Military Medicine最新文献

{"title":"Novel Tools for Providing Care for Military Working Dogs in Austere Environments.","authors":"Alyssa Brown","doi":"10.1093/milmed/usaf469","DOIUrl":"https://doi.org/10.1093/milmed/usaf469","url":null,"abstract":"<p><p>In future operations with limited access to outside hospitals in austere environments, medical professionals are likely the only available medical assets. To streamline care for military working dogs, medical professionals can use quick-reference flashcards and specialized kits for the treatment, working with Army veterinarians and handlers to provide proper care.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin Administration Safety Profile During Military En Route Critical Care Transports.","authors":"Richard Strilka, Shelia C Savell, Krystal K Valdez-Delgado, Lane L Frasier, Jill Lear, William T Davis","doi":"10.1093/milmed/usaf476","DOIUrl":"https://doi.org/10.1093/milmed/usaf476","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The aeromedical evacuation environment introduces unique logistical and physiological stressors for both patients and medical staff. Treating critically ill patients in confined spaces, under low-light conditions, amid aircraft noise, and with limited resources increases the risk of adverse drug events (ADEs). However, the true frequency and impact of medication errors in the en route care (ERC) setting remain poorly documented in both civilian and military sectors. In-flight, Critical Care Air Transport (CCAT) teams administer multiple high-risk medications, including paralytics, analgesics, cardiac drugs, anticoagulants, and insulin. The current CCAT model for medication safety relies largely on healthcare personnel performing high-risk procedures without error. Yet, significant gaps remain in understanding the frequency, nature, and consequences of medication errors in the en route critical care (ERCC) military environment. The purpose of this study was to describe CCAT in-flight insulin administration, glucose monitoring, and related interventions. The findings will inform CCAT pre-deployment readiness training and guide future CCAT clinical care practice guidelines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;We conducted a retrospective review of CCAT mission records for patients who received insulin during transport by USAF CCAT between 2012 and 2022. Research nurses trained at the En Route Care Research Center (ECRC) in San Antonio reviewed and abstracted data from Form 3899L into an Excel database. Descriptive statistics and univariate analyses were conducted for patient demographics and key measurements using SAS (version 9.4, SAS Institute, Inc., Cary, NC). Subgroup analyses stratified by insulin administration route were performed. Differences in hypoglycemia rates between administration routes were compared using the Fisher exact test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The records of 3,320 patients evacuated by CCAT between 2012 and 2022 were screened. After exclusion criteria were applied, 2,998 records were screened for insulin administration, among which 2% (59/2,998) documented at least one instance of insulin administration. Routes of insulin administration included 51 subcutaneous (SQ) injections, 15 intravenous pushes (IVPs), 13 continuous insulin infusions, and 3 unspecified. Four patients (6.8%) experienced at least one hypoglycemic event (blood glucose concentration [BG] &lt;70 mg/dL). Of these, three patients (75%) were receiving insulin infusions for hyperglycemia. For the 13 patients on insulin infusions, the median infusion rate was 4.0 U/hour (IQR [2.75-8.25]), and six patients (46%) had at least one 2-hour interval without a documented BG check. Most (60%) episodes of IVP insulin administration lacked a glucose check within 1 hour.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Insulin infusions managed by CCAT teams were rarely administered but were associated with a relatively high hypoglycemia r","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Austere Hot and Humid Conditions on the Physical and Biological Properties of Endodontic Sealers in Military Use.","authors":"Meaghan A Rose, Eun Y Huh, Heather M Zamora, Zachary S McIntosh, William B Arden, Yoon Y Hwang","doi":"10.1093/milmed/usaf475","DOIUrl":"https://doi.org/10.1093/milmed/usaf475","url":null,"abstract":"<p><strong>Introduction: </strong>Nearly 15 million root canals are performed annually for the treatment of diseased and infected tooth pulp, allowing teeth to be functionally and esthetically maintained. Non-surgical root canal therapy ties directly into dental readiness and the maintenance of US posture by preventing and successfully treating endodontic disease. However, this therapy has a 5-20% failure rate with approximately 60% of these failures attributed to incomplete obturation of the root canal. The composition and performance of endodontic sealers are vital for successful root canal treatments and may be affected by storage or transit conditions. Although most sealers in civilian settings are stored at ambient temperatures, military environments often expose dental materials to extreme heat, humidity, and other environmental stressors. Understanding the durability of endodontic sealers under such conditions is essential for optimizing material selection and ensuring reliable performance during deployment. The hypothesis for this study was that austere environmental conditions during transit, storage, or use alter the physical and biological properties of endodontic sealers thereby impacting their expected performance.