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  Subjects -> MILITARY (Total: 106 journals)
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Military Medicine
Journal Prestige (SJR): 0.373
Citation Impact (citeScore): 1
Number of Followers: 8  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0026-4075 - ISSN (Online) 1930-613X
Published by Oxford University Press Homepage  [423 journals]
  • Retraction To: Novel Approach for Detecting the Neurological or Behavioral
           Impact of Physiological Episodes (Pes) in Military Aircraft Crews

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      PubDate: Wed, 01 Jun 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac159
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • Recommendations for Improving Stop the Bleed: A Systematic Review

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      Abstract: ABSTRACTIntroductionIn response to mass casualty events, The Hartford Consensus brought together subject matter experts across multiple disciplines in health care and public safety to create guidelines and publications intended to improve survivability in active shooter events. Among the recommendations was the earlier recognition and treatment application of life-threatening hemorrhage control. These recommendations culminated in efforts to create the Stop the Bleed Campaign, which aims to empower the layperson to render aid in a life-threatening bleeding emergency. As of February 2020, the program has held over 86,000 courses, trained over 1.4 million attendees, and over 77,000 instructors since its inception. In addition to spreading within the United States, American College of Surgeons (ACS) Stop the Bleed (StB) classes have been held in 118 different countries. This systematic narrative review aims to answer the following research question: What does the ACS StB Initiative do well, and where can it improve'Materials and MethodsThe following search terms were utilized: “Stop the Bleed,” “American College of Surgeons,” “bleeding control,” “first-aid,” tourniquet, “wound pack,” “direct pressure” hemorrhage, and bystander. The inclusion criteria were that the article needed to speak to the program or some aspect of bystander first aid, the article needed to be in a civilian setting, the article needed to be more than a case study or overview, and the first aid tools needed to be in the StB curriculum. 4 databases were searched, which produced 138 articles for screening. One hundred four full-text articles were able to be retrieved, and 56 articles were determined to meet the inclusion criteria once the full text was reviewed.ResultsFifty-six articles were included in the final review and were placed into the following categories: Needs Within the Community, Confidence and Knowledge, Training Modalities, Barriers and Gaps in Training, Instructor Selection, Skill Retention, and Patient Outcomes. The articles were then organized into each outcome for synthesis and reporting of the results. The program overwhelmingly improves short-term confidence, but gaps in skill retention, data collection on patient outcomes, and settings that would benefit were identified.ConclusionStB is an effective tool in building confidence in laypersons, which is its biggest strength. A review of the literature shows several areas where the curriculum and materials could be better developed. Research can also be further refined to better quantify the program’s impact.
      PubDate: Thu, 27 Jan 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac019
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • Letter From the Executive Director Dr. John Cho

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      Pages: 289 - 290
      PubDate: Sat, 08 Oct 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac296
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • Military Contributions to the Field of Medical Ultrasound

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      Pages: 291 - 293
      Abstract: ABSTRACTMedical ultrasound is based on the same principle of the piezoelectric effect as sound navigation and ranging, used by the world’s navies and maritime industry. Many of the early advances in sound navigation and ranging technology influenced landmark discoveries in diagnostic ultrasound made by military officers and defense department researchers.
      PubDate: Mon, 29 Aug 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac262
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • Everyday Leadership Can Be Life Changing

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      Pages: 294 - 296
      Abstract: ABSTRACTServing as a flight surgeon after intern year marks an interesting time in a young medical officer’s career. It provides an opportunity for leadership and development for those we serve with in operational settings. This piece demonstrates how small, daily investments in others by leaders can dramatically change a life’s trajectory.
      PubDate: Wed, 15 Jun 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac148
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • On Protection of U.S. Forces From Global Health Threats: The Role of
           Health Security Advisors

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      Pages: 297 - 298
      Abstract: ABSTRACTThe coronavirus disease 2019 pandemic has exposed a health security gap within our nation and around the world. Recent national laws and policies have outlined the ends and means to improve health security. A decisive way is to achieve this objective is through health-related security cooperation efforts by increasing Health Services Support capacity.
      PubDate: Wed, 30 Mar 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac085
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • Inadvertent Radiation Exposures in Combat Zones: Risk of Contamination and
           Radiobiologic Consequences

