Showing papers in "Military Medicine in 2013"
TL;DR: The overall Moral Injury Events Scale and its two subscales had favorable internal validity, and comparisons between the 1-week and 3-month data suggested good temporal stability.
Abstract: Literature describing the phenomenology of the stress of combat suggests that war-zone experiences may lead to adverse psychological outcomes such as post-traumatic stress disorder not only because they expose persons to life threat and loss but also because they may contradict deeply held moral and ethical beliefs and expectations. We sought to develop and validate a measure of potentially morally injurious events as a necessary step toward studying moral injury as a possible adverse consequence of combat. We administered an 11-item, self-report Moral Injury Events Scale to active duty Marines 1 week and 3 months following war-zone deployment. Two items were eliminated because of low item-total correlations. The remaining 9 items were subjected to an exploratory factor analysis, which revealed two latent factors that we labeled perceived transgressions and perceived betrayals; these were confirmed via confirmatory factor analysis on an independent sample. The overall Moral Injury Events Scale and...
338 citations
TL;DR: The YBT showed good interrater test-retest reliability with an acceptable level of measurement error among multiple raters screening active duty service members, suggesting impaired balance symmetry and potentially increased risk for injury.
Abstract: The Y-balance test (YBT) is one of the few field expedient tests that have shown predictive validity for injury risk in an athletic population. However, analysis of the YBT in a heterogeneous population of active adults (e.g., military, specific occupations) involving multiple raters with limited experience in a mass screening setting is lacking. The primary purpose of this study was to determine interrater test–retest reliability of the YBT in a military setting using multiple raters. Sixty-four service members (53 males, 11 females) actively conducting military training volunteered to participate. Interrater test–retest reliability of the maximal reach had intraclass correlation coefficients (2,1) of 0.80 to 0.85 with a standard error of measurement ranging from 3.1 to 4.2 cm for the 3 reach directions (anterior, posteromedial, and posterolateral). Interrater test–retest reliability of the average reach of 3 trails had an intraclass correlation coefficients (2,3) range of 0.85 to 0.93 with an as...
246 citations
TL;DR: It is suggested that this yoga program may be an effective adjunctive therapy for improving hyperarousal symptoms of PTSD including sleep quality and overall sleep quality in Veterans with military-related PTSD.
Abstract: The purpose of this pilot study was to evaluate the feasibility and effectiveness of a yoga program as an adjunctive therapy for improving post-traumatic stress disorder (PTSD) symptoms in Veterans with military-related PTSD. Veterans (n = 12) participated in a 6 week yoga intervention held twice a week. There was significant improvement in PTSD hyperarousal symptoms and overall sleep quality as well as daytime dysfunction related to sleep. There were no significant improvements in the total PTSD, anger, or quality of life outcome scores. These results suggest that this yoga program may be an effective adjunctive therapy for improving hyperarousal symptoms of PTSD including sleep quality. This study demonstrates that the yoga program is acceptable, feasible, and that there is good adherence in a Veteran population.
82 citations
TL;DR: An assessment design framework that can help projects develop effective simulation-based assessments is described and how it aligns with the principles of simulation design is discussed.
Abstract: Simulations provide opportunities for people to learn and to develop skills for situations that are expensive, time-consuming, or dangerous. Careful design can support their learning by tailoring the features of situations to their levels of skill, allowing repeated attempts, and providing timely feedback. The same environments provide opportunities for assessing people's capabilities to act in these situations. This article describes an assessment design framework that can help projects develop effective simulation-based assessments. It reviews the rationale and terminology of the “evidence-centered” assessment design framework, discusses how it aligns with the principles of simulation design, and illustrates ideas with examples from engineering and medicine. Advice is offered for designing a new simulation-based assessment and for adapting an existing simulation system for assessment purposes.
80 citations
TL;DR: Salient components of improved family functioning in reducing child distress mirrored resilience processes targeted by FOCUS, and underscore the public health potential of family-centered prevention for military families.
Abstract: Family-centered preventive interventions have been proposed as relevant to mitigating psychological health risk and promoting resilience in military families facing wartime deployment and reintegration. This study evaluates the impact of a family-centered prevention program, Families OverComing Under Stress Family Resilience Training (FOCUS), on the psychological adjustment of military children. Two primary goals include (1) understanding the relationships of distress among family members using a longitudinal path model to assess relations at the child and family level and (2) determining pathways of program impact on child adjustment. Multilevel data analysis using structural equation modeling was conducted with deidentified service delivery data from 280 families (505 children aged 3–17) in two follow-up assessments. Standardized measures included service member and civilian parental distress (Brief Symptom Inventory, PTSD Checklist—Military), child adjustment (Strengths and Difficulties Questio...
