, have experienced less childhood adversity, joined the military after the age of 18 and took longer to seek help. Additionally, veterans from Northern Ireland had higher levels of obesity, sensory, mobility and systemic problems and a greater number of physical health conditions. Scottish and Welsh veterans had a higher risk of smoking and alcohol misuse. No differences were found in mental health presentations. The findings from this paper suggest that a greater focus needs to be placed on treating physical problems in Northern Irish veterans. Alcohol misuse should be addressed in more detail in treatment programmes, particularly in Scotland and Wales. As few differences were found in the mental health presentations, this suggests that standardised services are adequate. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Murauskiene, Liubove; Janoniene, Raimonda; Veniute, Marija; van Ginneken, Ewout; Karanikolos, Marina
This analysis of the Lithuanian health system reviews the developments in organization and governance, health financing, health-care provision, health reforms and health system performance since 2000.The Lithuanian health system is a mixed system, predominantly funded from the National Health Insurance Fund through a compulsory health insurance scheme, supplemented by substantial state contributions on behalf of the economically inactive population amounting to about half of its budget. Public financing of the health sector has gradually increased since 2004 to 5.2 per cent of GDP in 2010.Although the Lithuanian health system was tested by the recent economic crisis, Lithuanias counter-cyclical state health insurance contribution policies (ensuring coverage for the economically inactive population) helped the health system to weather the crisis, and Lithuania successfully used the crisis as a lever to reduce the prices of medicines.Yet the future impact of cuts in public health spending is a cause for concern. In addition, out-of-pocket payments remain high (in particular for pharmaceuticals) and could threaten health access for vulnerable groups.A number of challenges remain. The primary care system needs strengthening so that more patients are treated instead of being referred to a specialist, which will also require a change in attitude by patients. Transparency and accountability need to be increased in resource allocation, including financing of capital investment and in the payer provider relationship. Finally, population health,albeit improving, remains a concern, and major progress can be achieved by reducing the burden of amenable and preventable mortality. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).
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.
associated with PH in military men, and this relationship is mediated by MH. Keywords Hardiness Health Mediated effects Mental health Physical...overarching theoretical model delin- eating complex relationships between hardiness; stress/ strain; mental /physical health ; and associated causal path- ways is...Maddi, 1999), a distinct construct reflecting adverse consequences of cumulative stress. Hardiness, then, associates with aspects of mental health and
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.
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.
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. Copyright © 2015 International Society for Traumatic Stress Studies.
Kuvshinov, K E; Klipak, V M; Chaplyuk, A L; Moskovko, V M; Belyshev, D V; Zherebko, O A
The current task of the implementation of medical information systems in the military and medical organizations is an automation of the military-medical expertise as one of the most important activities. In this regard, noteworthy experience of the 9th Medical Diagnostic Centre (9th MDC), where on the basis of medical information system "Interi PROMIS" for the first time was implemented the automation of the work of military medical commission. The given paper presents an algorithm for constructing of the information system for the military-medical examination; detailed description of its elements is given. According to military servicemen the implementation of the Military Medical Commission (MMC) subsystem of the medical information system implemented into the 9th MDC has reduced the time required for the MMC and paperwork, greatly facilitate the work of physicians and medical specialists on military servicemen examination. This software can be widely applied in ambulatory and hospital practice, especially in case of mass military-medical examinations.
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
Kelly, Megan M; Vogt, Dawne S; Scheiderer, Emily M; Ouimette, Paige; Daley, Jennifer; Wolfe, Jessica
Few studies have addressed how military trauma exposure, particularly sexual assault and combat exposure, affects women veterans' use and perceptions of Veterans Health Administration (VHA) care. The aim of the present study was to evaluate the effects of military sexual assault and combat exposure on women veterans' use and perceptions of different aspects of VHA care. Cross-sectional telephone survey of a national sample of women veterans. Women from the VA's National Registry of Women Veterans. Sociodemographic characteristics, VHA care utilization, perceptions of care. Women veterans with histories of military sexual assault reported more use of VHA services, but less satisfaction, poorer perceptions of VHA facilities and staff, and more problems with VHA services compared to women veterans without histories of sexual assault. Combat exposure was related to more problems with VHA staff, although few other differences were observed for women with and without histories of combat exposure. Findings provide information on areas that can be targeted with respect to caring for women veterans exposed to military sexual trauma and combat exposure, including improving interactions with VHA staff and the ease of using VHA services.
of Schools of Public Health SYNOPSIS Objectives. Posttraumatic stress disorder (PTSD) results from experiencing or witnessing traumatic, life...124 Posttraumatic stress disorder (PTSD) is a psychiatric condition resulting from experiencing or witnessing traumatic events such as military...Statistical Manual of Mental Disorders , 3rd ed. (DSM-III), in 1980.30–38 Because traumas associated with PTSD are heterogeneous, defining PTSD and symptom
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. Copyright © 2017 Elsevier Ltd. All rights reserved.
Jenkins, Melissa M.; Colvonen, Peter J.; Norman, Sonya B.; Afari, Niloofar; Allard, Carolyn B.; Drummond, Sean P.A.
Study Objectives: There is limited information about prevalence of insomnia in general populations of veterans of recent wars in Iraq and Afghanistan. No studies have examined insomnia in veterans with military sexual trauma (MST). We assess prevalence of insomnia, identify types of services sought by veterans with insomnia, and examine correlates of insomnia in veterans with and without MST. Design: A cross-sectional study of first-encounter veterans registering to establish care. Setting: Veteran Affairs San Diego Healthcare System. Participants: Nine hundred seventeen veterans completed questionnaires assessing insomnia, MST, service needs, traumatic brain injury, resilience, and symptoms of depression, posttraumatic stress disorder (PTSD), pain, alcohol misuse, and hypomania. Interventions: N/A. Measurements and Results: 53.1% of veterans without MST and 60.8% of veterans with MST had clinically significant insomnia symptoms, with the MST subsample reporting more severe symptoms, P < 0.05. Insomnia was more prevalent than depression, hypomania, PTSD, and substance misuse. Veterans with insomnia were more likely to seek care for physical health problems and primary care versus mental health concerns, P < 0.001. For the veteran sample without MST, age, combat service, traumatic brain injury, pain, and depression were associated with worse insomnia, P < 0.001. For the MST subsample, employment status, pain, and depression were associated with worse insomnia, P < 0.001. Conclusions: Study findings indicate a higher rate of insomnia in veterans compared to what has been found in the general population. Insomnia is more prevalent, and more severe, in veterans with military sexual trauma. Routine insomnia assessments and referrals to providers who can provide evidence-based treatment are crucial. Citation: Jenkins MM, Colvonen PJ, Norman SB, Afari N, Allard CB, Drummond SP. Prevalence and mental health correlates of insomnia in first-encounter veterans with and
Hochman, Eldar; Shelef, Leah; Mann, J John; Portugese, Shirly; Krivoy, Amir; Shoval, Gal; Weiser, Mark; Fruchter, Eyal
About 45% of civilians who died by suicide had contact with a doctor within 1 month of death. Thus, educating primary care physicians (PCP) to detect and mitigate depression is an important suicide-prevention strategy. However, the PCP consulting rate before suicide has not been examined in a military population. We investigated the utilization of primary health care and mental health services by active-duty military personnel suicide cases prior to death in comparison to matched military controls. All suicides (N = 170) were extracted from a cohort of all active-duty Israeli military male personnel between 2002 and 2012. Applying a retrospective, nested case-control design, we compared primary care services utilization by suicide cases with demographic and occupationally matched military controls (N = 500). Whereas 38.3% of suicide cases contacted a PCP within the last month before death, only 27.6% of suicide cases contacted a mental health specialist during their entire service time. The PCP contact rate within 1 month before death or index day did not differ between suicide cases and military controls (38.3% vs. 33.8%, χ²₁ = 1.05, P = .3). More suicide cases contacted a mental health specialist within service time than did military controls (27.6% vs. 13.6%, χ²₁ = 10.85, P = .001). Even though PCP contact rate by military personnel who died by suicide is slightly lower than that reported for civilians who died by suicide prior to their death, it is higher than mental health specialist contact rate and higher than that by age-matched civilians who died by suicide. These results imply that PCPs education is a viable approach to suicide prevention in a military setting. © Copyright 2014 Physicians Postgraduate Press, Inc.
