Military medicine
-
Editorial Comment
More Research Needed, USCG Mission-Related Hazard Exposure.
-
Over the last 40 years, patient-centered medical home (PCMH) has evolved as the leading primary care practice model, replacing traditional primary care models in the United States and internationally. The goal of PCMH is to improve chronic condition management. In the U.S. Army, the scope of the medical home, which encompasses various care delivery platforms, including PCMH and soldier-centered medical home (SCMH), extends beyond the management of chronic illnesses. These medical home platforms are designed to support the unique health care needs of the U.S. Army's most vital asset-the soldier. The PCMHs and SCMHs within the U.S. Army employ patient-centered care principles while incorporating nationally recognized structural attributes and care processes that work together in a complex adaptive system to improve organizational and patient outcomes. However, U.S. Army policies dictate differences in the structures of PCMHs and SCMHs. Researchers suggest that differences in medical home structures can impact how organizations operationalize care processes, leading to unwanted variance in organizational and patient outcomes. This study aimed to compare 3 care processes (access to care, primary care manager continuity, and patient-centered communication) between PCMHs and SCMHs. ⋯ Our findings comparing 3 critical medical home care processes suggest that structural differences may impact continuity but not access to care or communication. There is an opportunity to further explore and improve access to appointments within 24 hours, primary care manager and medical home team continuity, perception of access to care, and the quality of patient-centered communication among soldiers. Knowledge gained from this study is essential to soldier medical readiness.
-
Operational ration packs are the sole source of nutrition when military personnel cannot access fresh food and field kitchens due to deployment and training in remote and hostile locations. They should be light, durable, nutrient rich, and contain sufficient energy to ensure that the personnel can carry out the expected duties. The macronutrient composition of rations has remained relatively unchanged despite escalating concerns related to the health and operational readiness of personnel globally. Currently, the New Zealand Defence Force (NZDF) provides the personnel with a 24-hour ration pack. The aims of this study were to (1) analyse the nutrient content, cost, and weight of the NZDF-supplied ration pack and (2) develop and analyse an alternate ration pack. The alternate ration pack was designed with the intention of improving overall quality and macronutrient distribution ratio, to align with optimal health and performance outcomes. ⋯ This work highlights the shortcomings of currently supplied military rations packs (i.e., excessive sugar and marginally inadequate protein) and proposes a novel alternate approach to ration pack formulation. This approach would significantly reduce sugar and increase protein and fat content in military rations. Although this work indicates that the alternate approach (which would produce lighter and nutritionally superior rations) is more costly, this cost could be reduced significantly through bulk purchasing and purpose-built rations and food items. Considering these findings, field user-testing of the alternate ration pack is recommended and subsequent reformulation of guidelines for ration pack development, as appropriate.
-
Medical readiness to deploy is an increasingly important issue within the military. Musculoskeletal back pain is one of the most common medical problems that affects service members. This study demonstrates the associations between risk factors and the prevalence of musculoskeletal back pain among active duty sailors and Marines within the Department of the Navy (DoN). ⋯ There was an increasing prevalence of back pain across the DoN from 2009 to 2015. Different occupational categories demonstrate different prevalence of back pain. Surprisingly, combat occupations and aviators were among the groups with the lowest prevalence. Lifestyle factors such as excess body weight and use of tobacco products are clearly associated with increased prevalence. These results could inform military leaders with regard to setting policies that could increase medical readiness.