Military medicine
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Cholera remains a significant public health threat for many countries, and the severity largely varies by the population and local conditions that drive disease spread, especially in endemic areas prone to natural disasters and flooding. Epidemiological models can provide useful information to military planners for understanding disease spread within populations and the effectiveness of response options for preventing the transmission among deployed and stationed personnel. This study demonstrates the use of epidemiological modeling to understand the dynamics of cholera transmission to inform emergency planning and military preparedness in areas with highly communicable diseases. ⋯ We modeled the notional re-emergence and spread of cholera following the August 2021 earthquake in Haiti while in the midst of the global COVID-19 pandemic. This information can help guide military and emergency response decision-making during an infectious disease outbreak and considerations for protecting military personnel in the midst of a humanitarian response. Military planners should consider the use of epidemiological models to assess the health risk posed to deployed and stationed personnel in high-risk areas.
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Few service members with posttraumatic stress disorder (PTSD) receive evidence-based psychotherapy (EBP) in the military health system (MHS). Efforts to increase EBP implementation have focused on provider training but have not adequately addressed organizational barriers. Thus, although behavioral health providers are trained in EBPs, clinic-, facility-, and system-level barriers preclude widespread EBP implementation. ⋯ Additional recommendations include providing ongoing support for EBP implementation (e.g., protected time to participate in EBP consultation) and matching patients to providers based on patient's clinical needs and treatment preferences. The barriers to EBP implementation that these recommendations target are interrelated. Therefore, adopting multiple policy recommendations is likely necessary to yield a meaningful and sustained increase in the implementation of EBPs for PTSD in the MHS.
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A range of evidence-based treatments are available for PTSD. However, many veterans with PTSD do not engage in these treatments. Concurrently, various novel PTSD treatments with little or no evidence based are increasingly popular among veterans. This qualitative study explored the expectations, experiences, and perceptions of help-seeking veterans with PTSD to improve understanding of how these veterans make treatment decisions. ⋯ These findings will inform strategies to improve engagement of veterans in evidence-based PTSD treatments and advance progress toward veteran-centered care.
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Medical capability surveys provide information about how U.S. forces can coordinate with partner nations to leverage partners' capabilities to deliver care to sick or injured U.S. service members. Rotating forces routinely conduct these surveys. Currently, medical capability surveys are conducted based on individual unit requirements and personnel expertise and stored locally on component-specific sites or individual computers. The lack of a systematic approach and a centralized survey depot may undermine the ability to access previous surveys, leading to redundant surveys and conflicting information, and may have critical implications for force health protection. Partner nation facilities could have capabilities that may be leveraged to care for U.S. service members when U.S. medical care is unavailable. A lack of understanding of medical capabilities at partner nation facilities may undermine the ability to plan missions that mitigate risks. ⋯ Implementing guidance and standardized templates for conducting medical capability surveys could improve the accuracy and completeness of surveys. Templates would likely increase the likelihood that surveyors collect relevant information on key medical capabilities. Training, along with guidance and templates, would provide a common understanding of how to conduct surveys. The lack of a DoD Global Health Engagement collaborative depot for storing and sharing surveys may undermine the ability to access previous surveys to inform future surveys and, thereby, results in inefficiencies in how surveys are conducted. The DoD should consider establishing a collaborative depot for medical capability surveys along with guidance or requirements for uploading surveys. Guidance, templates, training, and a collaborative depot could improve the effectiveness and efficiency of medical planning and thereby increase mission readiness.
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Amateur foraging, which can be described as the gathering of uncultivated plants for sustenance or recreation, supports many benefits for the forager and the environment; however, it can also present the hazard of unintentional poisoning. Asclepias syriaca, or common milkweed, is a potentially edible plant that also contains cardioactive steroids akin to digoxin. A 38-year-old female amateur forager boiled and sautéed 8-10 milkweed pods before ingesting them. ⋯ Recently, some military services have advocated for foraging as a means to sustain far-forward troops. However, misidentification of plants by inexperienced foragers can result in severe toxicity or death. If mass foraging becomes part of expeditionary operations, military clinicians must be trained and prepared for the potentially severe plant-related poisonings.