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.
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
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.
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.
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.
changing its posting strategies on the Taiwanese Ministry of Defense Facebook page. By enhancing public trust through social media, the military would be...Defense Facebook page. By enhancing public trust through social media, the military would be better positioned to increase recruitment, funding, and...stimulation stops but will be recalled from the memory if the same stimulation occurs again. Comparing the image with knowledge, there are some differences
Rosen, Bruce; Waitzberg, Ruth; Merkur, Sherry
Israel is a small country, with just over 8 million citizens and a modern market-based economy with a comparable level of gross domestic product per capita to the average in the European Union. It has had universal health coverage since the introduction of a progressively financed statutory health insurance system in 1995. All citizens can choose from among four competing, non-profit-making health plans, which are charged with providing a broad package of benefits stipulated by the government. Overall, the Israeli health care system is quite efficient. Health status levels are comparable to those of other developed countries, even though Israel spends a relatively low proportion of its gross domestic product on health care (less than 8%) and nearly 40% of that is privately financed. Factors contributing to system efficiency include regulated competition among the health plans, tight regulatory controls on the supply of hospital beds, accessible and professional primary care and a well-developed system of electronic health records. Israeli health care has also demonstrated a remarkable capacity to innovate, improve, establish goals, be tenacious and prioritize. Israel is in the midst of numerous health reform efforts. The health insurance benefits package has been extended to include mental health care and dental care for children. A multipronged effort is underway to reduce health inequalities. National projects have been launched to measure and improve the quality of hospital care and reduce surgical waiting times, along with greater public dissemination of comparative performance data. Major steps are also being taken to address projected shortages of physicians and nurses. One of the major challenges currently facing Israeli health care is the growing reliance on private financing, with potentially deleterious effects for equity and efficiency. Efforts are currently underway to expand public financing, improve the efficiency of the public system and constrain
Smatana, Martin; Pazitny, Peter; Kandilaki, Daniela; Laktisova, Michaela; Sedlakova, Darina; Paluskova, Monika; van Ginneken, Ewout; Spranger, Anne
This analysis of the Slovak health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. The health care system in Slovakia is based on universal coverage, compulsory health insurance, a basic benefit package and a competitive insurance model with selective contracting of health care providers. Containment of health spending became a major policy goal after the 2008 financial crisis. Health spending stabilized after 2010 but remains well below European averages. Some health indicators, such as life expectancy, healthy life years and avoidable deaths are worrisome. Furthermore, weak hospital management, high numbers of unused acute beds, overprescribing pharmaceuticals, and poor gatekeeping of the system all lead to over-utilization of services and system inefficiency. This suggests substantial room for improvement in delivery of care, especially for primary and long-term care. Additionally, there is inequity in the distribution of health providers, resulting in lengthy travelling distances and waiting times for patients. Given the ageing workforce, this trend is likely to continue. Current strategic documents and reform efforts aim to address the lack of efficiency and accountability. There has been a strong will to tackle these challenges but this has often been hindered by a lack of political consensus over issues such as the role of the state, the appropriate role of market mechanisms and profits, as well as the extent of out-of-pocket payments. Successive governments have taken different positions on these issues since the establishment of the current health system in 2002, and major reforms remain to be implemented. World Health Organization 2016 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).
Hofmarcher, Maria M; Quentin, Wilm
This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health-system performance. The Austrian health system provides universal coverage for a wide range of benefits and high-quality care. Free choice of providers and unrestricted access to all care levels (general practitioners, specialist physicians and hospitals) are characteristic features of the system. Unsurprisingly, population satisfaction is well above EU average. Income-related inequality in health has increased since 2005, although it is still relatively low compared to other countries. The health-care system has been shaped by both the federal structure of the state and a tradition of delegating responsibilities to self-governing stakeholders. On the one hand, this enables decentralized planning and governance, adjusted to local norms and preferences. On the other hand, it also leads to fragmentation of responsibilities and frequently results in inadequate coordination. For this reason, efforts have been made for several years to achieve more joint planning, governance and financing of the health-care system at the federal and regional level. As in any health system, a number of challenges remain. The costs of the health-care system are well above the EU15 average, both in absolute terms and as a percentage of GDP. There are important structural imbalances in healthcare provision, with an oversized hospital sector and insufficient resources available for ambulatory care and preventive medicine. This is coupled with stark regional differences in utilization, both in curative services (hospital beds and specialist physicians) and preventative services such as preventive health check-ups, outpatient rehabilitation, psychosocial and psychotherapeutic care and nursing. There are clear social inequalities in the use of medical services, such as preventive health check-ups, immunization or dentistry
Skabelund, Andrew J; Rawlins, Frederic A; McCann, Edward T; Lospinoso, Joshua A; Burroughs, Lorraine; Gallup, Roger A; Morris, Michael J
Significant concern exists regarding the respiratory health of military personnel deployed to Southwest Asia, given their exposures to numerous environmental hazards. Although the deployed military force is generally assumed to be fit, the pre-deployment respiratory health of these individuals is largely unknown. Soldiers deploying to Southwest Asia were recruited from the pre-deployment processing center at Fort Hood, Texas. Participants completed a general and respiratory health questionnaire and performed baseline spirometry. One thousand six hundred ninety-three pre-deployment evaluations were completed. The average age of the participants was 32.2 y, and 83.1% were male. More than one third of surveyed solders had a smoking history, 73% were overweight or obese, and 6.2% reported a history of asthma. Abnormal spirometry was found in 22.3% of participants. Soldiers with abnormal spirometry reported more asthma (10.1% vs 5.1%, P < .001), failed physical fitness tests (9.0% vs 4.6%, P = .02), and respiratory symptoms (32.8% vs 24.3%, P = .001). This is the first prospective pre-deployment evaluation of military personnel that delineates factors potentially associated with the development of pulmonary symptoms and/or disease. This study suggests that deploying soldiers are older, heavier, frequently smoke, and may have undiagnosed pre-deployment lung disease. Abnormal spirometry is common but may not represent underlying disease. Self-reported asthma, wheezing, and slower 2-mile run times were predictive of abnormal spirometry. Pre-deployment evaluation of military personnel identified numerous soldiers with active pulmonary symptoms and abnormal spirometry. When combined with questions regarding asthma history, wheezing and exercise intolerance, spirometry may identify individuals at risk for deployment-related respiratory complaints. Copyright © 2017 by Daedalus Enterprises.
Jones, P Eugene; Hooker, Roderick S
Little is known about the benefits to society of the educational development of health personnel in the military who return to civilian life and continue their careers. The U.S. Department of Defense has produced physician assistants (PAs) since the early 1970s, and PA training is now consolidated into one location in Texas as the Interservice Physician Assistant Program (IPAP). We studied redistribution of PAs upon service departure to determine if IPAP attendance had an effect on the Texas PA workforce. The Texas Medical Board dataset of licensed PAs was examined to identify program attended, practice specialty by supervising physician designation, practice location, and primary care or specialty care practice designation. Primary care was defined as family medicine, general pediatrics, or general internal medicine. All other designations were classified as specialty practice. Of 6016 licensed Texas PAs, 425 (7.0%) reported attending a military PA training program. Of the 254 PAs in full-time civilian clinical practice, 148 (58.3%) reported practice in primary care settings, and 106 (41.7%) reported specialty clinical practice settings. With the average military officer retirement age of 47 years and the 2010 average U.S. retirement age of 64 years for men and 62 for women, an estimated 16 years of community workforce productivity is provided per veteran PA following completion of military service. We estimated over 47,000 outpatient visits are provided per PA following military service. The care provided can be measured as a positive return-on-investment of taxpayer-provided education.
