Military medicine
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The Impact of the COVID-19 Pandemic on the Military Health System's Care of Military Sexual Assault.
Sexual assault remains a high priority challenge for leaders in the U.S. military. The COVID-19 pandemic further complicated the issue by disrupting work and lifestyles, potentially affecting reporting and care-seeking by victims. To date, there are no studies addressing the impact of changes in access to health services and reporting of sexual assault by active duty service members to inform medical and public health interventions in a post-COVID-19 era and during future public health emergencies. ⋯ Contrary to reports indicating a modest increase in the number of sexual assaults reported within the DoD, we found a reduction in the frequency of healthcare encounters associated with sexual assault during the pandemic which may be related to reduced access to care. Men comprised approximately 22% of sexual assault encounters delivered through the MHS although the racial distribution of encounters approximates the estimates of the DoD-published demographic statistics. This study illustrates that COVID-19 measures appear to have reduced access to care for sexual assault within the MHS but did not demonstrably alter the demographics of servicemembers seeking care. These findings suggest that the MHS may require contingency plans for future disruptions to care and public health emergencies.
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Many countries around the world employ defense capabilities in support of global health engagement (GHE) through bilateral and multilateral organizations. Despite this, there does not appear to be a strategic approach and implementation plan for U.S. DoD GHE in support of and through multilateral organizations. The purpose of this research is to identify which security multilateral organizations are engaged in GHE, as well as how and why. These findings could inform an interoperable approach for doing so going forward. ⋯ Although there is high demand for GHE, resourcing to enable implementation has not been prioritized. Therefore, multilateral organizations continue to support what is funded (e.g., disaster response) versus prioritizing capacity building or modifying authorities and appropriations to match demand. It is also worth noting most organizations included in this review support the European theater aligning to historical defense priorities, versus emerging threats in the Indo-Pacific region. Identifying a forum within these multilateral institutions to convene GHE policy makers and practitioners is a logical next step. The forums could guide and direct priorities, devise solutions, and implement best practices. Near term efforts could include GHE financing, governance, assurance, and technical assistance within and across multilateral institutions. Recent efforts highlight growth in both interest and action to support the variety of GHE activities regionally and internationally. As the United States seeks to reinforce multilateral institutions and uphold the international and rules-based order, employing GHE through multilateral cooperation could buttress efforts. Now is a perfect time given the sustained interest in global health, amplified value of allies and partners, and renewed emphasis placed on multilateral cooperation for the DoD to design a multilateral GHE strategy and seek Congressional support to resource it accordingly.
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The aims of this project were to assess (1) the prevalence and timing of post-traumatic osteoarthritis (PTOA) after a traumatic lower limb injury, (2) the risk of PTOA based on injury type, and (3) the association of PTOA with psychological health and quality of life (QoL). ⋯ Despite a low prevalence of lower limb PTOA in our study, fractures increased the risk of PTOA after deployment-related injuries. Additionally, those with PTOA reported lower QoL scores relative to those without PTOA. The findings of this study highlight the personalized needs of patients with trauma beyond just the repair of the immediate injury.
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Meta Analysis
Prevalence of PTSD in Active Duty Members with Mild Traumatic Brain Injury: Systematic Review and Meta-analysis.
Traumatic brain injury (TBI), particularly mild TBI (mTBI), is a significant health concern for U.S. active duty service members (ADSMs), with potential implications for psychiatric outcomes including PTSD. Despite recognizing this association, the prevalence of PTSD among ADSMs with mTBI remains unclear. ⋯ Methodological differences, including diagnostic criteria variability, contribute to the observed variability in prevalence estimates. Despite methodological challenges, this study provides crucial insights into the pooled prevalence of comorbid PTSD and mTBI within the military, emphasizing the need for standardized methodologies and further research to refine understanding and support strategies for affected individuals.