Military Medicine最新文献

{"title":"Exploring the Roles of Personality and Intellect in Completing U.S. Air Force Weather Technical Training.","authors":"Scott Deatherage, Robert Tett, Ivan A Colon Rivera, Songthip Ounpraseuth, Rachael N Martinez, Christopher King","doi":"10.1093/milmed/usaf257","DOIUrl":"https://doi.org/10.1093/milmed/usaf257","url":null,"abstract":"<p><p>Completion rate of military training programs is a commonly observed metric across the U.S. Air Force (USAF). Although Basic Military Training aims to identify recruits who possess the foundational elements for all Airmen, USAF technical school training programs aim to produce specialized and operations-ready Airmen. These training programs vary in duration and intensity to best simulate an operational environment and for Airmen to demonstrate the minimum competencies necessary for career progression within the respective USAF specialty. This study explored how intellectual aptitudes and personality tendencies differentiate between Airmen who are successful versus Airmen who are unsuccessful in completion of the weather specialist (1W0X1) technical training course. Results suggest that intellectual aptitudes and the addition of a narrow operationalization of personality traits were associated with higher performance. The challenge lies in making the analysis as precise as possible to gain a deeper understanding of the specific factors associated with optimal training results.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 Supplement_2","pages":"528-535"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125191","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":"Using Implementation Science to Improve the Adoption of Hearing Protector Fit Testing in the Department of Defense.","authors":"Sara Murphy, Hunter Taylor, Theresa Y Schulz","doi":"10.1093/milmed/usaf329","DOIUrl":"https://doi.org/10.1093/milmed/usaf329","url":null,"abstract":"<p><strong>Introduction: </strong>The Department of Defense (DoD) Hearing Conservation Program was established to prevent hearing loss from occupational and operational exposure and injury, as outlined in Department of Defense Instruction (DoDI) 6055.12. Updated November 22, 2023, DoDI 6055.12 now requires quantitative hearing protector fit testing (HPFT) to objectively measure the noise reduction hearing protection provided to an individual's ear. Although HPFT is recognized as an evidence-based best practice, it has not been widely adopted. An Implementation Science approach was applied to better understand the challenges associated with putting this new requirement into practice in the DoD.</p><p><strong>Materials and methods: </strong>A mixed methods approach was used, including 2 rounds of semi-structured interviews and a course evaluation survey. These instruments were developed to assess determinants (barriers and facilitators) and influence the implementation of HPFT training in the DoD. Responses informed training materials already in development.</p><p><strong>Results: </strong>Barriers identified through semi-structured interviews and course evaluation included: (1) difficulty determining target personal attenuation rating, (2) difficulty connecting HPFT systems to the network, (3) not having direct access to workers' noise exposure data, (4) space, (5) time, (6) equipment procurement, (7) stakeholder buy-in, and (8) inability to transfer HPFT data into the electronic medical record. Facilitators included evidence strength, ease of use, leadership buy-in, and appreciation from patients. This work prompted the development and refinement of HPFT training materials, including the creation of new resources (i.e., infographic and quick reference guide), simplification of terminology, and transfer of web-based training to a more user-friendly platform. Results suggested that web-based training, in conjunction with a practicum and user guide, is an effective model for teaching HPFT administration.</p><p><strong>Conclusions: </strong>These findings will influence the development of additional training materials and knowledge products to assist providers and others as they work to implement the new DoDI 6055.12 HPFT requirements.