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.
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.
skilled health personnel, number and quality of trained doctors and nurses , and percentage of the population using improved drinking-water sources... nurses , and percentage of the population using improved drinking-water sources and sanitation facilities. Importantly, these metrics are not...the independent, and caring young men and women they have become. They have been missed, and I look forward to our reunion. May we all be blessed
sexually transmitted diseases (STDs), pregnancy, and routine pelvic examination. This list of diagnoses the medics described is not unlike what the...medics were bacterial vaginosis, dysmenorrhea, urinary tract infection, urinary incontinence, dehydration, sexually transmitted diseases (STDs), and...C05 9 etc.), and sexual health. The medics believed that the time spent teaching women was an opportunity for their population to see them as a
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
systems engineering from the University of Florida in 1996. She was commissioned an officer in the United States Air Force in 1984...píìÇó= Real Options in Military System Acquisition: The Case Study of Technology Development for the Javelin Anti-Tank Weapon System 22 August 2013...Real Options in Military System Acquisition: The Case Study of Technology Development for the Javelin Anti-Tank Weapon System 5a.
Han, Peggy P.; Dougherty, Amber L.; Galarneau, Michael R.
Objective. We investigated the association of the length of time spent at home between deployments, or dwell time, with posttraumatic stress disorder (PTSD) and other mental health disorders. Methods. We included US Marine Corps personnel identified from military deployment records who deployed to Operation Iraqi Freedom once (n = 49 328) or twice (n = 16 376). New-onset mental health diagnoses from military medical databases were included. We calculated the ratio of dwell-to-deployment time (DDR) as the length of time between deployments divided by the length of the first deployment. Results. Marines with 2 deployments had higher rates of PTSD than did those with 1 deployment (2.1% versus 1.2%; P < .001). A DDR representing longer dwell times at home relative to first deployment length was associated with reduced odds of PTSD (odds ratio [OR] = 0.47; 95% confidence interval [CI] = 0.32, 0.70), PTSD with other mental health disorder (OR = 0.56; 95% CI = 0.33, 0.94), and other mental health disorders (OR = 0.62; 95% CI = 0.51, 0.75). Conclusions. Longer dwell times may reduce postdeployment risk of PTSD and other mental health disorders. Future research should focus on the role of dwell time in adverse health outcomes. PMID:22390601
Ferre, Francesca; de Belvis, Antonio Giulio; Valerio, Luca; Longhi, Silvia; Lazzari, Agnese; Fattore, Giovanni; Ricciardi, Walter; Maresso, Anna
Italy is the sixth largest country in Europe and has the second highest average life expectancy, reaching 79.4 years for men and 84.5 years for women in 2011. There are marked regional differences for both men and women in most health indicators, reflecting the economic and social imbalance between the north and south of the country. The main diseases affecting the population are circulatory diseases, malignant tumours and respiratory diseases. Italy's health care system is a regionally based national health service that provides universal coverage largely free of charge at the point of delivery. The main source of financing is national and regional taxes, supplemented by copayments for pharmaceuticals and outpatient care. In 2012, total health expenditure accounted for 9.2 percent of GDP (slightly below the EU average of 9.6 percent). Public sources made up 78.2 percent of total health care spending. While the central government provides a stewardship role, setting the fundamental principles and goals of the health system and determining the core benefit package of health services available to all citizens, the regions are responsible for organizing and delivering primary, secondary and tertiary health care services as well as preventive and health promotion services. Faced with the current economic constraints of having to contain or even reduce health expenditure, the largest challenge facing the health system is to achieve budgetary goals without reducing the provision of health services to patients. This is related to the other key challenge of ensuring equity across regions, where gaps in service provision and health system performance persist. Other issues include ensuring the quality of professionals managing facilities, promoting group practice and other integrated care organizational models in primary care, and ensuring that the concentration of organizational control by regions of health-care providers does not stifle innovation. World Health
Chiles, Daniel P; Roberts, Timothy A; Klein, David A
Long-acting reversible contraception is more effective for pregnancy prevention than shorter-acting contraceptive methods and has the potential to reduce healthcare disparities and costs. However, long-acting reversible contraception is underused in the United States. One population of interest is beneficiaries of the United States military healthcare system who have access to universal healthcare, including no-cost, no-copay contraception with unlimited method switching, and comprise a large, actual use cohort. Efforts to increase long-acting reversible contraception initiation and continuation in this population may improve health outcomes and mitigate the profound consequences of unintended or mistimed pregnancy on readiness and cost to the military. We aimed to determine long-acting reversible contraception initiation and continuation rates among the diverse population with universal healthcare who are enrolled in the US military healthcare system. This study is a retrospective cohort of >1.7 million women, aged 14-40 years, who were enrolled in the US military healthcare system, TRICARE Prime, between October 2009 and September 2014. Individuals were assessed for long-acting reversible contraception initiation and continuation with the use of medical billing records. Method continuation and factors that were associated with early method discontinuation were evaluated with the Kaplan-Meier estimator and Cox proportional hazard models. During the study dates, 188,533 women initiated long-acting reversible contraception. Of these, 74.6% women selected intrauterine contraceptives. Method initiation rates remained relatively stable (41.7-50.1/1000 women/year) for intrauterine methods, although the rate for subdermal implants increased from 6.1-23.0/1000 women/year. In analysis of women who selected intrauterine contraceptives, 61.2% continued their method at 36 months, and 48.8% continued at 60 months. Among women who selected the implant, 32.0% continued their
Laboratories High Integrity Software Systems PO Box 5800 Mail Stop 0860 Albuquerque, NM 87185 Abstract: Cryptographic embedded systems are used to...calculations exist, there is an increasing need for this level of assurance for software -based processor systems in the absence of equivalent failure type...and rate calculations for software . This paper presents a method to guarantee to a quantifiable level of confidence that external components are
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.
Ibrahimov, Fuad; Ibrahimova, Aybaniz; Kehler, Jenni; Richardson, Erica
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. Azerbaijan gained independence from the Soviet Union in 1991. Reform of the health care system in Azerbaijan has been incremental so that organizationally it still has many of the key hallmarks of the Soviet model of health care, the Semashko system. However, relatively low levels of government expenditure on health as a proportion of gross domestic product since independence has meant that out of pocket (OOP) payments accounted for almost 62% of total health expenditure in 2007. This has serious implications for access to care and financial risk protection for vulnerable households. The private provision of services is an increasingly important part of the health system, and services provided in parallel by other ministries and state enterprises continue to account for a certain amount of health expenditure. Revenues from the recent oil boom have been used to fund large capital investment projects such as the building of new hospitals with the latest technology and the import of modern equipment. However, future plans include the strengthening of primary care and the introduction of mandatory health insurance as part of major reforms to the health financing system.
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.
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
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.
de Almeida Simoes, Jorge; Figueiredo Augusto, Goncalo; Fronteira, Ines; Hernandez-Quevedo, Cristina
This analysis of the Portuguese health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Overall health indicators such as life expectancy at birth and at age 65 years have shown a notable improvement over the last decades. However, these improvements have not been followed at the same pace by other important dimensions of health: child poverty and its consequences, mental health and quality of life after 65. Health inequalities remain a general problem in the country. All residents in Portugal have access to health care provided by the National Health Service (NHS), financed mainly through taxation. Out-of-pocket payments have been increasing over time, not only co-payments, but particularly direct payments for private outpatient consultations, examinations and pharmaceuticals. The level of cost-sharing is highest for pharmaceutical products. Between one-fifth and one-quarter of the population has a second (or more) layer of health insurance coverage through health subsystems (for specific sectors or occupations) and voluntary health insurance (VHI). VHI coverage varies between schemes, with basic schemes covering a basic package of services, whereas more expensive schemes cover a broader set of services, including higher ceilings of health care expenses. Health care delivery is by both public and private providers. Public provision is predominant in primary care and hospital care, with a gate-keeping system in place for access to hospital care. Pharmaceutical products, diagnostic technologies and private practice by physicians constitute the bulk of private health care provision. In May 2011, the economic crisis led Portugal to sign a Memorandum of Understanding with the International Monetary Fund, the European Commission and the European Central Bank, in exchange for a loan of 78 billion euros. The agreed Economic and Financial Adjustment Programme included
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.