</p><p><strong>Materials and methods: </strong>This in vitro study examined one brand of 4 different sealer classes (resin, silicone, bioceramic, and zinc oxide-eugenol) exposed to hot and humid environmental conditions. Physical and biological tests were performed in accordance with manufacturers' guidelines and International Organization for Standardization (ISO) testing protocols, including flow, working time, film thickness, radio-opacity, solubility, setting time, antimicrobial activity, and cytotoxicity.</p><p><strong>Results: </strong>This study showed significant changes in sealers' physical and biological performance after hot and humid storage. Of the tested sealers, GuttaFlow2 was the most physically durable although EndoSequence BC was the least. AH Plus Jet had the highest sample variation among tests (physical and biological) performed, indicating an innate lower level of durability and consistency in this sealer that is exacerbated by hygrothermal stress. Pulp Canal Sealer experienced changes in all properties but few were statistically significant.</p><p><strong>Conclusions: </strong>This study showed that endodontic sealers are subject to potentially clinically significant changes in physical and biological properties after exposure to hot and humid conditions. Those composed of silicone and zinc oxide-eugenol materials could be most ideal for hot and humid areas of operation with more dependable solubility, setting time, and cytotoxic characteristics. Military and civilian clinicians can use the results of this study when choosing which endodontic sealers may be best suited for unique performance requirements and improving endodontic therapy success rates.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring Influenza in a Military Setting in Germany: Its Relevance in the 2023/2024 Season and Comparison to the Civil Population.","authors":"Julia Wenzel, Anna Leibinger, Ralf Dürrwald, Alexander Burgdorff, Daniela Cortnum, Leopold Böhm, Melanie Schmeil, Carsten Balczun, Svenja Liebler, Kai Kehe, Ralf Matthias Hagen, Manuela Andrea Hoffmann","doi":"10.1093/milmed/usaf466","DOIUrl":"https://doi.org/10.1093/milmed/usaf466","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Acute airway infections (AAI) can jeopardize force readiness. Influenza, as one of the main viral agents that cause AAI, is highly contagious and may lead to severe illness and even death. Consequently, AAI and influenza surveillance in the German Armed Forces (Bundeswehr) is crucial for timely monitoring its seasonal impact. With this retrospective analysis, we assessed the burden of disease in comparison with civilian surveillance data in order to evaluate potential risk and preventive factors for influenza infection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;From October to March of each year, military outpatient sentinel medical treatment facilities (MTF) report weekly numbers of AAI cases. Additionally, voluntary virological laboratory tests are conducted via RT-qPCR and aggregated influenza vaccination rates of all military personnel are monitored. With this retrospective analysis, we report AAI proportions and incidences as well as positivity rates (PR) of 7 viral agents for the 2023/2024 season. Influenza PR were analyzed for potentially confounding risk factors. Finally, we conducted a stratified analytic comparison with data from the national influenza surveillance system by the Robert Koch Institute (RKI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During the 2023/2024 season, our surveillance observed 18,999 soldiers served by 14 MTF throughout Germany. A total of 13,431 cases of AAI represented 27% (weekly range: 18.4%-44.8%) of all acute medical encounters. The 7-day-incidences of AAI varied from 420/100,000 to 5,686/100,000. A total of 3,636 virological laboratory tests were conducted. SARS-CoV-2 (17.3%), human rhinovirus (15.5%), and influenza A + B (4.4%) were the most relevant viruses detected. The statistical analysis of the military dataset showed a significantly elevated odds ratio (OR) for influenza and fever. Odds ratio for influenza and sex were slightly elevated for men in both groups but without clinical relevance [military OR 1.25 (95% CI 0.78-2.02); civilian OR 1.26 (95% CI 1.03-1.51)]. Age seemed to be a risk factor, however, as evident in rising influenza PR with higher age and a significant mean value difference (MVD) between positive and negative patients in the military but not in the civilian dataset. Age-stratified comparative analyses between the military and the civilian dataset showed a significantly elevated influenza OR (P &lt; .001) for civilian patients of all age groups except for those &gt;60 years. Differences between age groups were greatest in subgroup 1 (17-29 years) and least in subgroup 5 (60-67 years). Overall, the age-stratified Mantel-Haenszel influenza OR estimate for an influenza infection in civilian versus military patients was 4.06 (95% CI 3.32-4.96).