78 citations
TL;DR: Accelerated Resolution Therapy appears to be a safe and effective treatment for symptoms of combat-related PTSD, including refractory PTSD, and is delivered in significantly less time than therapies endorsed by the Department of Defense and Veterans Administration.
Abstract: Objectives: Therapies for post-traumatic stress disorder (PTSD) endorsed by the Department of Defense and Veterans Administration are relatively lengthy, costly, and yield variable success. We evaluated Accelerated Resolution Therapy (ART) for the treatment of combat-related psychological trauma. Methods: A randomized controlled trial of ART versus an Attention Control (AC) regimen was conducted among 57 U.S. service members/veterans. After random assignment, those assigned to AC were offered crossover to ART, with 3-month follow-up on all participants. Self-report symptoms of PTSD and comorbidities were analyzed among study completers and by the intention-to-treat principle. Results: Mean age was 41 ± 13 years with 19% female, 54% Army, and 68% with prior PTSD treatment. The ART was delivered in 3.7 ± 1.1 sessions with a 94% completion rate. Mean reductions in symptoms of PTSD, depression, anxiety, and trauma-related guilt were significantly greater (p < 0.001) with ART compared to AC. Favorable ...
67 citations
TL;DR: Preliminary research identifying critical LS skills, as well as their acquisition and decay rates are described, and models that identify critical skills related to laparoscopy are introduced, and objective metrics for measuring these critical skills are proposed.
Abstract: The U.S. military medical community spends a great deal of time and resources training its personnel to provide them with the knowledge and skills necessary to perform life-saving tasks, both on the battlefield and at home. However, personnel may fail to retain specialized knowledge and skills if they are not applied during the typical periods of nonuse within the military deployment cycle, and retention of critical knowledge and skills is crucial to the successful care of warfighters. For example, we researched the skill and knowledge loss associated with specialized surgical skills such as those required to perform laparoscopic surgery (LS) procedures. These skills are subject to decay when military surgeons perform combat casualty care during their deployment instead of LS. This article describes our preliminary research identifying critical LS skills, as well as their acquisition and decay rates. It introduces models that identify critical skills related to laparoscopy, and proposes objective ...
67 citations
TL;DR: The current findings suggest that combat veterans with PTSD may benefit from participation in group-based outdoor recreation as a means to improve psychosocial well-being.
Abstract: Purpose: Evaluate the effectiveness of a 2-day, 3-night outdoor recreation intervention involving fly-fishing in reducing the psychological concomitants of stress among 74 veterans (M = 47.27, SD = 14.55 years) with post-traumatic stress disorder (PTSD). Methods: Participants completed repeated assessments of attentiveness, mood, depression, anxiety, and somatic stress across 3 time periods, corresponding to 2 weeks before the trip (baseline), the last day of the trip, and a 6-week follow-up. Assessments of perceptual stress, PTSD symptoms, and sleep quality were also administered during the baseline and follow-up periods. Results: Acute effects were observed for improvements in attentiveness and positive mood states, coupled with significant and sustained reductions in negative mood states, anxiety, depression, and somatic symptoms of stress. Comparisons between the baseline and follow-up periods revealed significant improvements in sleep quality and reductions in perceptual stress and PTSD sympt...
66 citations
TL;DR: The present study highlights the role of perceived threat and trait neuroticism on postdeployment mental health symptoms and indicates social support is a robust protective factor and efforts aimed at increasing sustained postde deployment social support may help defend against significant mental health problems among veterans.
Abstract: Military personnel returning from the conflicts in Iraq and Afghanistan commonly experience mental health problems and efforts are underway to determine risk and protective factors associated with postdeployment mental health concerns. This study examined the contribution of trait neuroticism, predeployment life events, combat experience, perceptions of threat, and postdeployment social support on mental health symptoms at 6 months, 12 months, and 24 months postdeployment. Two hundred seventy-one veterans completed self-report measures. Hierarchical regression analyses demonstrated that neuroticism predicted post-traumatic stress and depressive symptoms at all 3 time points; perceived threat predicted post-traumatic stress symptoms at Time 1 and Time 2 and depressive symptoms at Time 2. Social support was a strong negative predictor of post-traumatic stress and depressive symptoms. Alcohol misuse was not significantly predicted by any of the variables. The present study highlights the role of perc...