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
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
Wesson, Matthew I; Whybrow, D; Greenberg, N; Gould, M
Recent service developments in the NHS on the provision of talking therapies such as the Improving Access to Psychological Therapies (IAPT) initiative have made the compliance with clinical supervision (CS) inherent among its service guidelines. This paper presents the findings of an audit, measuring compliance with CS among clinicians providing psychological therapies within a military Department of Community Mental Health. Adherence to the recommended monthly supervision and the presence of an indate CS contract were audited on two separate occasions over 2 years by analysing the departmental electronic CS database. Compliance rates were found to be lower than the Defence guidelines, which are already modest in their expectations compared with IAPT CS standards. Potential reasons are hypothesised including high levels of staff rotation, other military commitments, clinicians not keeping up-to-date records and the pressures of meeting performance indicators on other clinical issues. Proposals for improving the uptake of CS are suggested along with areas for further research.
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.
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.
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…
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…
Szalay, Tomás; Pazitný, Peter; Szalayová, Angelika; Frisová, Simona; Morvay, Karol; Petrovic, Marek; van Ginneken, Ewout
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 Slovak health system is a system in progress. Major health reform in the period 2002 to 2006 introduced a new approach based on managed competition. Although large improvements have been made since the 1990s (for example in life expectancy and infant mortality), health outcomes are generally still substantially worse than the average for the EU15 but close to the other Visegrad Four countries. Per capita health spending (in purchasing power parity [PPP]) was around half the EU15 average. A large share of these resources was absorbed by pharmaceutical spending (28% in 2008, compared to 16% in OECD countries). Some important utilization indicators signal plenty of resources in the system but may also indicate excess bed capacity and overutilization. The number of physicians and nurses per capita has been actively reduced since 2001 but remains above the average of the EU12 (i.e. the 12 countries that joined the EU in 2004 and 2007). An ageing workforce and professional migration may reinforce a shortage of health care workers. People have free choice of general practitioner (GP) and specialist. Their services are provided without cost-sharing from patients, with the notable exception of dental procedures. Inpatient care and specialized ambulatory care are provided in general hospitals and specialized hospitals. Pharmaceutical expenditure per capita accounts for one-third of public expenditure on health care. Long-term care is provided by health care
provides forward-deployed forces, i.e. Special Forces Operational Detachment Team Alphas, Seal Teams and Long Range Reconnaissance Detachment teams ...System • Army/Marine Corps Advanced Field Artillery Tactical Data System (AFATDS) • Army’s Grenadier BRAT (GB) Blue Force Tracking Device Tactical...providing greater signal power in theater through the use of the MGAS spot beam. 6 Existing GPS Wartime Values Proposed Low-Risk MGAS Technology
Dichter, Melissa E; Haywood, Terri N; Butler, Anneliese E; Bellamy, Scarlett L; Iverson, Katherine M
Intimate partner violence (IPV) includes psychological, physical, or sexual aggression by a current or former intimate partner and is associated with a wide range of health and social impacts, especially for women. Women veterans may be at increased risk for experiencing IPV, and some Veterans Health Administration (VHA) facilities have initiated routine screening of female patients for past-year IPV. This study presents the first examination of clinical IPV screening responses recorded from female VHA patients across 13 facilities nationwide, and identifies associations with patient demographic and military service characteristics. Electronic medical record data were extracted for a cohort of 8,885 female VHA patients who completed screening for experience of past-year IPV during a clinic visit between April 2014 and April 2016. Analyses, conducted in 2016, examined the overall proportion of patients screening positive for IPV, as well as associations by demographic and military service characteristics. Overall, 8.7% of patients screened positive for past-year IPV. Odds of screening positive for IPV were higher among women who were younger (aged <35 years); married; served in the most recent conflict era; experienced sexual assault or harassment during military service; or had not served in the military (non-veterans). Study findings indicate a significant proportion of female VHA patients disclosing past-year IPV during clinical screening, and identify characteristics associated with increased vulnerability. Implications for future research and program implementation include addressing high-risk subpopulations and further investigating the impact of screening and follow-up care. Published by Elsevier Inc.
Klingensmith, Katherine; Tsai, Jack; Mota, Natalie; Southwick, Steven M; Pietrzak, Robert H
To evaluate the prevalence of military sexual trauma (MST) among US veterans, identify sociodemographic and military characteristics of MST, and examine the relationships between MST and psychiatric comorbidities, functioning/quality of life, and mental health treatment utilization. Data were analyzed from the National Health and Resilience in Veterans Study, a contemporary, nationally representative survey of 1,484 US veterans conducted September-October 2013. Poststratification weights were applied to analyses to permit generalizability of results to the US veteran population. Outcomes measured include history of MST, trauma histories, lifetime and current DSM-IV mental disorders, functioning and quality of life, and utilization of mental health treatment. The overall prevalence of MST was 7.6% and was higher among female than male veterans (32.4% vs 4.8%) and younger than older veterans (22.8% among veterans aged 18-29 years vs 4.5% among veterans aged 60+ years). After adjustment for sociodemographic and military characteristics, MST was associated with elevated rates of current major depressive disorder, posttraumatic stress disorder, and generalized anxiety disorder (adjusted odds ratio [aOR] range, 2.19-3.12); past history of suicide attempt (aOR = 2.78) and current suicidal ideation (aOR = 2.19); and decreased mental and cognitive functioning and quality of life (Cohen d, 0.23-0.38). MST was also associated with increased current utilization of psychotropic medication (aOR = 3.70) and psychotherapy or counseling (aOR = 2.41), independent of psychiatric morbidities. 7.6% of US veterans screen positive for MST, with substantially higher rates among female and younger veterans. MST is associated with elevated rates of several psychiatric morbidities and suicidality, reduced functioning and quality of life, and increased mental health treatment utilization, independent of other sociodemographic, military, and mental health factors. These results suggest that
Akbayrak, Nalan; Oflaz, Fahriye; Aslan, Ozlem; Ozcan, C Tangül; Tastan, Sevinc; Ciçek, Hatice Sütcü
This descriptive study investigated traumatic experiences and post-traumatic stress disorder symptoms among military professionals in Turkey. The sample included 225 military health professionals who were in charge in districts in which traumatic events occurred frequently in the past decade. The Impact of Event Scale, Beck Anxiety Inventory, and Symptom Checklist were used to obtain data in the study. More than one-half of the health professionals had experienced at least one traumatic event. Those who had a history of traumatic experience and loss of relatives or friends reported more symptoms than did those who had not experienced traumatic events. As expected, health professionals who had traumatic experiences were more likely to have higher Impact of Event Scale scores than were those who had not experienced physical or psychological trauma. The findings indicate that health professionals are as affected by traumatic events as are those in other settings or occupations. Future research should focus on the long-term effects of post-traumatic stress among health professionals.
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.
Kirkpatrick, Jeffrey S
Deployments of U.S. Forces to the Persian Gulf (1991), Bosnia and Herzegovina (1995), and Kosovo (1999) were associated with diverse, potential environmental exposures. Health effects possibly associated with these exposures were cause for concern among service members, veterans, and military and civilian leaders. A need for the military to effectively respond to these exposures, and more importantly, to assess and mitigate exposures before deployments and to conduct environmental surveillance during deployments was identified. The Department of Defense encountered many obstacles in dealing with the exposures of 1991. Even though these obstacles were being identified, and in some cases, addressed, responses to historical exposure concerns continued to be reactive. In 1996, efforts were intensified to improve policy and doctrine, field sampling equipment, risk assessment processes, geographic information systems, and other tools needed to effectively identify and reduce the impact of exposures before troops deploy and to conduct environmental surveillance while deployed. Success in these efforts resulted in a comprehensive, planned approach being implemented to address environmental health concerns during the 1999 Kosovo deployment.