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our analysis adds new aspects to the knowledge on influenza infections in soldiers and reveals relevant differences in terms of burden of disease between the observed German military pe","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Emergency Department Use Among Veterans: Longitudinal Patterns and Opportunities for Targeted Intervention.","authors":"Anita A Vashi, Selen Bozkurt, Tracy Urech, Siqi Wu, Steven M Asch, Linda Diem Tran","doi":"10.1093/milmed/usaf479","DOIUrl":"https://doi.org/10.1093/milmed/usaf479","url":null,"abstract":"<p><strong>Introduction: </strong>Persistent frequent emergency department (ED) use may signal unmet medical, behavioral, and social needs. Understanding patterns of persistence and associated risk factors can inform ED-based interventions and care coordination strategies. This study aimed to examine patterns of frequent ED use, identify predictors of persistence, and assess frequent community ED users as a policy-relevant subgroup.</p><p><strong>Materials and methods: </strong>We conducted a national longitudinal cohort study of Veterans Health Administration (VA) enrollees from 2018 to 2022 using administrative data on ED visits across VA and non-VA (community) settings. Frequent ED use was defined as ≥4 visits in a year. We assessed the proportion of frequent users with persistent high utilization over 3 and 5 years, evaluated sociodemographic, clinical, and system-level predictors of persistence, and calculated 5-year mortality rates. Sensitivity analyses examined patterns and outcomes among frequent community ED users.</p><p><strong>Results: </strong>Annually, 12-13% of VA enrollees met criteria for frequent ED use. Among 174,510 veterans with frequent ED use in 2018, 14% remained frequent utilizers at 3 years and 5% at 5 years, indicating substantial turnover. The most common primary diagnoses among frequent users were chest pain, low back pain, urinary tract infection, suicide/intentional self-harm, and chronic obstructive pulmonary disease. Predictors of persistence included Black race, medical and mental health comorbidities, and higher baseline ED use. Five-year mortality among frequent ED users was 24%. Among frequent community ED users, only 3% remained frequent users, yet their 5-year mortality rate approached 40%.</p><p><strong>Conclusions: </strong>Although most Veterans cycle out of high ED use, those with persistent use face high mortality. These findings highlight the importance of early identification and risk stratification to guide ED-based care management, behavioral health integration, and end-of-life planning for vulnerable populations.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Simulated Field Storage Conditions on Common Dental Medications.","authors":"Logan G Ledesma, Meaghan A Rose, Heather M Zamora, Zachary S McIntosh, Yoon Y Hwang, Kraig S Vandewalle","doi":"10.1093/milmed/usaf439","DOIUrl":"https://doi.org/10.1093/milmed/usaf439","url":null,"abstract":"<p><strong>Introduction: </strong>Military dental providers often operate in environments with extreme temperature gradients. The purpose of this study was to analyze the effect of simulated storage in extreme cold conditions on 8 medications-4 local anesthetics (2% Lidocaine with 1:100,000 epinephrine, 0.5% Marcaine with 1:200,000 epinephrine, 4% Articaine with 1:100,000 epinephrine, 3% Polocaine), 2 pain medications (Acetaminophen 325 mg, Ibuprofen 800 mg), and 2 antibiotics (Amoxicillin 500 mg, Azithromycin 500 mg), who are commonly used by the military for dental treatment.</p><p><strong>Materials and methods: </strong>Medications were subjected to simulated freeze-thaw (FT) conditions (MIL-STD-810H), using an environmental chamber to expose any tendency for degradation. The medications were cycled through 13 hours at -10 °C and 11 hours at 4 °C for 28 days, to simulate springtime FT conditions experienced by Kyiv, Ukraine. Samples were analyzed at 0, 7, 14, 21, and 28 days under both environmental stress and room temperature (RT) conditions. Liquid chromatography-mass spectrometry (LC-MS) was completed with electrospray ionization interface and triple quadrupole mass analyzer. Each medication was used as an internal standard (IS) for the other and response factors determined for each. All drugs and their respective IS were measured in multiple reaction monitoring in electrospray positive ionization. Room temperature data from each time point were compared to the respective environmentally stressed drug data using T-tests adjusted via Bonferroni's method (α = 0.01). Parametric first-order autoregressive moving-average repeated-measures analysis of variance using maximum likelihood was performed using the \"MIXED\" procedure in SAS v9.4 to determine if concentrations were affected by time and environmental stress (α = 0.05).</p><p><strong>Results: </strong>Lidocaine, Polocaine, Acetaminophen, and Azithromycin concentrations were affected by time and environmental stressing. All other medication concentrations were affected by time but not by environmental stressing.