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 Supplement_2","pages":"767-776"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125221","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":"Characterization of Service Members and Veterans with Mild Traumatic Brain Injury Participating in the Department of Veterans Affairs Intensive Evaluation and Treatment Programs.","authors":"Jessica L Ryan, Hari H Venkatachalam, Daniel W Klyce, Jacob A Finn, Natalie M Gilmore, Aaron M Martin, Eric J Munger, Linda M Picon, Risa Nakase-Richardson, Alicia A Swan, Marc A Silva","doi":"10.1093/milmed/usaf159","DOIUrl":"https://doi.org/10.1093/milmed/usaf159","url":null,"abstract":"<p><strong>Introduction: </strong>Over 514,000 active duty Service Members (SMs) have sustained traumatic brain injuries (TBIs) since 2000, with mild TBI (mTBI) emerging as the signature injury of recent wars. Although many recover fully, some experience chronic mTBI with persistent symptoms such as headaches, memory issues, post-traumatic stress disorder (PTSD), chronic pain, depression, and cognitive impairment. The 2021 Department of Veterans Affairs (VA)/Department of Defense (DOD) clinical practice guidelines (CPGs) recommend symptom-focused treatment, addressing comorbid conditions, and supporting reintegration. Congress mandated specialized centers to provide comprehensive care, research, and rehabilitation for combat-injured Veterans and SMs (V/SMs) leading to the development of Intensive Evaluation and Treatment Programs (IETPs) at 5 VA Polytrauma Rehabilitation Centers offering interdisciplinary, individualized inpatient care. The IETPs integrate rehabilitation and specialty services for V/SMs with chronic mTBI and associated health issues.</p><p><strong>Objective: </strong>The study aimed to describe the IETPs and the participants it serves with chronic, multiple mTBI and comorbidities.</p><p><strong>Methods: </strong>Participants were V/SMs enrolled in the VA TBI Model Systems study and admitted to 1 of the 5 IETPs between 2009 and 2023. Inclusion criteria included TBI diagnosis, age ≥16, and consent for study participation. Data included demographics, military service characteristics, TBI history, and comorbidities. Injury data represented the index TBI qualifying participants for the study, although many had multiple TBIs. Measures included Functional Independence Measure, Disability Rating Scale, PTSD Checklist, and Neurobehavioral Symptom Inventory, among others.</p><p><strong>Results: </strong>There have been 821 IETP participants from the program start through 2023. Participants averaged 35.3 years at admission, were predominantly White, non-Hispanic, married men, and included active duty SMs, many from Special Operations Forces (74.2%).</p><p><strong>Discussion and conclusions: </strong>Our findings show the prevalence of participants with comorbidities at IETP admission. The 2021 VA/DOD CPGs caution against over-involvement of specialty care for mTBI but acknowledge that patients with persistent symptoms and comorbidities may benefit from specialized programs like IETPs. Chronic pain, sleep apnea, musculoskeletal issues, and hypertension were common among IETP participants, highlighting the need for intensive inpatient care to address dynamic and interactive symptoms. IETPs provide integrated treatment, removing external demands and offering opportunities for medication trials, interventions, and evidence-based therapies.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 Supplement_2","pages":"281-287"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124375","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":"Multidisciplinary Case Review Committee: Comprehensive Referral Source for Evaluation and Treatment of High-Risk Exertional Injuries Fostering Safe and Expeditious Return to Duty Decisions.","authors":"Francesca Cariello, Melissa Rittenhouse, Josh Kazman, Mark Haigney, M Alaric Franzos, Glen Cook, Jeffrey C Leggit, Francis G O'Connor","doi":"10.1093/milmed/usaf060","DOIUrl":"10.1093/milmed/usaf060","url":null,"abstract":"<p><strong>Introduction: </strong>Exertion-related injuries (ERIs) affect Service Members (SM) worldwide with a direct impact on force readiness. Recent evidence has identified that the diagnostic coding of heat-related clinical illnesses can be subjective and prone to errors. Furthermore, ERIs, often have complex presentations impacting multiple organ systems. Optimal management, including establishing the correct diagnosis and plan for return to duty or disability evaluation system referral, frequently requires the expertise of multiple clinical specialties.</p><p><strong>Materials and methods: </strong>This manuscript describes the function and process of the Consortium for Health and Military Performance (CHAMP) Multidisciplinary Case Review Committee (MDCRC), a multi-disciplinary clinical resource specifically focused on assisting clinicians with complex ERIs. To illustrate how the MDCRC works, we include methodology, and descriptive and inferential analysis of all MDCRC-referred cases.