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
Lehavot, Keren; Der-Martirosian, Claudia; Simpson, Tracy L; Shipherd, Jillian C; Washington, Donna L
Posttraumatic stress disorder (PTSD) is a significant predictor of both poorer physical health and increased health care utilization, whereas adequate social support is associated with better physical health and less health care utilization. However, research has not previously examined the simultaneous effects of PTSD and social support on health and health care utilization. This study examined both the independent and interactive effects of PTSD and a particular type of social support (postactive-duty social support from military friends) on self-reported physical health and number of Veterans Health Administration (VHA) visits in the last year. These relationships were examined in a representative, national sample of 3,524 women veterans who completed telephone interviews as part of the National Survey of Women Veterans in 2008-2009. Regression analyses were conducted using these cross-sectional data to examine main effects of PTSD and military social support on physical health and VHA utilization and their interaction. Screening positive for PTSD was associated with poorer health (B = -3.19, SE = 1.47) and increased VHA utilization (B = 0.98, SE = 0.16), whereas greater military social support was associated with better health (B = 0.97, SE = 0.44) and less frequent VHA utilization (B = -0.15, SE = 0.05). Neither moderation model was significant, such that military social support behaved in a similar way regardless of PTSD status. Published 2013. This article is a US Government work and is in the public domain in the USA.
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
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.
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.
Khodjamurodov, Ghafur; Sodiqova, Dilorom; Akkazieva, Baktygul; Rechel, Bernd
The pace of health reforms in Tajikistan has been slow and in many aspects the health system is still shaped by the countrys Soviet legacy. The country has the lowest total health expenditure per capita in the WHO European Region, much of it financed privately through out-of-pocket payments. Public financing depends principally on regional and local authorities, thus compounding regional inequalities across the country. The high share of private out-of-pocket payments undermines a range of health system goals, including financial protection, equity, efficiency and quality. The efficiency of the health system is also undermined by outdated provider payment mechanisms and lack of pooling of funds. Quality of care is another major concern, due to factors such as insufficient training, lack of evidence-based clinical guidelines, underuse of generic drugs, poor infrastructure and equipment (particularly at the regional level) and perverse financial incentives for physicians in the form of out-of-pocket payments. Health reforms have aimed to strengthen primary health care, but it still suffers from underinvestment and low prestige. A basic benefit package and capitation-based financing of primary health care have been introduced as pilots but have not yet been rolled out to the rest of the country. The National Health Strategy envisages substantial reforms in health financing, including nationwide introduction of capitation-based payments for primary health care and more than doubling public expenditure on health by 2020; it remains to be seen whether this will be achieved. World Health Organization 2016 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).
Bullmore E, (2005). N-back working memory paradigm: a meta - analysis of normative functional neuroimaging studies. Human Brain Mapping, 25 (1), 46-59...and are most noticeable in those body systems that are directly related to oxygen delivery (i.e. respiratory and cardiovascular ), but changes occur in...operations in mountainous areas: At high altitudes, peripheral SaO2 (haemoglobin-oxygen saturation ) measured by pulse-oximetry should preferably use the
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
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.
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
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
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.
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
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.
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.
education full time or not immediately after graduating from high school; and have family and work responsibilities, as well as other life...some military spouses who receive the scholarship may not be entering higher education immediately out of high school, they may have dependents, they...The Military Spouse Education and Career Opportunities Program Recommendations for an Internal Monitoring System Gabriella C. Gonzalez, Laura L
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
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
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
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.
Friedl, Karl E
In 1994, Congress provided dollar 40 M for biomedical research on issues of importance for military women. This supported 104 intramural and 30 extramural studies and launched an era of research to narrow the knowledge gap on protection and enhancement of health and performance of military women. Projects addressed issues specific to female physiology (e.g., gynecological health in the field, maternal malaria), problems with higher prevalence for women (e.g., marginal iron deficiency, stress fracture), and issues of drug and materiel safety that had only been extrapolated from studies of men (e.g., chemical agent prophylaxis, fatigue countermeasures). Several important assumptions about female physiology and occupational risks were found to be astoundingly wrong. Hormonal changes through the menstrual cycle were less important to acute health risks and performance than predicted, exercise did not increase risk for amenorrhea and consequent bone mineral loss, and women tolerated G-forces and could be as safe as men in the cockpit if their equipment was designed for normal size and strength ranges. Data on personal readiness issues, such as body fat, physical fitness, nutrition, and postpartum return to duty, allowed reconsideration of standards that were gender appropriate and not simply disconnected adjustments to existing male standards. Other discoveries directly benefited men as well as women, including development of medical surveillance databases, identification of task strength demands jeopardizing safety and performance, and greater understanding of the effects of psychosocial stress on health and performance. This surge of research has translated into advances for the welfare of service women and the readiness of the entire force; relevant gender issues are now routine considerations for researchers and equipment developers, and some key remaining research gaps of special importance to military women continue to be investigated.
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.
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
Piontkovski, V; Novakovska, L; Pasternak, V
The purpose of the discussion is to evaluate certain aspects of the Polish health care system - its ability to respond to contemporary dynamic social, economic and epidemiological changes (including the spread of chronic diseases, aging population or family crisis - its possibilities for providing care of the sick). The analysis of such a problem was based on a critically-oriented perspective that is developed in the field of the sociology of health and illness. The text pays particular attention to the problem of deepening social inequalities, which can be considered as one of the major factors that hinder access to health care and influence poorer health condition: In this context the mechanism of "saving health" and borrowing in order to satisfy the health needs in the face of financial difficulties was mentioned. Moreover, the text includes the attempt to evaluate the effectiveness of health promo- tion programs in our country as potentially the most effective way of raising the level of public health. There is also the issue of public confidence in health care institutions and the approval of attempts towards reforming the medical system in our country. A separate part of the discussion was devoted to criticism of the idea of reducing the role of the state in the health care sector.
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
Patterson, Steven L; Dancy, Blair C R; Ippolito, Danielle L; Stallings, Jonathan D
: This paper presents environmental health risks which are prevalent in dense urban environments.We review the current literature and recommendations proposed by environmental medicine experts in a 2-day symposium sponsored by the Department of Defense and supported by the Johns Hopkins University Applied Physics Laboratory.Key hazards in the dense urban operational environment include toxic industrial chemicals and materials, water pollution and sewage, and air pollution. Four critical gaps in environmental medicine were identified: prioritizing chemical and environmental concerns, developing mobile decision aids, personalized health assessments, and better real-time health biomonitoring.As populations continue to concentrate in cities, civilian and military leaders will need to meet emerging environmental health concerns by developing and delivering adequate technology and policy solutions.
Sareen, Jitender; Belik, Shay-Lee; Stein, Murray B; Asmundson, Gordon J G
There is increasing concern about mental health problems and need for mental health care among soldiers after deployment. This study examined correlates of self-perceived need for mental health care among active military personnel. Data were from a 2002 cross-sectional population-based survey of 8,441 active Canadian military personnel (2,592 women) aged 16 to 54 (response rate 81%). A fully structured lay-administered interview for past-year DSM-IV mental disorders and perceived need for mental health care was conducted. Five domains of self-perceived need were assessed: information, medication, counseling, social intervention, and skills training. Several deployment factors were assessed (length of deployment, number of deployments, and exposure to deployment-related traumatic events), as were long-term restriction in activities because of disability and suicidal ideation. Multiple logistic regression models were used to determine correlates of perceived need. After adjustment for mental disorders, the strongest and most consistent correlates of perceived need were long-term restriction in activities, suicidal ideation, female gender, and regular service status (versus reserve status) (adjusted odds ratios ranging from 1.28 to 4.37). Deployment and exposure to combat and witnessing atrocities were moderately associated with an increase in self-perceived need for mental health care. The findings suggest that a range of issues beyond the presence of common mental disorders need to be considered in understanding the factors that contribute to a sense of need for mental health treatment. Postdeployment screening programs should consider systematically assessing self-perceived need for mental health treatment.