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      Pages: 303 - 307
      Abstract: ABSTRACTOn February 24, 2022, Russia began a military invasion of Ukraine. Missile and air strikes were reported throughout the country, shortly followed by a large ground invasion from multiple directions. Four major theaters developed: the Kyiv offensive, the Northeastern Ukraine offensive, the Eastern Ukraine offensive, and the Southern Ukraine offensive, with continued missile and air strikes far into Western Ukraine. Advancing Russian military units launched an attack and captured the Chernobyl nuclear station. Russian troops dug trenches into the area commonly known as the “Red Forest,” violating the established radiation safety measures and threatening security within the Chernobyl Exclusion Zone. The placement of military units in such close proximity to the station also sparked concerns of possible damage occurring to the containment vessel constructed around the station’s wrecked fourth reactor. There are 15 operating nuclear reactors in Ukraine. Each is vulnerable to an attack or sabotage that could precipitate a malfunction and possible release of radioactive isotopes. In this short commentary, we will discuss radiobiologic data obtained after the analysis of historical nuclear power plant (NPP) accidents and emphasize new challenges for nuclear security when NPPs are found and are possible targets within a conflict zone.
      PubDate: Wed, 13 Jul 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac213
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • From the Defense Health Board: Military Accessions and the Continuum of
           Mental Health Research

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      Pages: 308 - 310
      Abstract: ABSTRACTThe Defense Health Board conducted a year-long examination of mental health accession screening and related issues. In its August 2020 report, Examination of Mental Health Accession Screening: Predictive Value of Current Measures and Processes, the Board recommends a paradigm shift in how mental health impacts on readiness are understood and addressed. This shift can only occur with the development and implementation of a research plan that follows cohorts of military personnel from recruitment through their military career. The following article describes this research plan as an excerpt of the larger report.
      PubDate: Sat, 02 Jul 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac186
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • We Can Do Better at Protecting Our Service Members From Skin Cancer

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      Pages: 311 - 313
      Abstract: ABSTRACTSkin cancer rates have been steadily increasing among the American public for decades, but multiple studies have demonstrated that the U.S. military suffers from higher rates of skin cancer than the general public. As with so many aspects of health, simple preventive measures made early on can dramatically improve long-term health outcomes. Ample research has demonstrated that ultraviolet protection reduces skin damage and cancer rates. Although further research is needed to fully understand current barriers to soldiers’ use of sun protection, we recommend a variety of simple measures the U.S. military can implement to reduce skin cancer risk for our soldiers. Early education and intervention to reduce skin cancer risk and promote sun-protective strategies is critical. These include improving sun protection offered by uniform items, such as increasing the availability of the sun hat, using eye protection with tinted inserts, and testing and publicizing the ultraviolet protection level of uniform items. We also recommend increasing sunscreen access for soldiers. Options to do so include issuing soldiers small portable packets or bottles of sunscreen to carry on their person, incorporating small packets of sunscreen in MREs, and issuing sunscreen to commands to distribute before field exercises. Unit and medical leadership should encourage the use of sunscreen and sun-protective strategies when possible; leadership engagement is critical to overcoming current behavioral barriers to change. Finally, we recommend that units attempt to reduce sun exposure during training by encouraging soldiers to seek shade and avoiding outdoor training in the middle of the day.
      PubDate: Tue, 05 Jul 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac198
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • The Capability Gap in Occupational Health Information Management

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      Pages: 319 - 322
      Abstract: ABSTRACTThe lack of an integrated approach to data capture, information management, and analysis limits the contribution of occupational and environmental medicine to protecting 2.3 million uniformed and civilian DoD workers. Despite an abundance of military information systems that include the terms “Safety” and “Occupational Health” in their names, none of these systems provide capabilities needed to aggregate and analyze the results of occupational medicine exams, use medical surveillance to mitigate exposure incidents, provide enterprise-level management of occupational medicine services, or comply with privacy and recordkeeping law and regulation. Instead, they provide a patchwork of data that meets most regulatory compliance requirements but fails to achieve the true objectives of occupational health programs. Bridging these capability gaps will improve the occupational health care of the DoD workforce, improve the quality of occupational medicine services, increase public trust in the DoD management of exposure incidents, and potentially generate hundreds of millions of dollars through cost-avoidance on workers’ compensation claims and through identification and elimination of non–value-added medical certification exams. The ongoing Military Health System transformation represents a unique opportunity to bridge these long-recognized but persistent capability gaps.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac233
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • Secondary Syphilis, Urticarial Eruption, and COVID-19 Vaccination