</p><p><strong>Results: </strong>The MDCRC has evaluated 205 SM with complex exertional illness presentations; exertional rhabdomyolysis (ER; 53%), exertional heat illness (34%), exertional collapse associated with sickle cell trait (ECAST; 5%), cardiomyopathy (6%), or other exertion-related conditions. Most SMs (72%) successfully returned to duty within 3 months, but there was a very wide range of duty restriction durations, especially for SM with ER (median: 3 months; interquartile range: 1, 8) and ECAST (median: 12; IQR: 3, 18). Duty restrictions were longer for younger SM (<26 vs ≥26 years: risk ratio [RR]: 1.49, 95% CI: 0.98, 2.29) and history of multiple ERIs (RR: 1.69; 95% CI: 1.07, 2.62).</p><p><strong>Conclusions: </strong>The MDCRC is a coordinated and comprehensive resource for all military health care practitioners and SM providing the most up-to-date evidence based clinical expertise for ERIs. MDCRC assists with proper diagnosis, facilitates expedited evaluations to optimize return to duty decisions, and increases SM readiness. MDCRC may be especially crucial for providers who have limited resources and experience in treating SM with ERIs.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e2220-e2226"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557265","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":"Sleep, Daytime Symptoms, and Healthcare Resource Utilization in Military Personnel with Comorbid Insomnia and Obstructive Sleep Apnea.","authors":"Connie L Thomas, Vincent F Capaldi, Jacob Collen, Zhiwei Zhao, Scott G Williams, Samson Z Assefa, Shuo Chen, Jennifer S Albrecht, Emerson M Wickwire","doi":"10.1093/milmed/usaf108","DOIUrl":"10.1093/milmed/usaf108","url":null,"abstract":"<p><strong>Introduction: </strong>Comorbid insomnia and obstructive sleep apnea (COMISA) are prevalent conditions with significant physical and mental health comorbidities. Our study sought to estimate the effect of COMISA vs. obstructive sleep apnea (OSA) alone on subjective and objective sleep, daytime symptoms including cognition, and healthcare resource utilization (HCRU) among military service members (SMs).</p><p><strong>Materials and methods: </strong>Military SMs (n = 201) completed research questionnaires and then an intensive 10-day remote monitoring assessment, including wearing a commercial sleep tracker, completing daily sleep diaries, and completing twice-daily symptom surveys via a mobile application. Subjective cognition was measured using 3 self-report items assessing memory, concentration, and executive function. Between-groups (COMISA vs. OSA) differences in subjective and objective sleep, daytime symptoms, and HCRU were examined using a series of one-way ANOVAs.</p><p><strong>Results: </strong>Compared to participants with OSA alone (n = 98; 48.8%), participants with COMISA (n = 81; 40.3%) demonstrated poorer subjective sleep and daytime symptoms as measured by traditional questionnaires (i.e., Epworth Sleepiness Scale and Insomnia Severity Index) and twice-daily symptom surveys, as well as increased HCRU. No between-groups differences were observed in objectively measured sleep.</p><p><strong>Conclusions: </strong>Among military SMs and relative to OSA alone, COMISA was associated with worsened subjective but not objective sleep, worsened daytime symptoms including cognition, and greater HCRU.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e2072-e2078"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772377","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":"Parental Mental Health Conditions and Infant Health Outcomes Among Military Families.","authors":"Anna T Bukowinski, Gia R Gumbs, Clinton Hall, Zeina G Khodr, Sabrina Richardson, Ava Marie S Conlin","doi":"10.1093/milmed/usaf069","DOIUrl":"10.1093/milmed/usaf069","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Little is known about the effects of parental mental health burdens during pregnancy on infant health among military families, who are subject to various stressors unique to military life. The present study leveraged infant data from the DoD Birth and Infant Health Research (BIHR) program and self-reported parental survey data from the Millennium Cohort Study (MCS) to examine associations of parental mental health conditions with adverse infant health outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Subjects included singleton infants captured in BIHR program data, born between July 2001 and December 2012, to MCS women and men who completed a baseline or follow-up survey from 1 year before pregnancy start through infant birth date. Survey assessment included mental health screenings and behavioral health measures (e.g., smoking and alcohol use). Mental health exposures included post-traumatic stress disorder, major depression, and panic/anxiety disorder and were assessed as \"any mental health condition\" (yes or no) and \"count of mental health conditions\" (0, 1, 2, or 3). Infant outcomes included birth defects, low birth weight, and preterm birth and were assessed individually and as a composite measure of \"any adverse outcome.