66 citations
TL;DR: Examination of aspects of internal and external validity of the CES provided evidence that probable post-traumatic stress disorder, depression, and anxiety are highly correlated with all forms of deployment-related experiences and underscores the importance of casting a wide net.
Abstract: Few studies have measured combat exposure during deployment to a war zone. Valid, reliable, and specific measurement is needed to broaden existing knowledge of combat experiences to accurately answer clinically important questions regarding postcombat treatment and recovery, particularly with the recognition of new kinds of combat and resulting psychological sequelae. The Combat Experiences Scale (CES) is a 33-item measure that assesses deployment-related experiences. The psychometrics of this measure, however, were undefined before this study. The purpose of this study was to examine aspects of internal and external validity of the CES. Data were collected as part of a study of 500 veterans of the conflicts in Iraq and Afghanistan across five Veterans Affairs medical centers in Upstate New York. An exploratory factor analysis suggested that three factors represented the scale well: Exposure to Combat Environment, Physical Engagement, and Proximity to Serious Injury and Death. The CES scores showe...
60 citations
TL;DR: It is suggested that reducing unmet need forMH treatment for veterans in the general population may require improving outreach to all Americans and creating greater acceptance for MH treatment.
Abstract: Many veterans returning from Afghanistan and Iraq experience serious mental health (MH) concerns including substance use disorders (SUD), post-traumatic stress disorder, traumatic brain injury, depression, or serious psychological distress (SPD). This article uses data from the 2004 to 2010 National Survey on Drug Use and Health to examine the prevalence of unmet MH needs among veterans aged 21 to 34 in the general population. The prevalence of untreated SUD among veterans (16%) was twice as high as untreated SPD (8%), a nonspecific diagnosis of serious MH concerns. Surprisingly, similar rates of untreated SUD and SPD were found among a nonveteran comparison sample matched on gender and age. These findings suggest that reducing unmet need for MH treatment for veterans in the general population may require improving outreach to all Americans and creating greater acceptance for MH treatment. The need for further analyses of reasons for not obtaining treatment is discussed.
TL;DR: In this article, U.S. Army flight medics performed a process improvement initiative of 15 blood product transfusions on select Category A (Urgent) helicopter evacuation casualties meeting approved clinical indications for transfusion.
Abstract: U.S. Army flight medics performed a process improvement initiative of 15 blood product transfusions on select Category A (Urgent) helicopter evacuation casualties meeting approved clinical indications for transfusion. These transfusions were initiated from point of injury locations aboard MEDEVAC aircraft originating from one of two locations in southern Afghanistan. All flight medics executing the transfusions were qualified through a standardized and approved program of instruction, which included day and night skills validation, and a 90% or higher written examination score. There was no adverse reaction or out-of-standard blood product temperature despite hazardous conditions and elevated cabin temperatures. All casualties within a 10-minute flight time who met clinical indications were transfused. Utilization of a standard operating procedure with strict handling and administration parameters, a rigorous training and qualification program, an elaborate cold chain system, and redundant documen...
TL;DR: Flight performance and spatial cognition test scores were significantly (p < 0.05) poorer for pilots who had low fluid intakes and experienced dehydration in comparison to the hydrated pilots, indicating fluid intake differences resulting in dehydration may have safety implications.
Abstract: The objective of this study was to examine the effect of fluid intake and possible dehydration on cognitive flight performance of pilots. A repeated-measures, counterbalanced, mixed study design was used to examine differences in working memory, spatial orientation, and cognitive flight performance of 40 randomly selected healthy pilots after having high and low fluid intakes. Serial weights were also analyzed to determine differences in cognitive flight performance of the dehydrated (1–3% weight loss) and hydrated study participants. Results showed flight performance and spatial cognition test scores were significantly (p < 0.05) poorer for pilots who had low fluid intakes and experienced dehydration in comparison to the hydrated pilots. These findings indicate fluid intake differences resulting in dehydration may have safety implications because peak cognitive performance among pilots is critical for flight safety.
TL;DR: The methodology used in the "National Health Study for a New Generation of U.S. Veterans," a large-scale longitudinal study of the health of 30,000 Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom (Iraq) veterans, and30,000 veterans who were not deployed to these conflicts, underscores the complexity of sampling and studying this population of recent veterans.