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
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
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.
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.
Kelly, Ursula A; Skelton, Kelly; Patel, Meghna; Bradley, Bekh
Military sexual trauma (MST) is reported by 20-40% of female veterans. The purpose of this study of female veterans referred for MST treatment was to examine the relationships between lifetime trauma (physical, sexual, and psychological) and posttraumatic stress disorder (PTSD), depression, physical health, and quality of life using retrospective cross-sectional data from medical records. Of the 135 participants, 95.4% reported at least one trauma in addition to MST, most notably sexual abuse as adult civilians (77.0%) and as children (52.6%). PTSD, depression, and sleep difficulty rates were clinically significant. Chronic pain (66.4%) was associated with childhood abuse, physical health, sleep difficulties, and coping. Integrating mental and physical health treatment is necessary to treat MST and PTSD in female veterans. Copyright © 2011 Wiley Periodicals, Inc.
Bareis, Natalie; Mezuk, Briana
Childhood poverty has been associated with depression in adulthood, but whether this relationship extends to later life major depression (MD) or is modified by military service is unclear. Data come from the Health and Retirement Study (HRS) 2010 wave, a longitudinal, nationally representative study of older adults. Men with data on military service and childhood poverty were included (N=6330). Childhood poverty was assessed by four indicators (i.e., parental unemployment, residential instability) experienced before age 16. Military service was categorized as veteran versus civilian, and during draft versus all-volunteer (after 1973) eras. Past year MD was defined by the Composite International Diagnostic Inventory. Four in ten men ever served, with 13.7% in the all-volunteer military. Approximately 12% of civilians, 8% draft era and 24% all-volunteer era veterans had MD. Childhood poverty was associated with higher odds of MD (Odds Ratio (OR): 2.38, 95% Confidence Interval (CI): 1.32-4.32) and higher odds of military service (OR: 2.58, 95% CI: 1.58-4.21). Military service was marginally associated with MD (OR: 1.28, 95% CI: 0.98-1.68) and did not moderate the association between childhood poverty and MD. Self-report data is subject to recall bias. The HRS did not assess childhood physical and emotional abuse, or military combat exposure. Men raised in poverty had greater odds of draft and all-volunteer military service. Early-life experiences, independent of military service, appear associated with greater odds of MD. Assessing childhood poverty in service members may identify risk for depression in later life. Copyright © 2016 Elsevier B.V. All rights reserved.
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."
Naval Health Research Center A Comparison of Mental Health Outcomes in Persons Entering U.S. Military Service Before and After September 11, 2001...Smith et al., 2008; T. C. Smith et al., 2008; Wells et al., 2010). It is unclear whether the effects of combat expo- sure on mental health outcomes ...analyses were performed to assess poten- tial confounders, which were defined as changing the asso- ciation between each mental health outcome and accession
Azzopardi-Muscat, Natasha; Buttigieg, Stefan; Calleja, Neville; Merkur, Sherry
Maltese life expectancy is high, and Maltese people spend on average close to 90% of their lifespan in good health, longer than in any other EU country. Malta has recently increased the proportion of GDP spent on health to above the EU average, though the private part of that remains higher than in many EU countries. The total number of doctors and GPs per capita is at the EU average, but the number of specialists remains relatively low; education and training are being further strengthened in order to retain more specialist skills in Malta. The health care system offers universal coverage to a comprehensive set of services that are free at the point of use for people entitled to statutory provision. The historical pattern of integrated financing and provision is shifting towards a more pluralist approach; people already often choose to visit private primary care providers, and in 2016 a new public-private partnership contract for three existing hospitals was agreed. Important priorities for the coming years include further strengthening of the primary and mental health sectors, as well as strengthening the health information system in order to support improved monitoring and evaluation. The priorities of Malta during its Presidency of the Council of the EU in 2017 include childhood obesity, and Structured Cooperation to enhance access to highly specialized and innovative services, medicines and technologies. Overall, the Maltese health system has made remarkable progress, with improvements in avoidable mortality and low levels of unmet need. The main outstanding challenges include: adapting the health system to an increasingly diverse population; increasing capacity to cope with a growing population; redistributing resources and activity from hospitals to primary care; ensuring access to expensive new medicines whilst still making efficiency improvements; and addressing medium-term financial sustainability challenges from demographic ageing. World Health
Stroop, Davis M; Dietrich, Kim N; Hunt, Allen N; Suddendorf, Lawrence R; Giangiacomo, Mark
In children, lead can cause serious permanent damage as a neurotoxicant. The objectives of the study were to evaluate potential exposure to lead-based paint in family housing units at a typical U.S. military installation and determine blood lead (PbB) levels in children ages 6 years or younger residing in these housing units. The authors conducted a risk assessment of 1,723 housing units and occupants at Fort Devens in Massachusetts. Data from the military dependent cohort was compared to estimates for the U.S. national population as reported from Phase 1 of the Third National Health and Nutrition Examination Survey (NHANES III). A total of 1992 individuals (1,009 males and 983 females) were screened for PbB, stratified into age groups, and separated into racial/ethnic categories. Four (0.3%) dust samples and 59 (11.6%) internal and 298 (77.8%) external paint chip samples contained hazardous levels of lead. The geometric mean PbB concentration for people ages 1 year and older reported by NHANES III was 2.8 micro g/dL, compared with 1.5 microg/dL for the military installation cohort (p<0.0001). PbB levels were higher for males than for females and higher for blacks than whites 6 years of age and older. Hispanics had lower PbB concentrations for all age groups except for those ages 1-2.9 years. Prevalence of PbB levels >10 microg/dL for all age groups was 1.6% in the military cohort, compared with 4.5% for the general population. For ages 1-2.9 years, no blacks or Hispanics and 0.6% of whites had PbB levels >10 micro g/dL, compared with 21.6% of blacks, 10.1% of Hispanics, and 8.5% of whites for the general population. For ages 3-5.99 years, 0.15% of blacks, 0% of Hispanics, and 0.3% of whites had PbB levels > or = 10 microg/dL, compared with 20.0% of blacks, 6.8% of Hispanics, and 3.7% of whites for the general population. Lead exposure for occupants of on-post military housing is much less than for those residing in the civilian sector.
