Military medicine
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The U.S. Preventive Services Task Force (USPSTF) modified their screening guidelines for breast cancer in November 2009. Previous studies evaluated the impact of these guideline changes among privately and Medicare insured populations. Women in the military form a unique population exposed to many social, environmental, and occupational hazards that may increase breast cancer incidence. By evaluating mammography screening rates among women in the military before and after the USPSTF guideline changes, this study evaluated the impact of the USPSTF breast cancer guideline change on screening mammography use within the military population and determined whether current guidelines were followed for this high-risk population with universal health care access. ⋯ The USPSTF guidelines had differential impacts among some subpopulations. While older women, aged 50 to 64 years, had a greater temporary reduction immediately after the guideline change, younger women aged 40 to 49 years had a longer-term reduction in screening following the guideline changes. No racial disparities in the proportion screened or in the impact of the guideline change were noted in this population with universal health coverage. The lack of Department of Defense standard breast cancer screening guidelines was evident from the different patterns of mammography utilization observed among military branches. To completely understand the impact of the updated screening guidelines, future studies must incorporate research focusing on changes in breast cancer morbidity and mortality as well as updated cost-benefit analyses.
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We compared the stage at diagnosis for non-small cell lung cancer (NSCLC) patients in the military healthcare system (MHS) and the general public to assess differences between these two groups as well as to assess the trends in stage at diagnosis in the recent past. ⋯ The majority of NSCLC patients in the MHS and general population are diagnosed with stage IV NSCLC and the percentage is increasing. Compared to the general population, NSCLC patients in the MHS have a higher percentage of stage I, a lower percentage of stage IV, and of unknown stage cancer. Universal care along with more rigorous staging across the MHS may play a role in these findings.
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In January 2016, the U.S. Department of Defense increased the duration of paid maternity leave for active duty service members from 6 weeks to 12 weeks. Our study aims to determine the impact of maternity leave length on breastfeeding duration and postpartum depression rates in active duty service members. ⋯ The ideal maternity leave duration is unknown. With recent changes to the Department of Defense maternity leave policy, we aimed to evaluate the effect this had on breastfeeding and postpartum depression rates. No statistically significant difference was seen when we compared rates of breastfeeding in women who had 6 weeks versus 12 weeks of maternity leave. Further research is required to determine the ideal maternity leave duration and best practices to promote breastfeeding.When looking at postpartum depression, our study shows that postpartum depression was noted in 16% of patients who took 6 weeks versus 9% of those who took 12 weeks of maternity leave. No statistically significant difference was seen; however, this was likely because of the small sample size. Only 29 out of 214 women suffered from depression regardless of length of maternity leave. More research is needed to determine if maternity leave length does indeed impact postpartum depression rates.
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Historical Article
Non-Pharmaceutical Interventions and Military Hygiene at the United States Military Academy between 1890 and 1910.
Military installations are at increased risk for the transmission of infectious disease. Personnel who live and train on military installations live and train near one another facilitating disease transmission. An understanding of historical sanitation and hygiene can inform modern practices. This is especially pertinent considering the continuing rise of variants of infectious diseases, such as the recent pandemic of the 2019 severe acute respiratory syndrome coronavirus 2. In this article, we review the rise and decline of infectious disease at the United States Military Academy (USMA) during the period spanning 1890 through 1910, and the public health interventions used to combat disease spread. ⋯ The USMA experience mirrored what was occurring in the larger U.S. Army in the early 20th century and may serve as a model for the application of NPIs in response to modern infectious diseases resulting from novel or unknown etiologies.
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Occupational disability among military service members is an important target for preventive screening. The specific aim of this study was to quantify disability risk levels among soldiers with selected risk factors (body mass index extremes, poor or absent physical fitness scores, and tobacco and opioid use) and combinations thereof, suggesting priorities for preventive actions. ⋯ We identified marked disability hazard increases, especially in association with opioid use and high body mass index. These factors, in addition to tobacco use and low physical fitness, are potential early prevention targets for clinicians who screen military service members.