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      Pages: 323 - 323
      PubDate: Fri, 12 Aug 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac246
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • Secondary Syphilis Presentation and Urticarial Eruption After Moderna
           COVID-19 Vaccination Response to the Letter to the Editor

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      Pages: 324 - 324
      PubDate: Sat, 20 Aug 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac247
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • COVID-19 on Board a Submarine; a Retrospective Review

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      Pages: 325 - 325
      PubDate: Tue, 20 Sep 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac270
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • Sleep Deprived, Injured, Not Seeking Medical Care. A Commentary on Elliman
           Et Al (2022)

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      Pages: 326 - 327
      PubDate: Thu, 02 Jun 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac156
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • Review of Humanitarian Guidelines to Ensure the Health and Well-being of
           Afghan Refugees on U.S. Military Bases

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      Pages: 1299 - 1309
      Abstract: ABSTRACTIntroductionThe U.S. military has a 50-year history of managing resettlement or refugee camps on bases. In July and August 2021, more than 124,000 persons were evacuated from Afghanistan, with 55,000 Afghans temporarily housed at U.S. military bases around the world during Operation Allies Welcome (OAW) at its peak.MethodsPubMed was searched for papers published in English between January 1, 1980, and February 1, 2021, using “Afghanistan” and “health” (including “public health,” “maternal health,” and “child health”), “maternal, newborn, and child health,” and “health situation” as search terms and specific topics of interest. Where scholarly work was unavailable, reports of the United States Agency for International Development, implementing partners, gray literature, donor reports, Afghanistan Ministry of Health documents, national health plans, policies, and strategies, DoD after-action reviews (AARs), and guidance from previous refugee airlifts were also included in the search.ResultsAlthough AARs may provide some helpful guidance for these refugee settings, a review of open-source AARs and had little to no health guidance, focused primarily on administrative issues, and do not follow humanitarian guidelines. DoD guidance for refugee settings is dated and requires updating to be useful. There is a well-developed body of literature of international standards, guidelines, and best practices for refugee settings. Using the standardized Needs Assessment for Refugee Emergencies checklist as a guide, this review provides a standardized refugee health assessment framework for ensuring the health and well-being of Afghan refugees on U.S. military bases is based on humanitarian response guidelines and best practices to ensure their care meets international standards. All groups, especially minority ethnic groups (e.g., Hazaras), sexual and gender minorities, elderly, disabled, or mentally ill persons, need equal access to protection to ensure they are not targeted. Water, sanitation, and hygiene must be gender-sensitive and inclusive which includes well-lit separate facilities for males and females to decrease vulnerability to violence. The displaced population must be involved in the management of the camp through community participation and representation. All providers in OAW should be briefed on the food security and nutrition context of those in their care. Medical providers are most effective if they have significant experience with the refugee population health context. Understanding refugee medicine, the ability to work with illiterate and uneducated populations and translators are important skills. Abiding by international standards of care and being up-to-date with current guidelines for refugee care is important. Reproductive health must be a core component of the overall health response to decrease mortality, morbidity, and disability among reproductive-age women in crisis situations. Immediate and exclusive breastfeeding and international standards for breastfeeding must be adhered to, especially among nutritionally at-risk Afghans who are part of OAW. Education implementors familiar with education in refugee settings are an important contributor to establish formal, informal, non-formal, accelerated, and essence-based education programs.ConclusionsPartners and providers involved in any refugee setting should become familiar with updated guidelines, standards, and best practices and apply them to any operation to ensure a rights-based approach to protection, care, and the health and well-being of refugees.
      PubDate: Tue, 05 Apr 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac086
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • Anterior Cruciate Ligament Reconstruction Surgery: Creating a Permissive
           

