Military medicine
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With the rising costs of cancer care, it is critical to evaluate the overall cost-efficiency of care in real-world settings. In the United States, breast cancer accounts for the largest portion of cancer care spending due to high incidence and prevalence. The purpose of this study is to assess the relationship between breast cancer costs in the first 6 months after diagnosis and clinical outcomes by care source (direct or purchased) in the universal-access US Military Health System (MHS). ⋯ In the MHS, higher breast cancer costs in the first 6 months after diagnosis were associated with lower risk for clinical outcomes in direct care, but not in purchased care. Organizational, institutional, and provider-level factors may contribute to the observed differences by care source. Replication of our findings in breast and other tumor sites may have implications for informing cancer care financing and value-based reimbursement policy.
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Gender disparity in academic medicine has been well described in the civilian sector. This has not yet been evaluated in the military health system where hundreds of female surgeons are practicing. Military service limits factors such as part time work and control over time spent away from family, which are often cited as contributors to the pay and promotion gap in civilian academic medicine. The military has explicit policies to limit discrimination based on gender. Pay between men and women is equal as it is based on rank and time in rank. One would expect to see less disparity in promotion through the academic ranks for military female surgeons given this otherwise equal treatment. This has not previously been objectively tracked or reported. It is beneficial to characterize the military academic medicine gender gap and benchmark against national data to define the academic gender gap and lay the groundwork for future work to identify factors contributing to the observed difference. ⋯ Fewer female surgeons in military medicine hold academic appointment when compared with their counterparts in civilian medicine. Similar to the civilian sector, military academic surgery also demonstrates less likelihood of female representation in higher academic stations. This discrepancy in representation follows a linear trend over the different ranks. This discrepancy has not been previously documented. The military offers a unique opportunity to study the issue of gender imbalance in academic promotion practices given its otherwise equal treatment of males and females. Additional studies will be necessary to understand uniformed female surgeons' barriers to academic advancement.
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This study is the first to our knowledge to examine associations of survey-reported dietary supplement use with medical record diagnoses, rather than retrospective self-reported supplement use at the time of the medical encounter or case reports of adverse events. Dietary supplement (DS) use and adverse events associations in US Navy and Marine Corps personnel remains unknown. This study assessed associations of DS use in active duty (AD) personnel with ICD-9-CM diagnostic codes from outpatient medical encounters from the Military Health System Data Repository (MDR). ⋯ The percentages of service members with diseases in specific ICD-9-CM diagnostic categories were similar to those reported in other studies using military medical data. There is a greater prevalence of dietary supplement use by the service members who participated in this survey compared with the general population, with 73% of US Navy and Marine Corps personnel reporting use of dietary supplements one or more times per week compared to the estimated 50% of all Americans currently using some form of dietary supplement. The DoD ensures the optimal readiness, performance, and health of its military service members, thus future longitudinal evaluation of dietary supplement use by this population will test the preliminary findings of this study.
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Strength training has been routinely used in exercise programs of military groups; however, no review has been ever conducted to clarify the selection of exercise tests to monitor its effectiveness. Therefore, the aim of the present review was to critically evaluate the current practices in the choice of assessment methods for muscle strength in military and suggest directions for future research. ⋯ Although strength training has been included in military training, it was concluded that the existed physical fitness test batteries focused mostly on muscle endurance rather than on muscle strength. Therefore, it would be suggested that muscle strength tests be included in future physical fitness test batteries in order to evaluate effectively the content of military training.
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Excessive alcohol consumption continues to be a significant concern to overall military readiness; each year, it results in non-deployable active duty service members and service members separated from service. In 2009, The Community Preventive Services Task Force recommended limiting the hours of alcohol sales as an evidence-based and effective intervention to reduce alcohol-related harms. In June 2014, partnerships at an Army Installation in the Midwestern United States implemented a policy to reduce excessive alcohol consumption and associated alcohol-related harms. Although community-based interventions have been shown to successfully reduce alcohol-related negative consequences, little research has explored the effects of these interventions in military communities. ⋯ This was the first known evaluation within a military community to report improvements in crime statistics following an eight hour reduction in daily retail sale hours of alcohol. The reduction in alcohol-related harms presented in this evaluation are typical for small communities implementing alcohol-related policies; however, the effect sizes reported here are larger than those reported in the current literature, suggesting that the policy positively impacted the installation community in decreasing alcohol-related harms. Evaluation data did not show statistically significant reductions in DUI/DWI citations and SIRs occurring during night hours. Further, the evaluation design disallows the ability to draw a causal relationship between the intervention and measured outcomes. Additional installations should consider implementing similar policies to determine if observed effects are replicable. Future studies should include a longitudinal design that would allow for long-lasting changes to be observed within the population, measurement of additional proximal outcomes (e.g., reported alcohol consumption), and investigating social and health outcomes both inside and outside the confines of the installation community.