Abstract: This article describes the methodology used in the "National Health Study for a New Generation of U.S. Veterans," a large-scale longitudinal study of the health of 30,000 Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom (Iraq) veterans, and 30,000 veterans who were not deployed to these conflicts. Veterans could participate by mail, online, or through a computer-assisted telephone interview. A medical records review was also conducted to validate responses to the survey. The response rate was 34.3%, with 20,563 surveys accepted. This study underscores the complexity of sampling and studying this population of recent veterans.
TL;DR: Training programs should address the altered dynamic postural stability while wearing body armor in attempts to promote adaptations that will result in safer performance during dynamic tasks.
Abstract: Poor postural stability has been identified as a risk factor for lower extremity musculoskeletal injury. The additional weight of body armor carried by Soldiers alters static postural stability and may predispose Soldiers to lower extremity musculoskeletal injuries. However, static postural stability tasks poorly replicate the dynamic military environment, which places considerable stress on the postural control system during tactical training and combat. Therefore, the purpose of this study was to examine the effects of body armor on dynamic postural stability during single-leg jump landings. Thirty-six 101st Airborne Division (Air Assault) Soldiers performed single-leg jump landings in the anterior direction with and without wearing body armor. The dynamic postural stability index and the individual stability indices (medial–lateral stability index, anterior–posterior stability index, and vertical stability index) were calculated for each condition. Paired sample t-tests were performed to determ...
TL;DR: A retrospective analysis using a patient-level utilization database and a survey of enrollees in the Walter Reed PCMH found that treating patients with chronic conditions is 4 times more costly than treating patients without such conditions and dollar savings are attributable to chronic care.
Abstract: Context: Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, where patients take a leading role and responsibility. Objective: To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine whether access, quality, and cost impacts differ by chronic condition status. Design, setting, and patients: This study conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Results: Costs were 11% lower for tho...
TL;DR: The author describes the Adaptive Response-Time-based Sequencing (ARTS) system, which uses each learner's accuracy and speed in interactive learning to guide spacing, sequencing, and mastery.
Abstract: Recent advances in the learning sciences offer remarkable potential to improve medical education and maximize the benefits of emerging medical technologies. This article describes 2 major innovation areas in the learning sciences that apply to simulation and other aspects of medical learning: Perceptual learning (PL) and adaptive learning technologies. PL technology offers, for the first time, systematic, computer-based methods for teaching pattern recognition, structural intuition, transfer, and fluency. Synergistic with PL are new adaptive learning technologies that optimize learning for each individual, embed objective assessment, and implement mastery criteria. The author describes the Adaptive Response-Time-based Sequencing (ARTS) system, which uses each learner's accuracy and speed in interactive learning to guide spacing, sequencing, and mastery. In recent efforts, these new technologies have been applied in medical learning contexts, including adaptive learning modules for initial medical diagnosis and perceptual/adaptive learning modules (PALMs) in dermatology, histology, and radiology. Results of all these efforts indicate the remarkable potential of perceptual and adaptive learning technologies, individually and in combination, to improve learning in a variety of medical domains.
TL;DR: Issues associated with the technical quality of evaluations and methods for achieving it in evaluations of the effectiveness of medical simulations are discussed.
Abstract: Simulations hold great promise for medical education, but not all simulations are effective, and reviews of simulation-based medical education research indicate that most evaluations of the effectiveness of medical simulations have not been of sufficient technical quality to produce trustworthy results. This article discusses issues associated with the technical quality of evaluations and methods for achieving it in evaluations of the effectiveness of medical simulations. It begins with a discussion of the criteria for technical quality, and then discusses measures available for evaluating medical simulation, approaches to scoring simulation performance, and methodological approaches. It concludes with a summary and discussion of future directions in methods and technology for evaluating medical simulations.
TL;DR: The abdominal aortic tourniquet (AAT) is a prehospital device capable of preventing pelvic and proximal lower limb hemorrhage by means of external abdominal compression as discussed by the authors.