Stroop, Davis M.; Dietrich, Kim N.; Hunt, Allen N.; Suddendorf, Lawrence R.; Giangiacomo, Mark
OBJECTIVE: In children, lead can cause serious permanent damage as a neurotoxicant. The objectives of the study were to evaluate potential exposure to lead-based paint in family housing units at a typical U.S. military installation and determine blood lead (PbB) levels in children ages 6 years or younger residing in these housing units. METHODS: The authors conducted a risk assessment of 1,723 housing units and occupants at Fort Devens in Massachusetts. Data from the military dependent cohort was compared to estimates for the U.S. national population as reported from Phase 1 of the Third National Health and Nutrition Examination Survey (NHANES III). RESULTS: A total of 1992 individuals (1,009 males and 983 females) were screened for PbB, stratified into age groups, and separated into racial/ethnic categories. Four (0.3%) dust samples and 59 (11.6%) internal and 298 (77.8%) external paint chip samples contained hazardous levels of lead. The geometric mean PbB concentration for people ages 1 year and older reported by NHANES III was 2.8 micro g/dL, compared with 1.5 microg/dL for the military installation cohort (p<0.0001). PbB levels were higher for males than for females and higher for blacks than whites 6 years of age and older. Hispanics had lower PbB concentrations for all age groups except for those ages 1-2.9 years. Prevalence of PbB levels >10 microg/dL for all age groups was 1.6% in the military cohort, compared with 4.5% for the general population. For ages 1-2.9 years, no blacks or Hispanics and 0.6% of whites had PbB levels >10 micro g/dL, compared with 21.6% of blacks, 10.1% of Hispanics, and 8.5% of whites for the general population. For ages 3-5.99 years, 0.15% of blacks, 0% of Hispanics, and 0.3% of whites had PbB levels > or = 10 microg/dL, compared with 20.0% of blacks, 6.8% of Hispanics, and 3.7% of whites for the general population. CONCLUSION: Lead exposure for occupants of on-post military housing is much less than for those residing in the
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Blosnich, John R; Gordon, Adam J; Fine, Michael J
To assess the associations of self-identified lesbian, gay, bisexual, and questioning sexual orientation or transgender status (LGBTQ) and military experience with health indicators. We used data from the Fall 2012 National College Health Assessment. The survey included self-identified sociodemographic characteristics, mental (e.g., depression) and physical (e.g., human immunodeficiency virus) conditions, health risk behaviors (e.g., smoking), and social stressors (e.g., victimization). We used modified Poisson regression models, stratified by self-reported military service, to examine LGBTQ-related differences in health indicators, whereas adjusting for sociodemographic characteristics. Of 27,176 in the sample, among the military-experienced group, LGBTQ individuals had increased adjusted risks of reporting a past-year suicide attempt (adjusted risk ratio [aRR] = 4.37; 95% confidence interval [CI] = 1.39-13.67), human immunodeficiency virus (aRR = 9.90; 95% CI = 1.04-79.67), and discrimination (aRR = 4.67; 95% CI = 2.05-10.66) than their non-LGBTQ peers. Among LGBTQ individuals, military experience was associated with a nearly four-fold increased risk of reporting a past-year suicide attempt (aRR = 3.61; 95% CI = 1.46-8.91) adjusting for age, sex, race and ethnicity, marital status, depression, and other psychiatric diagnoses. Military experience may moderate health indicators among LGBTQ populations, and likewise, LGBTQ status likely modifies health conditions among military-experienced populations. Results suggest that agencies serving military populations should assess how and if the health needs of LGBTQ individuals are met. Published by Elsevier Inc.
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
Reneke, J.A.; Fryer, M.O.
Well designed large systems include many instrument taking data. These data are used in a variety of ways. They are used to control the system and its components, to monitor system and component health, and often for historical or financial purposes. This paper discusses a new method of using data from low level instrumentation to monitor system and component health. The method uses the covariance of instrument outputs to calculate a measure of system change. The method involves no complicated modeling since it is not a parameter estimation algorithm. The method is iterative and can be implemented on a computer in real time. Examples are presented for a metal lathe and a high efficiency particulate air (HEPA) filter. It is shown that the proposed method is quite sensitive to system changes such as wear out and failure. The method is useful for low level system diagnostics and fault detection.
Each year, approximately 800 new construction projects costing over $2 billion are proposed by the Military Departments and Defense Agencies as...Congressional requirement 2-4 00-I IZ Q I.-t ~ zI ~us wi cm z CZ = = uI 4c m 4iCca -. 4 LldJ t0 ww caa o cr z 2-5 for new construction projects and updates to
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
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.
Background Complementary and Alternative Medicine use and how it impacts health care utilization in the United States Military is not well documented. Using data from the Millennium Cohort Study we describe the characteristics of CAM users in a large military population and document their health care needs over a 12-month period. The aim of this study was to determine if CAM users are requiring more physician-based medical services than users of conventional medicine. Methods Inpatient and outpatient medical services were documented over a 12-month period for 44,287 participants from the Millennium Cohort Study. Equal access to medical services was available to anyone needing medical care during this study period. The number and types of medical visits were compared between CAM and non-CAM users. Chi square test and multivariable logistic regression was applied for the analysis. Results Of the 44,287 participants, 39% reported using at least one CAM therapy, and 61% reported not using any CAM therapies. Those individuals reporting CAM use accounted for 45.1% of outpatient care and 44.8% of inpatient care. Individuals reporting one or more health conditions were 15% more likely to report CAM use than non-CAM users and 19% more likely to report CAM use if reporting one or more health symptoms compared to non-CAM users. The unadjusted odds ratio for hospitalizations in CAM users compared to non-CAM users was 1.29 (95% CI: 1.16-1.43). The mean number of days receiving outpatient care for CAM users was 7.0 days and 5.9 days for non-CAM users (p < 0.001). Conclusions Our study found those who report CAM use were requiring more physician-based medical services than users of conventional medicine. This appears to be primarily the result of an increase in the number of health conditions and symptoms reported by CAM users. PMID:21481260
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.
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
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
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.
Cederbaum, Julie A; Wilcox, Sherrie L; Sullivan, Kathrine; Lucas, Carrie; Schuyler, Ashley
Although many service members successfully cope with exposure to stress and traumatic experiences, others have symptoms of depression, posttraumatic stress disorder (PTSD), and anxiety; contextual factors may account for the variability in outcomes from these experiences. This work sought to understand mechanisms through which social support influences the mental health of service members and whether dyadic functioning mediates this relationship. We collected cross-sectional data as part of a larger study conducted in 2013; 321 military personnel who had at least 1 deployment were included in these analyses. Surveys were completed online; we collected data on demographic characteristics, social support, mental health measures (depression, PTSD, and anxiety), and dyadic functioning. We performed process modeling through mediation analysis. The direct effects of social support on the mental health of military personnel were limited; however, across all types of support networks, greater social support was significantly associated with better dyadic functioning. Dyadic functioning mediated the relationships between social support and depression/PTSD only when social support came from nonmilitary friends or family; dyadic functioning mediated social support and anxiety only when support came from family. We found no indirect effects of support from military peers or military leaders. Findings here highlight the need to continue to explore ways in which social support, particularly from family and nonmilitary-connected peers, can bolster healthy intimate partner relationships and, in turn, improve the well-being of military service members who are deployed.
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.
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
Smith, Tracey J; White, Alan; Hadden, Louise; Young, Andrew J; Marriott, Bernadette P
To determine if overweight or obesity is associated with mental health disorder (MHD) symptoms among military personnel Methods: Secondary analysis using the 2005 Department of Defense Health Related Behaviors Survey (N = 15,195). Standard Body Mass Index (BMI) categories were used to classify participants' body composition. For women, obesity was associated with symptoms of serious psychological distress (SPD), post-traumatic stress disorder, and depression. For men, obesity and overweight was associated with symptoms of generalized anxiety disorder and SPD, respectively. Self-reported high personal stress was the strongest predictor of MHD symptoms and suicide attempts. Self-reported stress was a stronger predictor of MHD symptoms than BMI. There is potential value in screening personnel for personal stress as a MHD risk factor.
Hurtado, Suzanne L; Simon-Arndt, Cynthia M; McAnany, Jennifer; Crain, Jenny A
The purpose of this paper is to report on the development of a mental health stigma reduction toolkit and training, and the acceptability and level of stigma awareness following the stigma-reduction training for military personnel. The overall aims of the training were to provide discussion tools highlighting the experiences of Marines seeking help for stress concerns, improve communication between leaders and their Marines around the issue of help seeking, and familiarize Marines with behavioral health treatment. Senior enlisted leaders and officers (N = 52) from a Marine Corps battalion participated in a pretest, 2-h stigma-reduction training and immediate posttest. Acceptability of the training was measured by querying participants about the usefulness and helpfulness of the training among other factors, and stigma awareness was measured with 10 items about mental health stigma. The stigma-reduction training and materials were well accepted by participants. In addition, there was a significant improvement in four of ten stigma-reduction awareness concepts measured before and immediately after the training, which included an increase in agreement that mental health treatments are usually effective in reducing stress reactions [t(51) = -3.35, p = 0.002], and an increase in disagreement that seeking counseling after a deployment will jeopardize future deployments [t(51) = -3.05, p = 0.004]. Level of agreement with several statements including those regarding perceptions of invincibility, and malingering, among others, did not change significantly after the training. The stigma-reduction training containing educational and contact strategies was highly acceptable to the leaders and may have promise for initially dispelling myths associated with seeking help for stress concerns among military service members; however, results indicate that there is clearly more work to be done in combatting stigma.
