Military medicine
-
Improving the dietary behaviors of personnel can result in positive impact beyond the individual, creating benefits for their organization and wider society. Military personnel endure extended periods of physical and cognitive activity. Healthful dietary behaviors by military personnel support preparedness; yet poor diet behaviors remain common and persistent, and adversely impact health and physical and cognitive performance. Urgent and effective action is needed to improve diet behaviors, but this action has not been prioritized. This study aimed to estimate the value that could be realized from improved diet behaviors to support prioritization of investment in this area for policy and program change. ⋯ These estimates were constructed using the best available data and transparency within the calculations, but they remain estimates. The collection of additional data would enable the calculation of further outcomes and increase the usefulness of Social Return on Investment estimation in this area. Militaries should invest greater effort and funding in achieving, maintaining, and optimizing personnel health and performance. Promoting healthy diet behaviors should be prioritized as a cost-effective preventive action that supports productivity and performance, in comparison with the costs of remediating treatment. Conceptualizing the value of improving diet behaviors in monetary terms may refocus efforts on prevention rather than treatment.
-
Transfusion of packed red blood cells (PRBC) or low-titer group O whole blood (LTOWB) has become standard practice in trauma patients with significant blood loss. As blood ages, it undergoes metabolic and structural changes. This study aimed to test the association between age of PRBC/LTOWB and mortality among adult trauma patients. ⋯ The mean age of LTOWB or PRBC units transfused during the first 24 hours after presenting to the ED for a traumatic injury was not found to be associated with in-hospital mortality.
-
Breast and cervical cancer screening is critical to identifying cases at earlier stages in order to begin treatment earlier and improve survival. Screening rates have been shown to vary within the Military Health System (MHS). The goal is to estimate drivers of variation in screening rates within the MHS. ⋯ Our finding of higher screening in catchment areas with higher rates of purchased care warrants additional study to understand what factors may drive this result. The differential findings of the association between individual characteristics and breast and cervical cancer screening suggest important differences in these 2 types of screening with potentially different policies required to encourage and enhance breast vs. cervical cancer screening. Finally, our results showing higher screening among non-Hispanic Black women suggests important features of the MHS, such as universal, low-cost sharing coverage may help to reduce racial and ethnic disparities in breast and cervical cancer screening.
-
Attention-deficit/hyperactivity disorder (ADHD) is common among Veterans but overlapping symptoms with other prevalent psychiatric disorders (e.g., posttraumatic stress disorder [PTSD]) complicate diagnosis. This study aims to (1) assess the prevalence of ADHD, (2) evaluate the correspondence between ADHD self-report measures, and (3) examine the association between ADHD and PTSD in a sample of combat-deployed post-9/11 Veterans. ⋯ Attention-deficit/hyperactivity disorder is prevalent in this sample of Veterans and is associated with an increased risk of current and lifetime PTSD. The low correspondence across self-report ADHD measures illustrates the complexity of assessing ADHD in this highly comorbid population. When evaluating ADHD in Veterans, clinicians should carefully consider alternative and contributory symptom etiologies, such as PTSD, to ensure accurate diagnosis and treatment.