\" Descriptive statistics were calculated for the maternal and the paternal study populations stratified by exposure status. Log-binomial models estimated risk ratios (RRs) and confidence intervals (CIs) for all outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 9489 infants born to MCS women, 1006 (10.6%) were born to women who screened positive for any mental health condition; 571 (6.0%), 268 (2.8%), and 167 (1.8%) were born to women who screened positive for 1, 2, and 3 mental health conditions, respectively. Of the 9377 of these infants included in analyses, 256 (2.7%) had a birth defect, 331 (3.5%) were low birth weight, and 596 (6.4%) were born preterm. Among 19,149 infants born to MCS men, 1433 (7.5%) were born to men who screened positive for any mental health condition; 838 (4.4%), 351 (1.8%), and 244 (1.3%) were born to men who screened positive for 1, 2, and 3 mental health conditions, respectively. Of the 18,983 of these infants included in analyses, 54 (2.8%) had a birth defect, 649 (3.4%) were low birth weight, and 1,359 (7.2%) were born preterm. Infants born to men or women who screened positive for all 3 mental health conditions vs. none exhibited elevated risk estimates for each individual infant outcome, but CIs included the null. Increased risk for any adverse infant outcome, however, was observed for women with all 3 mental health conditions (RR = 1.70, CI, 1.12-2.59), but not men (RR = 1.29, CI, 0.89-1.88).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Findings suggest an association between parental mental health and adverse infant health outcomes, particularly for maternal mental health. Future research would benefit from larger sample sizes to detect potentially small effect","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e2048-e2057"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616290","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":"Computed Tomography Scan Detection of Intra-Articular Air in the Ankle Joint: A Cadaveric Study.","authors":"J Scott Donoughe, Daniel Wido, Kyle Mombell, Bryce Lokey, Ben Wheatley, Andrew Hurvitz","doi":"10.1093/milmed/usaf114","DOIUrl":"10.1093/milmed/usaf114","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnosis of traumatic arthrotomy is often accomplished using the saline load test. The introduction of large volumes of saline into the joint is uncomfortable for the patient and has been reported to have low sensitivity and specificity. Computed tomography (CT) scan has been previously validated as a fast and reliable method of detecting free air in the knee joint. The primary objective of this study was to evaluate the use of CT scan for the detection of intra-articular free air in the ankle joint.</p><p><strong>Methods: </strong>Eighteen fresh-frozen cadaver distal lower extremities were thawed, and then CT scans were obtained at their baseline harvested state. The tibiotalar joint was injected with 0.05cc free air, and then repeat CT scans of each specimen were obtained. Specimens with instrumentation, intra-articular air, or ambiguous free air prior to intervention were excluded from the study. Scans were performed from the mid leg through the entire foot at institution standard radiation dose (120 kV, 170 mA) and a slice thickness of 0.6 mm. Images were anonymized, randomized, and sent to 4 reviewers (2 orthopedic surgeons, 1 musculoskeletal radiologist, and 1 radiology resident) for evaluation of free air. Sensitivity and specificity of CT to detect free air were calculated, and Fleiss's Kappa coefficient was used to determine interobserver reliability.</p><p><strong>Results: </strong>The sensitivity and specificity of CT to detect free air in cadaver ankles was 100%. Twenty-two CT scans (11 natural state and 11 with simulated air arthrotomies) were correctly identified for the presence or absence of intra-articular free air by all reviewers with kappa coefficient 1.0 (complete agreement).</p><p><strong>Conclusions: </strong>Computed tomography is a fast, reproducible method for detecting small volumes of free air in the ankle and may offer clinical benefit in evaluation of traumatic arthrotomy of the ankle.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1957-e1962"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788078","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":"Efficacy and Safety of Pulmonary Vein Isolation in Active Duty Military Members with Atrial Fibrillation.","authors":"Andrew S Wilson, Andrea N Keithler, Matthew A Tunzi, Kelvin N V Bush","doi":"10.1093/milmed/usaf112","DOIUrl":"10.1093/milmed/usaf112","url":null,"abstract":"<p><strong>Introduction: </strong>There is currently limited literature reviewing the role of atrial fibrillation (AF) catheter ablation in service members. This study aims to describe the efficacy and safety of AF catheter ablation in the active duty military population.