Showing papers by "Defense Health Agency published in 2015"

Mosaic Attenuation: Etiology, Methods of Differentiation, and Pitfalls.

Abstract: Various causes of mosaic attenuation at chest CT are discussed in terms of clinical, radiologic, and histologic features, with emphasis on specific clues that are essential to narrowing the differential diagnosis.

Overview of depression, post-traumatic stress disorder, and alcohol misuse among active duty service members returning from Iraq and Afghanistan, self-report and diagnosis.

Abstract: Previous studies have found deployment to combat areas to be associated with an increased risk of post-traumatic stress disorder (PTSD), depression, and alcohol abuse, but many previous studies were limited by samples that were not representative of the deployed military as a whole. This study presents an overview of these three mental health problems associated with deployment among Air Force, Army, Marine Corp, and Navy service members returning from deployment to Iraq and Afghanistan between January 2007 and March 2008. With postdeployment health data on over 50,000 service men and women, including diagnostic information, we were able to estimate prevalence of those who screened positive for risk of each disorder in self-report data at two time points, as well as prevalence of diagnoses received during health care encounters within the military health care system. The prevalence ranges of the three disorders were consistent with previous studies using similar measures, but service members in the Navy had higher rates of screening positive for all three disorders and higher prevalence of depression and PTSD diagnoses compared to the other branches. Further, PTSD risk was higher for service members returning from Afghanistan compared to Iraq, in contrast to previous findings.

Factors associated with psychiatric evacuation among service members deployed to Operation Enduring Freedom and Operation Iraqi Freedom, January 2004 to September 2010

Abstract: Objectives: To calculate the annual rate of psychiatric evacuation of U.S. Service members out of Iraq and Afghanistan and identify risk factors for evacuation. Methods: Descriptive and regression analyses were performed using deployment records for Service members evacuated from January 2004 through September 2010 with a psychiatric diagnosis, and a 20% random sample of all other deployers (N = 364,047). Results: A total of 5,887 deployers psychiatrically evacuated, 3,951 (67%) of which evacuated on first deployment. The rate increased from 72.9 per 100,000 in 2004 to 196.9 per 100,000 in 2010. Evacuees were overrepresented in both combat and supporting duty assignments. In multivariate analysis, Army active duty had the highest odds of evacuation relative to Army National Guard (adjusted odds ratio [AOR] 0.852, 95% confidence interval [CI] 0.790–0.919), Army Reserve (AOR 0.825, 95% CI 0.740–0.919), and all other components. Accessions in 2005 had the highest risk (AOR 1.923, 95% CI 1.621–2.006)...

Army active duty members' linkage to Veterans Health Administration services after deployments to Iraq or Afghanistan and following separation

Abstract: This study described the rate and predictors of Operation Enduring Freedom/Operation Iraqi Freedom active duty Army members' enrollment in and use of Veterans Health Administration (VHA) services (linkage), as well as variation in linkage rates by VHA facility. We used a multivariate mixed effect regression model to predict linkage to VHA, and also calculated linkage rates in the catchment areas of each facility (n = 158). The sample included 151,122 active duty members who deployed to Iraq or Afghanistan and then separated from the Army between fiscal years 2008 and 2012. Approximately 48% of the active duty members separating utilized VHA as an enrollee within one year. There was significant variation in linkage rates by VHA facilities (31–72%). The most notable variables associated with greater linkage included probable serious injury during index deployment (odds ratio = 1.81), separation because of disability (odds ratio = 2.86), and various measures of receipt of VHA care before and after s...

The association of combat exposure and injuries with behavioral health problems among enlisted female Army members returning from Iraq or Afghanistan

Abstract: Materials and methods Using longitudinal data from The Substance Use and Psychological Injury Combat Study, we selected a sample of enlisted female Army members returning from Afghanistan or Iraq in FY2008–2011, who completed a health questionnaire within 60 days of their deployment end date (N = 42397; 6.6% of cohort). Combat score was constructed as an ordinal variable (0–3) based on four items: being wounded, injured, assaulted, or hurt; encountering dead bodies/seeing people killed; firing a weapon; and being in danger of being killed. Multivariate logistic regression models examined how combat score, demographic, and deployment characteristics predicted posttraumatic stress disorder (PTSD), depression, and at-risk drinking. Models were stratified by component: Active Duty (AD) and National Guard/Reserves (NG/Rs).

The association of deployment and behavioral health problems with positive drug tests among Army members returning from Iraq or Afghanistan

Abstract: Materials and methods Using longitudinal data from The Substance Use and Psychological Injury Combat Study, we identify predictors of testing positive for one or more drugs post-deployment among 306,345 enlisted Army active-duty (AD) members returning from Iraq or Afghanistan in FY2008–2011. Subsample analyses examine findings from those members who completed a follow-up questionnaire approximately 6 months after the deployment (n = 262846). Urinalysis tests for metabolites of cocaine, heroin, THC, and/or amphetamines are routinely and randomly tested by the military’s drug test program. These data were examined to estimate the percent of the sample with any positive drug test 6 months and up to 3 years post-deployment (followup). Demographic and deployment characteristics and self-report of post-deployment problems were examined as potential predictors of a positive drug test.

Building the science: Join us.

Abstract: Comments on the article "Don Bloch's vision for Collaborative Family Health Care: Progress and next steps" by C. J. Peek (see record 2015-25290-002). As Peek points out, Don Bloch's vision is alive and well. Teams of health and behavioral health professionals are now working in concert with a shared biopsychosocial frame of reference to improve care and health. You have the opportunity to be involved and move science forward. Seek out like-minded colleagues and expect your system to collect process and outcome metrics. Learn and disseminate your knowledge so that we can provide the outstanding services we all deserve.

Blanchfield Army Community Hospital Polypharmacy Clinic.

Abstract: The increased use of central nervous system depressants (CNSD) and psychotropics are one of the many factors that contribute to suicidal behavior in soldiers. U.S. Army policy requires medication screening for any soldier prescribed 4 or more medications when at least 1 of the medications is a CNSD or psychotropic. Constant deployments challenged health care provider ability to comply with required screenings, and senior leaders sought proactive intervention to reduce medication risks upon return of the 101 st Airborne Division (Air Assault) from deployment in 2011. A pharmacy-led team established the Polypharmacy Clinic (PC) at Blanchfield Army Community Hospital. Of the 3,999 soldiers assigned, 540 (13.5%) met the initial screening criteria. Success of the pilot program led to the mandatory screening of all other Fort Campbell, Kentucky, brigades. During the first 12 months, 895 soldiers were seen by a clinical pharmacist, and 1,574 interventions were documented. Significant interventions included medication added (121), medication changed (258), medication stopped (164), lab monitoring recommended (172), adverse reaction mitigated (41), therapeutic duplication prevented (61), and drug-drug interaction identified (93). Additionally, 55 soldiers were recommended for temporary duty profiles based on their adverse drug effects. Ten soldiers were recommended for enhanced controlled substance monitoring. Placing soldiers on clinically appropriate medications and removing potentially harmful medications from their possession are examples of how the PC positively impacted the Commanding General's ability to deploy a fully medically ready force. Soldiers consistently remarked favorably on the thorough medication counseling provided at their PC appointments. Innovative notes within the electronic health record summarized relevant findings regarding soldiers' medications, which allowed providers to quickly pinpoint and adjust medication regimens. With each identified high-risk soldier, we decreased the potential for postdeployment medication issues. Additionally, the PC generated over $70,000 in relative value units for the hospital.