Abstract: Despite improved body armor, hemorrhage remains the leading cause of preventable death on the battlefield. Trauma to the junctional areas such as pelvis, groin, and axilla can be life threatening and difficult to manage. The Abdominal Aortic Tourniquet (AAT) is a prehospital device capable of preventing pelvic and proximal lower limb hemorrhage by means of external aortic compression. The aim of the study was to evaluate the efficacy of the AAT. Serving soldiers under 25 years old were recruited. Basic demographic data, height, weight, blood pressure, and abdominal girth were recorded. Doppler ultrasound was used to identify blood flow in the common femoral artery (CFA). The AAT was applied while the CFA flow was continuously monitored. The balloon was inflated until flow in the CFA ceased or the maximum pressure of the device was reached. A total of 16 soldiers were recruited. All participants tolerated the device. No complications were reported. Blood flow in the CFA was eliminated in 15 out of ...
TL;DR: Economic analysis must be considered in training assessments if training budgets are to compete successfully with other requirements for funding and to identify ways of minimizing costs without reducing performance effectiveness or maximizing performance without increasing costs.
Abstract: This article reviews simulation used for medical training, techniques for assessing simulation-based training, and cost analyses that can be included in such assessments. Simulation in medical training appears to take four general forms: human actors who are taught to simulate illnesses and ailments in standardized ways; virtual patients who are generally presented via computer-controlled, multimedia displays; full-body manikins that simulate patients using electronic sensors, responders, and controls; and part-task anatomical simulations of various body parts and systems. Techniques for assessing costs include benefit–cost analysis, return on investment, and cost-effectiveness analysis. Techniques for assessing the effectiveness of simulation-based medical training include the use of transfer effectiveness ratios and incremental transfer effectiveness ratios to measure transfer of knowledge and skill provided by simulation to the performance of medical procedures. Assessment of costs and simulati...
TL;DR: Post-traumatic symptoms and military and civilian traumatic stressors of all types should be assessed in homeless veterans because they may be contributing to poor social and occupational functioning.
Abstract: Objectives: To better understand potential risk factors for post-traumatic stress disorder (PTSD) and homelessness in veterans, we studied trauma exposure and responses in archival data on 115 homeless veterans. Methods: Rates of exposure to military and a variety of civilian high magnitude stressor (HMS) and persistent post-traumatic distress (PPD) events and symptoms of post-traumatic stress were assessed. The relationships between frequency of different trauma types and symptoms of post-traumatic stress were examined. Results: Exposure to both HMS and PPD events were extremely high in this sample, with particularly high exposure to adult (82%) and childhood (62%) interpersonal violence HMS events and HMS events during military service (53%). Exposure to both military and civilian PPD events was associated with significantly higher levels of PTSD symptoms than exposure to no PPD events or only civilian PPD events, and almost all HMS event types were significantly correlated with both PTSD and di...
TL;DR: Results indicate that until validated neurocognitive testing is introduced, the ANAM4 TBI battery, especially reaction time-based tests, has prognostic utility.
Abstract: The Concussion Restoration Care Center has used the Automated Neuropsychological Assessment Metrics version 4 Traumatic Brain Injury (ANAM4 TBI) battery in clinical assessment of concussion. The study's aim is to evaluate the prognostic utility of the ANAM4 TBI. In 165 concussed active duty personnel (all ultimately returned to duty) seen and tested on the ANAM4 TBI on days 3 and 5 (median times) from their injury, Spearman's ρ statistics showed that all performance subtests (at day 5) were associated with fewer days return-to-duty (RTD) time, whereas concussion history or age did not. Kruskal–Wallis statistics showed that ANAM4 TBI, loss of consciousness, and post-traumatic amnesia were associated with increased RTD time; ANAM4 TBI reaction time-based subtests, collectively, showed the largest effect sizes. A survival analysis using a Kaplan–Meier plot showed that the lowest 25% on the reaction time-based subtests had a median RTD time of 19 days, whereas those in the upper 25% had a median RTD t...
TL;DR: This investigation identifies activities with the highest risk of injury in IET and those that should be targeted for injury prevention efforts and identifies the most frequently recorded diagnoses.
Abstract: Previous studies have not reported activities associated with injuries in initial entry training (IET) because these data were seldom available in medical records and not contained in electronic databases. This investigation obtained activities associated with outpatient encounters in IET recorded by primary medical care providers at Fort Leonard Wood, Missouri. Data were entered into a standard database that included fields for diagnosis and activity associated with the injury. Fifty percent of the new injury encounters (i.e., exclusive of follow-ups) were not associated with a specific event but were reported as having a gradual onset. Other activities included physical training (16%), road marching (15%), confidence/obstacle courses (5%), and barracks activities (3%). Risks per unit of training time were estimated at 13, 62, and 97 injuries per hour for physical training, road marching, and the confidence/obstacle courses, respectively. The most frequently recorded diagnoses were joint pain (27...