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      Pages: 1310 - 1317
      Abstract: ABSTRACTIntroductionAnterior cruciate ligament (ACL) rupture in military personnel and civilians can be a devastating injury. A service member is 10 times more likely to suffer an ACL injury than their civilian counterparts, and despite successful surgical stabilization, 4%-35% will develop arthrofibrosis, over 50% will not return to full active duty, and up to 50% will develop post-traumatic osteoarthritis (PTOA) within 15 years. Equally concerning, woman are 2 to 8 times more likely to experience ACL injuries than men, which represents a major knowledge gap.Materials and MethodsA comprehensive literature search was performed in December 2021 using structured search terms related to prevalence, risk factors, disease progression, and treatment of ACL injury and reconstruction. The literature search was conducted independently by two researchers using PubMed, Cochrane, and Embase databases, with inclusion of articles with military, civilian, and sex relevance, and exclusion of most papers with a publication date greater than 10 years. The resources used for the review reflect the most current data, knowledge, and recommendations associated with research and clinical findings from reliable international sources.ResultsCurrently, there is no effective system-based drug therapy that creates a “permissive environment” to reduce synovial and cartilage stress after ACL injury and reconstruction and prevent secondary complications. We argue that progress in this area has been hampered by researchers and clinicians failing to recognize that (1) an ACL injury is a system’s failure that affects the whole joint, (2) the early molecular events define and perpetuate different injury phenotypes, (3) male and female responses may be different and have a molecular basis, (4) the female phenotype continues to be under-represented in basic and clinical research, and (5) the variable outcomes may be perpetuated by the trauma of surgery itself. The early molecular events after ACL injury are characterized by an overexpression of joint inflammation, immune dysfunction, and trauma-induced synovial stress. We are developing an upstream adenosine, lidocaine, and magnesium therapy to blunt these early molecular events and expedite healing with less arthrofibrosis and early PTOA complications.ConclusionsACL injuries continue to be a major concern among military personnel and civilians and represent a significant loss in command readiness and quality of life. The lack of predictability in outcomes after ACL repair or reconstruction underscores the need for new joint protection therapies. The male–female disparity requires urgent investigation.
      PubDate: Thu, 07 Apr 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac093
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • The Association Between Sleep and Musculoskeletal Injuries in Military
           Personnel: A Systematic Review

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      Pages: 1318 - 1329
      Abstract: ABSTRACTIntroductionMusculoskeletal injuries (MSKIs) are a significant health problem in the military. Accordingly, identifying risk factors associated with MSKI to develop targeted strategies that attenuate injury risk remains a top priority within the military. Insufficient sleep has garnered increased attention as a potential risk factor for MSKI in both civilians and military personnel. Yet, there are no systematic evaluations of the potential association between sleep and MSKI in the military. The purpose of this review is to examine the relationship between sleep and injury in military personnel.Materials and MethodsLiterature searches were performed in multiple electronic databases using keywords relevant to sleep quantity and quality, MSKI, and military populations. Two investigators independently assessed the methodological quality of each study using the Newcastle–Ottawa Scale for cohort studies or an adapted form of this scale for cross-sectional studies.ResultsThe search yielded 2402 total citations, with 8 studies (3 cohort and 5 cross-sectional) fitting the inclusion criteria. Overall, the systematic review found 5 of the 8 reviewed studies supporting an association between sleep (quality and duration) and MSKI in military personnel. Specifically, poor sleep was associated with increased injury incidence in 2 cohort and 3 cross-sectional studies.ConclusionThis is the first systematic review to evaluate the published literature on the association between sleep and MSKI risk in military populations. Although there is currently limited research on this topic, findings suggest that sleep is associated with MSKI and should be considered when designing strategies aimed at reducing MSKI risk in military personnel.
      PubDate: Wed, 11 May 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac118
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • Physical Injuries, Treatment-Seeking, and Perceived Barriers to Treatment
           in U.S. Army Drill Sergeants

