Military medicine
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Multicenter Study Observational Study
Post-mTBI Pain Interference in a U.S. Military Population: A Chronic Effects of Neurotrauma Consortium Study.
Chronic pain is a significant problem for service members and veterans with mild traumatic brain injury (mTBI). While the root cause of pain is not clearly understood, comorbidities may contribute to how their pain disrupts their functional status, a construct termed "pain interference." The purpose of this study is to examine the associations between mTBI, other comorbidities, and pain interference. ⋯ These results identify clinical features of veterans and service members with mTBI(s) who are at highest risk for pain-related disability. These findings also demonstrate the need to consider mental health and sleep problems in their pain evaluation and treatment approach.
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Weight gain and obesity in people living with HIV have been associated with increased risk for non-AIDS-related comorbidities, and integrase strand transfer inhibitor (INSTI)-based regimens may lead to comparatively more weight gain than other regimens. We evaluated body mass index (BMI) following antiretroviral therapy (ART) initiation among participants in the U.S. Military HIV Natural History Study (NHS). ⋯ In our cohort of young military members with HIV infection, those with BMI <25 experienced BMI gains across all ART classes. Among those with BMI ≥25, African Americans on INSTI regimens had the greatest BMI gains. Further studies are needed to determine whether NNRTI regimens should be considered in certain individuals at risk for INSTI-associated weight gain.
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The U.S. Preventive Services Task Force recommends regular cervical cancer screening for women aged 21-65 years. Such screening is key to reducing mortality and morbidity. Despite improvement in the screening rate, cervical cancer still disproportionately affects women of minority groups because of access to quality health care. The Military Health System (MHS) mitigates this barrier through universal healthcare coverage for all active duty service members and their families. However, such racial/ethnic disparities, seen in civilian population, have not been studied in the MHS. ⋯ The women in our population demonstrated similar or lower compliance than other studies conducted in the U.S. general population, and racial disparities for cervical cancer screening were partially mitigated in active duty service women. While our research demonstrates that universal insurance can help provide equal access and care, investigation into the factors that encourage greater usage among members of different military branches may help to understand and develop policies to improve health care systems.
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The Department of Defense (DoD) operates a large, multi-channeled physician accession pipeline to maintain a professional workforce of over 10,000 active duty physicians. The Uniformed Services University (USU) operates the nation's only federal medical school providing trained doctors to the Army, Navy, Air Force, and Public Health Service. Although the school serves an essential purpose, policymakers question the cost of operating the University's medical school. One challenge is to develop reproducible and transparent costing methods that can be used to evaluate the University's value and efficiency. ⋯ This work provides a foundational framework and approach to estimate the costs of accessioning a physician at USU. This methodology can be replicated for subsequent value analyses of physician accession and retention as budgetary pressures change to match the DoD operating environment. Uniformed Services University's costs should be periodically reassessed against those of alternative accession sources.
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The U.S. military currently utilizes unmanned aerial vehicles (UAVs) for reconnaissance and attack missions; however, as combat environment technology advances, there is the increasing likelihood of UAV utilization in prehospital aeromedical evacuation. Although some combat casualties require life-saving interventions (LSIs) during medical evacuation, many do not. Our objective was to describe patients transported from the point of injury to the first level of care and characterize differences between patients who received LSIs en route and those who did not. ⋯ Approximately half of casualties evaluated in our study did not receive an LSI during transport and may have been transported safely by UAV. Having a blunt injury or the highest AIS severity score in the head/neck region significantly predicted an uneventful flight.