TL;DR: SSD was pervasive in this clinical sample and was significantly associated with multiple modifiable emotional symptoms as well as headache and fatigue; this is consistent with previous literature including samples with history of nonblast-related mTBI.
Abstract: Objectives: This investigation sought to characterize prevalence and factors associated with subjective sleep disturbance (SSD) in a clinical sample of veterans with blast-related mild traumatic brain injury (mTBI). Methods: Adult veterans with history of blast-related mTBI were enrolled in a cross-sectional study. Data on demographics, injury, and current symptoms, including SSD, were obtained. Descriptive and univariate analyses investigated prevalence of SSD and associated factors. Results: Participants were 114 veterans with blast-related mTBI (96% male; mean age = 31 years, SD = 8; mean number of days since injury =1,044, SD = 538). 78% screened positive for post-traumatic stress disorder and 77% reported SSD. Loss of consciousness at time of injury, current nightmares, depression, headache, fatigue, and positive screen for post-traumatic stress disorder were significantly associated with SSD (p < 0.05). Conclusions: SSD was pervasive in this clinical sample and was significantly associated w...
TL;DR: The impact of depressive symptoms on the relationship between PTSD and various forms of aggression in Operation Enduring Freedom or Operation Iraqi Freedom (OEF/OIF) veterans was examined and no mediation relationship between depression and physical aggression toward others was found.
Abstract: Aggression is a problem among some combat veterans. Post-traumatic stress disorder (PTSD) is associated with physical aggression in veterans, and co-occurring depression increases the risk of committing aggressive acts. Few studies have examined the impact of PTSD on various forms of aggression. While using a standardized multidimensional measure of aggression, this study examines the impact of depressive symptoms on the relationship between PTSD and various forms of aggression in Operation Enduring Freedom or Operation Iraqi Freedom (OEF/OIF) veterans. Depressive symptoms are hypothesized to mediate the relationship between PTSD and four types of aggression: (1) physical aggression toward others, (2) physical aggression toward objects, (3) physical aggression toward self, and (4) verbal aggression. Seventy-two OEF/OIF veterans completed assessment batteries and clinical interviews upon enrollment into a postdeployment mental health clinic. Study results partially supported the study hypotheses; depressive symptoms indirectly mediated the relationship between PTSD and two forms of aggression: verbal aggression and physical aggression toward self. In contrast to some prior studies of intimate partner violence in veterans with PTSD, no mediation relationship between depression and physical aggression toward others was found. Study results have implications for the development of interventions to treat aggressive behaviors in OEF/OIF veterans with PTSD and depression.
TL;DR: This study compares models developed by Liljegren at Argonne National Laboratory and by Matthew at the U.S. Army Institute of Environmental Medicine that calculate Wet-Bulb Globe Temperature using standard meteorological measurements and indicates LiljEGren is an acceptable alternative to direct WBGT measurement, but verification under other environmental conditions is needed.
Abstract: Environmental heat illness and injuries are a serious concern for the Army and Marines. Currently, the Wet-Bulb Globe Temperature (WBGT) index is used to evaluate heat injury risk. The index is a weighted average of dry-bulb temperature (Tdb), black globe temperature (Tbg), and natural wet-bulb temperature (Tnwb). The WBGT index would be more widely used if it could be determined using standard weather instruments. This study compares models developed by Liljegren at Argonne National Laboratory and by Matthew at the U.S. Army Institute of Environmental Medicine that calculate WBGT using standard meteorological measurements. Both models use air temperature (Ta), relative humidity, wind speed, and global solar radiation (RG) to calculate Tnwb and Tbg. The WBGT and meteorological data used for model validation were collected at Griffin, Georgia and Yuma Proving Ground (YPG), Arizona. Liljegren (YPG: R2 = 0.709, p < 0.01; Griffin: R2 = 0.854, p < 0.01) showed closer agreement between calculated and ac...
TL;DR: The methods quantify and compare the predicted and observed thermal- work strain resulting from environment and worn or carried equipment and illustrate that a small increase in ambient temperature and solar load might result in increased thermal-work strain.