</p><p><strong>Conclusions: </strong>Utilization and/or storage of commonly used local anesthetics, antibiotics, and pain medications in these climate conditions may experience concentration changes who may affect their efficacy in treating dental-related conditions.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Blast Exposures and Intestinal Permeability and Neurotrauma Symptoms During Mortar Fire Military Tactical Training Operations.","authors":"Zhaoyu Wang, Qingkun Liu, Jeffrey Nemes, Alis Kranfli, Molly Sullan, Andrew Hoisington, Lisa A Brenner, Maciej Skotak, Christina R LaValle, Yongchao Ge, Walter Carr, Fatemeh Haghighi","doi":"10.1093/milmed/usaf478","DOIUrl":"https://doi.org/10.1093/milmed/usaf478","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Military members are exposed in combat and training to recognized traumatic brain injury (TBI)-causing events and other sub-concussive events that result in physical, psychological, and physiological impacts. Studies by this team and others involving Service Members (SMs) engaged in tactical training operations with repeated exposure to low level blast (LLB) have shown associations with concussion-like symptomology as well as transient decrements in performance, blood-based neurotrauma biomarkers, and perturbations in epigenome and transcriptome profiles, as well as alterations in intestinal permeability (IP). The present study focused on SMs engaged in mortar fire tactical trainings, builds on our previous findings in breachers that identified associations between blast exposures and IP and neurotrauma symptoms following exposures to LLB.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Self-report symptom data and blood specimens from 31 SMs were collected including 22 mortarmen who directly participated in tactical training operations and were exposed to LLB and 9 unexposed study controls. Symptom data and blood samples were collected at pre-, post, and follow-up time points, across 3 consecutive mortar fire training sessions. Blood samples were assessed across all sessions via enzyme-linked immunosorbent assay (ELISA) to measure levels of IP protein biomarkers (i.e., Zonulin, Lipopolysaccharide-Binding Protein (LBP), Claudin-3, Intestinal-Fatty Acid Biding Protein (I-FABP). Correlations between IP biomarker changes and magnitude of blast exposures in each training session were calculated and reported as effect sizes measured by Cohen's d using correlation to effect size conversion via R package effectsize. Impact of blast magnitude on IP biomarker changes across sessions were tested using a linear mixed effect model via R package lme4 and emmeans, with similar models used to investigate associations of IP biomarker changes following blast with physical and psychological symptoms or prior history of TBI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In mortarmen LLB exposure magnitudes were significantly associated with change in Intestinal-Fatty Acid Binding Protein (pre vs. post, P = .028) and Zonulin (pre vs. follow-up, P = .003) levels across training sessions. Associations with moderate to large effect sizes were observed between changes in LBP and CLDN3 levels and neurotrauma symptoms, including taking longer to think, dizziness, and concentration difficulties following exposures to LLB (Cohen's |d| &gt; 0.5). Associations between TBI history and blast induced alterations in LBP and CLDN3 levels were identified with large effect sizes (|d| &gt; 0.8).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The present study in mortarmen corroborates our prior findings showing that exposures to LLB can contribute to IP that is also associated with prior mild traumatic brain injury (mTBI) history, with concomitant decreases in self-reported cognitiv","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Quality of Musculoskeletal Injury Research in Military Settings: Introducing the Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) Common Data Element Checklist.","authors":"M A J Daniel I Rhon, C O L Paul F Pasquina, B G Deydre S Teyhen","doi":"10.1093/milmed/usaf363","DOIUrl":"https://doi.org/10.1093/milmed/usaf363","url":null,"abstract":"<p><p>Noncombat musculoskeletal injuries are the single greatest threat to medical readiness. They also impart a tremendous burden on the Military Health System, accounting for the most medical encounters of any kind, more than double the next most common cause, mental health disorders. This has mobilized efforts to better understand injury causes, risk factors, and methods to mitigate the onset and impact of injuries. However, lack of standardization has led to great variability in how injury, risk factors, and injury-related outcomes have been defined. The variability in the definition of these terms limits the comparisons that can be made. Ultimately, this variability impacts our ability to understand the generalizability and applicability of current research. It also limits the ability to conduct meta-analysis, where data from multiple studies is combined and analyzed in aggregate, improving the precision of current research, and answering additional questions that could not be addressed by the original individual studies alone. The recent conclusion of an international effort led by the Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) workgroup to reach consensus on the recommended minimum data elements that should be collected and reported when assessing injury risk in military populations aims to help close this gap. The value of injury-related research in military medicine has the potential to substantially improve with widespread adoption of the ROMMIL checklist. Scientists working in military settings should use this checklist when planning their studies and when reporting their findings. Funders and journal editors should encourage use of the ROMMIL common data elements checklist whenever applicable.