Tsai, Jack; Kong, Grace
The mental health of American military soldiers and veterans is of widespread concern; yet, there has been no prior review of studies on Asian Americans and Pacific Islanders (AAPIs) veterans. This article provides a brief, but comprehensive review of the mental health of AAPI veterans. An exhaustive literature search was conducted using the major medical and mental health literature databases. Of 13 identified articles, nine were empirical studies on either post-traumatic stress disorder among AAPI Vietnam veterans or health functioning of AAPI veterans based on national veteran surveys. Findings from these studies showed that some AAPI veterans who served during the Vietnam War encountered racism from fellow soldiers and race-related stressors were associated with more severe post-traumatic stress disorder symptoms. As a group, AAPI veterans were found to be physically healthier than other veterans, but reported poorer mental health and were less likely to use mental health services. However, these findings were limited by the paucity of studies on AAPI veterans and suggest a need for more research on this subpopulation.
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
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…
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
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.
Jones, Norman; Keeling, Mary; Thandi, Gursimran; Greenberg, Neil
The relationship between mental health symptoms, stigmatising beliefs about mental health and help seeking is complex and poorly understood. 1636 UK Armed Forces personnel provided study data immediately after deployment (T1) and approximately 6 months later (T2). Stigmatising beliefs were assessed using an eight-item scale previously used in studies of UK military personnel. Symptoms of probable common mental disorder, probable post-traumatic stress disorder and subjective stressful, emotional, relationship and family problems were evaluated at T1 and T2. Help seeking during deployment was assessed at T1 and post-deployment help seeking at T2. Alcohol use and subjective alcohol problems were assessed at T2 only. Reporting a probable mental health disorder or potentially harmful alcohol use following deployment was both significantly associated with higher levels of stigmatising beliefs. The reported degree of stigma was associated with changes in mental health symptom levels; compared to those who were never classified as a probable mental health disorder case, recovered cases experienced significantly lower levels of stigmatisation, whereas new onset cases reported significantly higher levels. The way that individuals report mental health stigmatisation is not static; rather stigma fluctuates in proportion to the frequency and severity of psychological symptoms. These results suggest that public health stigma-reduction strategies which aim to promote engagement with mental health services should be focused towards people who are experiencing worsening mental health. Our results suggest that willing volunteers who have recovered from a mental-ill-health episode may be well placed to assist in the delivery of such a strategy.
NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS Approved for public release; distribution is unlimited ASSOCIATION BETWEEN FISH OIL...REPORT TYPE AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE ASSOCIATION BETWEEN FISH OIL CONSUMPTION AND THE INCIDENCE OF MENTAL HEALTH ISSUES...Health Related Behaviors Survey of Active Duty Military Personnel, we analyze the association between fish oil consumption and mental health outcomes
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.
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.
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.
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
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
Haddock, Christopher K; Poston, Walker SC; Pyle, Sara A; Klesges, Robert C; Vander Weg, Mark W; Peterson, Alan; Debon, Margaret
Background Single item questions about self ratings of overall health status are widely used in both military and civilian surveys. Limited information is available to date that examines what relationships exist between self-rated health, health status and health related behaviors among relatively young, healthy individuals. Methods The current study uses the population of active duty United States Air Force recruits (N = 31,108). Participants completed surveys that asked about health behaviors and health states and were rated their health on a continuum from poor to excellent. Results Ratings of health were consistently lower for those who used tobacco (F = 241.7, p < .001), reported binge drinking (F = 69.0, p < .001), reported drinking and driving (F = 19.4, p < .001), reported taking health risks (F = 109.4, p < .001), were depressed (F = 256.1, p < .001) and were overweight (F = 39.5, p < .001). Conclusion Given the consistent relationship between self-rated overall health and factors important to military health and fitness, self-rated health appears to be a valid measure of health status among young military troops. PMID:16939653
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
Stevelink, S A M; Malcolm, E M; Mason, C; Jenkins, S; Sundin, J; Fear, N T
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. 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)). 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%). 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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.
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.
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.
Rice, Valerie J Berg; Mays, Mary Z; Gable, Clayton
It is important to be aware of the health and injury status of students in military training settings in order to adequately plan for their progression through required physical training and provision of health care to meet their needs. This paper describes the self-reported health status of students arriving in two medical training Battalions at Ft. Sam Houston. The results revealed that 43% of arriving soldiers had musculoskeletal symptoms and 35% had symptoms that interfered with their ability to accomplish the normal daily activities required as students. The most common sites of symptoms were knee (17 and 18%), foot/toe (16 and 13%), ankle (9 and 10%), and lower leg (9 and 12%) for the 232nd and 187th Medical Battalions respectively. Risk factors for those with musculoskeletal injury (MSI) symptoms that interfere with their abilities to do their jobs include gender, past history of injury, and self-reported stress and fitness levels. Other risk factors for medical specialties other than combat medic include being older (over 24 yrs of age), active duty status, being overweight, and use of smokeless tobacco. This information can help identify soldiers considered at risk of incurring a MSI during AIT. With this knowledge, physical training can be designed to help soldiers achieve fitness without additional injury and health care facilities can be designed to provide appropriate staffing of the health care professionals needed for evaluation and treatment.
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. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.
in the military, all branches have adopted strict policies and programs concerning the promotion of equal opportunity and prevention of sex ...Assistant Secretary of Defense for Manpower, Reserve Affairs and Logistics, the only sex -specific issue affecting military readiness is that of... sex discrimination, sexual harassment, or prejudice against a minority group (i.e., women in the military), this association warrants research
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.
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.
Rong, Honghui; Cheng, Xin; Garcia, Jose M.; Zhang, Ling; Lu, Lu; Fang, Jian; Le, Mingshan; Hu, Peng; Dong, Xinlu; Yang, Junli; Wang, Ya; Luo, Ting; Liu, Jun
Health literacy (HL) has become an important public health issue and is receiving growing attention. However, the HL levels of military college students in China have never been analyzed. This study aimed to investigate the HL and related associate factors in military college students in Chongqing, China. Data was obtained with the “Chinese Citizen Health Literacy Questionnaire (2012 edition)” from 3183 military college students aged 16–28 years at Chongqing in December 2015. A total score of ≥80 points determined adequate HL, and HL level was defined as the proportion of students who had adequate HL out of the total number of participants. Multiple logistic regression analysis with a stepwise forward likelihood ratio (LR) method was used to determine the effects of sociodemographic characteristics, health-related behaviors, and family-related factors on HL level. The mean score of HL was 68.56, and the HL level of military college students was 21.05%; the overall knowledge rate was 71.33%. The independent factors that were associated with HL level were years in college, educational system, time playing online games, annual household income and father's education level. Senior (odds ratio [OR] = 1.229, 95% confidence interval [CI] 1.018∼1.484), undergraduate (OR = 1.509, 95% CI 1.151∼1.978), time played games more than 5 hours each week (OR = 0.638, 95% CI 0.486∼0.837), annual household incomes more than 50,000 yuan (OR = 1.231, 95% CI 1.027∼1.476) and father's education level (high school: OR = 2.327, 95% CI 1.186∼4.565; university: OR = 2.450, 95% CI 1.244∼4.825), were independently associated with higher HL level. HL levels of military college students in Chongqing need to be improved across the board. Our data suggests that special emphasis should be placed on students in junior and those in the specialist educational system. School departments may also benefit from incorporating health literacy into their curricula and helping students