Military medicine
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Traumatic brain injury (TBI) can trigger vision-based sequelae such as oculomotor and accommodative abnormalities, visual-vestibular integrative dysfunction, visual field loss, and photosensitivity. The need for diagnosis and management of TBI-related vision impairment has increased because of the increasing frequencies of combat warfighters returning from Iraq and Afghanistan with TBIs. The purpose of this research was to learn the sequelae of rehabilitation service delivery to veterans with TBI-related visual dysfunction after they are diagnosed. To accomplish this, we investigated vision rehabilitation assessments and interventions provided to veterans with TBI-related visual dysfunction at the Department of Veterans Affairs (VA) specialty polytrauma facilities for the 2 years following their injury. The research questions asked what assessments, interventions, and prescribed assistive devices were provided by VA specialty clinics (e.g., occupational therapy, polytrauma, and blind rehabilitation) and how service delivery was affected by demographic and clinical variables. ⋯ The delivery of patient services should be driven by the needs of veterans and not by system-level factors such as the availability of specific vision rehabilitation services at specific locations. Traditional low vision and blind rehabilitation programs were not designed to treat the comorbidities and symptoms associated with TBI. To address this challenge, blind rehabilitation and neurologic recovery cross training is needed. Our findings document how five VA Polytrauma Rehabilitation Centers implemented this training in 2008. The next step is to extend and standardize this new paradigm to community care, where these post-deployment patients now reside.
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The U.S. Army is updating the physical fitness assessment for soldiers to the six-event Army Combat Fitness Test (ACFT). A paucity of data regarding the ACFT maximum deadlift (MDL) event, especially in military populations, has increased concern over the objectivity of the test. The reliability of scoring the MDL has not been established. It is unknown if grader professional experience impacts the reliability of scoring, and if so, what level of experience is required for reliable assessment. Performance and assessment of the MDL could impact military occupational selection, promotion, and retention within the Army. The purposes of this study were to determine the inter- and intra-rater reliabilities of raters with varying degrees of professional experience on scoring the MDL and to determine the relationships between load lifted, overall lift success, sex, and body mass index (BMI). ⋯ Inter-rater reliability of the six raters ranged from poor to substantial, while intra-rater reliability ranged from moderate to excellent. Compared to a reference standard, inter-rater reliability ranged from poor to substantial. The wide range in consistency demonstrated in this study, both between and within raters, brings into question the current subjective methods used to grade the MDL. More research is needed to understand the most feasible, valid, and reliable way to assess performance standards like the MDL that may affect a soldier's career progression.
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For tactical reasons, the foot-borne soldiers sometimes undertake nighttime operations. However, the metabolic demand during walking in complete darkness may be markedly increased. The purpose of this study was to investigate if metabolic demand and kinematics would change while walking on a gravel road and a slightly hilly trail in darkness with or without visual aid. ⋯ Walking on a gravel road or a forest trail wearing a blindfold or visual aid increased the metabolic demand. Thus, it appears that the metabolic demand is higher during overground walking with night vision goggles than with full vision, which may influence the performance of nighttime operations.
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Changes to severe acute respiratory syndrome 2 (SARS-CoV-2) vaccine guidance since their initial authorization may lead to confusion and hesitancy. Suggested recommendations for an annual SARS-CoV-2 vaccine naturally draw comparisons with the influenza vaccine program. Considering viral and vaccine characteristics between these pathogens provides an important perspective that can help increase vaccine confidence with SARS-CoV-2 vaccines.
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Psychological problems and family maltreatment are significant public health problems. Although research focuses almost exclusively on either individual psychological problems or family maltreatment, there is substantial co-occurrence of these problems. Similarly, intervention services are often "siloed": individuals with mental health needs are referred for mental health services, individuals with family conflict are referred for family-based treatment, etc. These treatment "silos" may miss the larger picture of the co-occurrence of risk, promotion, and the problems themselves. In a previous paper, we used latent class analysis to identify subgroups of individuals with crosscutting patterns (i.e., classes) of psychological and family maltreatment problems. In this study, we explored the predictors of these latent classes. ⋯ These findings reinforce the need for integrated prevention and treatment of psychological and family maltreatment problems. Not only do these problems often co-occur, but their risk and promotive factors also tend to be intertwined. The unique (i.e., not on the continuum of the other five classes) problem profile of participants evidencing disinhibitory psychopathology is matched by a unique risk/promotive factor profile, and they will thus likely require a unique intervention approach.