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      Pages: 1403 - 1411
      Abstract: ABSTRACTIntroductionDrill sergeants work under mentally and physically challenging conditions. The current study examined self-reported rates of physical injuries in drill sergeants; rates of treatment-seeking for injuries; perceived barriers toward treatment-seeking; and associated demographic and environmental factors.Materials and MethodsDrill sergeants from across all Army basic training locations completed self-report surveys from September to November of 2018. In total, 726 drill sergeants were included in analyses. Drill sergeants indicated whether they had acquired an injury during their time in the drill sergeant role and whether they had sought treatment for all such injuries. Furthermore, drill sergeants rated their agreement with a number of possible perceived barriers to treatment-seeking for physical injuries. Regression models examining each phenomenon included hours of sleep obtained per day; general- and health-specific leadership behaviors of the company command teams; unit cohesion; time as a drill sergeant; duty location; gender; military operational specialty; years in the military; previous combat deployments; and route of assignment. The study was approved by the Walter Reed Army Institute of Research Institutional Review Board.ResultsIn total, 38% of respondents reported acquiring an injury during their time as drill sergeants. Of those who had acquired an injury, 61% reported seeking medical help for all injuries acquired. Injuries were more likely in females (49%) than in males (34%) and less likely in drill sergeants reporting at least 6 hours of sleep (27%) versus those reporting 5 hours (40%) and 4 hours or less (43%). Reported comparisons were significant after controlling for demographic and environmental variables in regression models. The most strongly endorsed perceived barriers to treatment-seeking were “Seeking help would place too much burden on the other drill sergeants” (69%) and “Seeking help would interfere with my ability to train the recruits” (60%). Both of these perceived barriers were significantly associated with reduced treatment-seeking in injured drill sergeants, after controlling for demographic and environmental variables.ConclusionsThis study is the first to examine injury occurrence, treatment-seeking, and perceived barriers to treatment-seeking in U.S. Army drill sergeants. Building on previous studies that showed the negative effects of sleep deprivation on the safety and behavioral health of drill sergeants, the current study gives further evidence of the negative effects of such sleep deprivation, this time in the domain of physical injuries. The results suggest that pursuing strategies that allow for healthier sleep duration may contribute to injury reduction.
      PubDate: Mon, 20 Jun 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac153
      Issue No: Vol. 187, No. 11-12 (2022)
       
  • Coronavirus Disease 2019 On Board a Submarine: A Retrospective Review

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      Pages: 1474 - 1479
      Abstract: ABSTRACTBackgroundThe submarine environment presents unique challenges in mitigating the spread of respiratory viruses because of the re-circulatory atmosphere and lack of ability to physically distance. The atmosphere of a submarine is periodically ventilated and continuously scrubbed. However, the air is recycled for months until the ship is able to ventilate. An outbreak of coronavirus disease 2019 (COVID-19) occurred on a U.S. Navy fast-attack nuclear submarine (SSN) with a crew of 128 personnel.MethodsDemographics, symptom data, and test results for all crew members on board during the outbreak were collected. Testing was completed by real-time reverse-transcriptase polymerase chain reaction, and symptom data were collected via a patient-reported online application. Symptom results were collected from August 4, 2020 to September 1, 2020.ResultsThe crew was 100% male, with a mean age of 27.0 years. All crew members met the stringent medical standards for submarine and sea duty. Fifty-five Sailors tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (43.0% of the crew) during the outbreak. Additionally, nine Sailors (7.0% of the crew) met the criteria for infection despite testing negative, resulting in an overall attack rate of 50.0%. Among the 64 crew members with suspected or confirmed COVID-19, 1 (1.6%) was hospitalized. There were no deaths. Out of the 55 positive tests, there were 6 (10.9%) asymptomatic positive cases.ConclusionsAs expected, SARS-CoV-2 was able to spread rapidly among a submarine crew. In 11 days, the infection spread to 64 total crewmembers out of 128. Outbreaks such as these have played a role in future COVID-19 testing and mitigation protocols that have affected day-to-day operations.
      PubDate: Mon, 27 Jun 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac155
      Issue No: Vol. 187, No. 11-12 (2022)
       
 
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