Abstract: The physiological burden created by heat strain and physical exercise, also called thermal-work strain, was quantified for 10 male Marines (age 21.9 ± 2.3 years, height 180.3 ± 5.2 cm, and weight 85.2 ± 10.8 kg) during three dismounted missions in Helmand Province, Afghanistan. Heart rate (HR) and core body temperature (Tcore) were recorded every 15 seconds (Equivital EQ-01; Hidalgo, Cambridge, United Kingdom) during periods of light, moderate, and heavy work and used to estimate metabolic rate. Meteorological measures, clothing characteristics, anthropometrics, and estimated metabolic rates were used to predict Tcore for the same missions during March (spring) and July (summer) conditions. Thermal-work strain was quantified from HR and Tcore values using the Physiological Strain Index (PSI) developed by Moran et al. July PSI and Tcore values were predicted and not observed due to lack of access to in-theater warfighters at that time. Our methods quantify and compare the predicted and observed the...
TL;DR: Limb circumference/tourniquet width occlusion pressure predictions are not good substitutes for measurements and decreases in muscle tension lead to decreases in tournique pressure, especially with the nonelastic CAT, which can lead to occlusions loss.
Abstract: Nerve injuries result from tourniquet pressure. The objective was to determine arterial occlusion and completion pressures with the 3.8-cm-wide windlass Combat Application Tourniquet (CAT) and the 10.4-cm-wide Stretch, Wrap, and Tuck Tourniquet (SWAT-T). Methods: Sixteen volunteers self-applied and had tourniquets applied to their thighs and arms (CAT and SWAT-T, random order, then blood pressure cuffs). Results: Occlusion (Doppler signal elimination) pressures were higher than predicted (p 500 mm Hg. Pressure decreases and occlusion losses occurred over 1 minute (pressure decrease: CAT 44 ± 33 mm Hg; SWAT-T 6 ± 8 mm Hg; cuff 14 ± 19 mm Hg; p < 0.0001; loss/initially occluded: CAT 17 of 61, SWAT-T 5 of 61, cuff 40 of 64, p < 0.01). CAT pressures before ...
TL;DR: ADSM with a history of treatment for pain and mood disorders, and who self-report headaches, sleep disorders,and fatigue are at higher risk for misusing prescription drugs, perhaps in an effort to self-manage symptoms.
Abstract: Objectives: This study identifies predictors of prescription drug misuse among U.S. active duty service members (ADSM). The 2008 Department of Defense Survey of Health-Related Behaviors (HRB) Among Active Duty Military Personnel indicated that ADSM misuse pain relievers, tranquilizers, sedatives, and stimulants at levels ranging from 2% to 17%. Methods: Secondary, multivariate analyses of HRB survey data examined predictors of self-reported prescription drug misuse for 4 distinct drug categories. Results: Receipt of a pain reliever prescription in the past month, year, or previous year were strong predictors (adjusted odds ratio above 2.0) of misuse for all drug categories; receipt of a prescription for anxiety or depression medication in the past year was the strongest predictor of sedative misuse (adjusted odds ratio = 4.46, 95% confidence intervals 3.18–6.24). Absence of a drug testing program was significantly related to the likelihood of drug misuse for all drug categories. Conclusions: ADSM ...
TL;DR: The results suggested that stigma, including the fear of being treated differently by commanders and loss of trust among peers, was greater than perceived BTC, and that a careful balance must be struck between encouraging help-seeking and maintaining the operational effectiveness of deployed personnel.
Abstract: Stigmatizing beliefs about seeking help for mental health conditions and perceived barriers to care (BTC) may influence the decision to seek support and treatment in U.K. military personnel. Many coalition partners, including the U.K. Armed Forces (UKAF), have made considerable efforts to reduce stigma/BTC although the impact of these efforts over time has not been assessed. We surveyed a total of 23,101 UKAF personnel who deployed to Afghanistan and Iraq between 2008 and 2011 and examined whether stigma/BTC levels changed during this time. The results suggested that stigma, including the fear of being treated differently by commanders and loss of trust among peers, was greater than perceived BTC. The likelihood of reporting stigma/BTC, although significantly greater during deployment than postdeployment, reduced significantly over the survey period. A similar reduction was less apparent during postdeployment phase. These findings support the notion that UKAF's anti-stigma campaigns may have had some positive effects, particularly among deployed personnel. However, we suggest that stigma still plays a part in inhibiting help-seeking, particularly during deployment when stigma rates are higher, and that a careful balance must be struck between encouraging help-seeking and maintaining the operational effectiveness of deployed personnel.