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Department of Defense Birth and Infant Health Research Program: Characteristics of Live Births and Adverse Birth and Infant Health Outcomes Among TRICARE Beneficiaries, 2016-2021.","authors":"Clinton Hall, Anna T Bukowinski, Monica Burrell, Gia R Gumbs, Zeina G Khodr, Jackielyn Lanning, Sandra Maduforo, Celeste J Romano, Ava Marie S Conlin","doi":"10.1093/milmed/usaf474","DOIUrl":"https://doi.org/10.1093/milmed/usaf474","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The Department of Defense Birth and Infant Health Research (BIHR) program regularly identifies live births among TRICARE beneficiaries (i.e., United States military-connected families) for epidemiologic surveillance and research purposes. Linkage of infants with their TRICARE sponsor and birth mother (who may also be the sponsor) provides the capability to examine parental and military characteristics of births and associated health outcomes. The current study describes BIHR data methodology and presents population characteristics for a recent, 6-year cohort of live births among military families.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;The study cohort comprised all infants in BIHR data born January 2016 through December 2021. Same-sex multiples were not captured because of difficulty differentiating their neonatal medical records. Infants were identified and linked with sponsors and birth mothers using data from the Military Health System Data Repository and Defense Manpower Data Center, which were also used to derive demographic, military, and medical characteristics. Birth and infant health outcomes were ascertained using diagnosis and procedure codes from medical encounter files, which encompassed all care covered by TRICARE (i.e., across military and civilian facilities). Population characteristics were reported using descriptive statistics, overall and by birth mother beneficiary type: sponsor, dependent spouse, or other. Trends in selected adverse outcomes were also described (i.e., cesarean delivery, preterm birth [&lt;37 weeks' gestation], low birthweight [&lt;2500 g], and birth defects).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 632,565 live births identified from 2016 to 2021; birth mother beneficiary type was most frequently dependent spouse (78.0%, n = 493,183), followed by sponsor (17.3%, n = 109,293) and other (4.8%, n = 30,089). Overall, mean maternal age at delivery was 28.4 years; the majority of infants had sponsors who were married (89.3%, n = 564,999), non-Hispanic White (60.7%, n = 384,148), on active duty status (73.1%, n = 462,107), and of any enlisted rank (79.6%, n = 503,848). Most infants' sponsors deployed at least once before their birth (57.0%, n = 360,312), with a smaller proportion deployed during pregnancy (7.5%, n = 47,306). Births were more likely to occur at civilian versus military hospitals, and the proportion of births at civilian hospitals increased over the study period, from 61.6% in 2016 to 69.5% in 2021. Among all infants, 28.2% (n = 178,589) were delivered by cesarean, 7.3% (n = 45,940) were preterm, 5.2% (n = 32,605) were low birthweight, and 3.4% (n = 21,222) were diagnosed with a major structural birth defect in the first year of life; all of these outcomes were more likely to occur among civilian versus military hospital births.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Overall, BIHR data comprise a large number of live births with distinct parental demographic and exp","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic Incarceration of a Right Inguinal Hernia Due to a Deceleration Injury Following Airborne Operations: A Case Report.","authors":"Alec K Donohue, Elizabeth I Andersen, Adam Jared Kaplan","doi":"10.1093/milmed/usaf483","DOIUrl":"https://doi.org/10.1093/milmed/usaf483","url":null,"abstract":"<p><p>Anterior abdominal wall hernias are a common and well-described surgical pathology occurring in an estimated 5%-10% of the population. Here, we describe a patient found to have acute incarceration of omentum through a patent processus vaginalis (PPV) secondary to a high-energy deceleration injury following airborne operations. Many studies and meta-analyses have been performed to examine the association between occupational risk factors, patient factors, and precipitating events leading to acute hernia and found insufficient evidence to support a causal link between single strenuous events and acute hernia formation. This case underscores the need to consider occult inguinal hernia in high-energy trauma, particularly with a PPV, to enable timely diagnosis and intervention.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}