Military medicine
-
We report the case of a 29-year-old male soldier with a time in service above 10 years, found to have asymptomatic long QT syndrome (LQTS), a condition associated with increased risk of potentially fatal ventricular arrhythmias, during a flight physical. A review of his past medical history revealed a transient QT prolongation during an episode of hypoglycemia due to endogenous hyperinsulinism caused by an insulinoma, as an infantryman 7 years earlier; the resolution of the QT prolongation was spontaneous. He was evaluated and considered fit for duty by cardiology. ⋯ Military setting facilitated the detection of an otherwise occult LQTS in this asymptomatic young serviceman. Retrospectively, the LQTS was transiently unmasked during an episode of hypoglycemia. Hypoglycemia deserves more recognition as a potential cause of QT prolongation.
-
Cardiovascular disease (CVD) is the leading cause of death for women in the United States, and U.S. female Veterans have higher rates of CVD compared to civilian women. With an increasing number of women joining the military, the number of female Veterans is expected to rise; therefore, providing appropriate cardiovascular care must be a top priority for the DoD and the Veterans Health Administration (VHA). This scoping review will answer the question: "Among U.S. female Veterans, what are the challenges faced in cardiovascular health, and what are potential future implications and interventions?" We designed this scoping review to identify common themes and gaps in the literature, guide further investigations, and contribute to developing targeted interventions and policies to enhance cardiovascular outcomes among female Veterans. ⋯ This review highlighted 3 main challenges female Veterans face in accessing CVD care from the VHA: perceived barriers, unique risk factors, and gender/racial disparities. It emphasized the need for improved CVD research, screening, education, and social support for female Veterans. The authors propose two main strategies to address these challenges: (1) pre-transition education from the DoD and (2) enhanced CVD training in the VHA. Cardiovascular disease risk factor recognition and prevention education should occur in military settings, allowing medical providers in DoD clinics to engage female service members in discussions and screenings before transitioning to VHA care. The VHA should educate providers on the barriers female Veterans face, the identification of nontraditional risk factors, and existing health care disparities. Additionally, it should continue to support successful initiatives focused on improving CVD care for female Veterans, such as the Women's Health Research Network, the Quality Enhancement Research Initiative, and the Enhancing Mental and Physical Health of Women through Engagement and Retention program.
-
As illustrated by the "Walker Dip," there is growing concern regarding the lack of combat casualty care during peacetime. Surgical volume and case complexity are paramount for training and skill sustainment. We sought to quantify the recent orthopedic trauma surgical case load of all military orthopedic surgeons across the Military Health System (MHS). ⋯ Across the MHS, there was a low volume of ACGME-minimum orthopedic trauma procedures performed. These data help to frame the current orthopedic trauma surgical volume in the United States MHS in support of efforts to maximize military surgeon training and readiness, ultimately in preparation for future conflicts.
-
Load carriage is an inherent part of tactical operations. Critical speed (CS) has been associated with technical and combat-specific performance measures (e.g., loaded running). The 3-min all-out exercise test provides estimates of CS and the maximal capacity to displace the body (D') at speeds above CS. The current study investigated the contributions of CS, D', lean body mass (LBM), thigh lean mass (TLM), and lower body isokinetic strength and endurance parameters related to load carriage time trials (LCTTs). ⋯ The results of this study highlight that CS and LBM were the best predictors of the 3,200-m LCTT, and TLM was the best predictor of the 400-m LCTT. The findings of this study support that CS and LBM, including TLM, are important in predicting load carriage task completion in the time trial tasks.