</p><p><strong>Materials and methods: </strong>Military personnel with symptomatic AF who underwent ablation from 2004 to 2019 were analyzed in 4 age groups (group 1, n = 26, 18-27 years; group 2, n = 38, 28-37 years; group 3, n = 28, 38-49 years; group 4, n = 12, greater than or equal to 50 years). Primary endpoints were (1) AF control defined as no or rare AF recurrence (≤6 episodes) 3 months after last pulmonary vein isolation, and (2) procedure-related adverse events and complications.</p><p><strong>Results: </strong>A total of 104 personnel underwent 142 AF ablations with mean follow up of 55.8 ± 47 months. AF control was attained in 96.2% of group 1, 78.9% of group 2, 75.0% of group 3, and 66.7% of group 4 (P = .004). AF freedom was observed in 80.3% of group 1, 55.3% of group 2, 46.4% of group 3, 41.7% of group 4 (P = .02). Four (3.8%) complications occurred with none in the youngest group.</p><p><strong>Conclusions: </strong>AF catheter ablation is safe and most effective in younger military personnel and prospective studies are needed to confirm these findings.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1972-e1978"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972007","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":"Bedroom Sharing, Retention, and Mental Health Among Soldiers Living in U.S. Army Barracks.","authors":"Matthew R Beymer, Cheri L Roseberry, Kirsten M Anke, Christopher G Hill, Erin M Anderson Goodell, Melissa M Boyd, Esther J Pfau","doi":"10.1093/milmed/usaf133","DOIUrl":"10.1093/milmed/usaf133","url":null,"abstract":"<p><strong>Introduction: </strong>Little is known about the potential impact of shared versus private bedroom barracks configurations on the quality of life, retention, and mental health of enlisted Soldiers in the U.S. Army. The objective of the present study was to use a sample of enlisted U.S. Army Soldiers from five different installations to assess the differences in behavioral and social health outcomes between respondents in shared versus private bedroom configurations.</p><p><strong>Materials and methods: </strong>The unaccompanied housing survey was administered to unaccompanied housing (UH) barracks residents at 5 different U.S. Army installations from July to November 2022 (n = 8,703). The main risk factor of interest was bedroom sharing (shared versus private), and the main outcomes of interest were intentions to leave the military after the current enlistment period (intent to leave), quality of life, issues experienced with others while living in the barracks, insufficient sleep, and symptoms of depression, anxiety, and loneliness. Seven separate multivariable logistic regression models were used to evaluate the associations between bedroom sharing and the outcomes.</p><p><strong>Results: </strong>Sixty percent of UH respondents reported residing in a private bedroom and 40% reported sharing a bedroom. UH respondents who lived in shared bedrooms had higher adjusted odds of poorer quality of life (adjusted odds ratio [AOR]: 1.67; 95% confidence interval [CI]: 1.54-1.82) when compared to respondents in private bedrooms. Respondents who lived in shared bedrooms also had a higher adjusted odds of reporting issues with others while living in the barracks (AOR: 1.47; 95% CI: 1.33-1.63) compared to respondents in private bedrooms. The models analyzing the association between bedroom sharing and intentions to leave, sleep, anxiety, and loneliness were statistically significant, but the lower level of the CI demonstrated that the associations were not clinically meaningful. There was no statistically significant association between bedroom sharing and depression (AOR: 1.09; 95% CI: 0.98-1.22). There were no meaningful differences in the types of issues reported between those who lived in shared and private bedrooms.</p><p><strong>Conclusions: </strong>Bedroom sharing was associated with greater adverse behavioral and social health outcomes when compared to private bedrooms for a large sample of UH residents in the U.S. Army. Findings indicated private bedrooms may be more beneficial for quality of life, readiness, and reenlistment rates among Army Soldiers residing in the barracks. These findings should be used in the development of future studies aimed at assessing Soldier quality of life, as well as to inform Army Senior Leaders and decision makers during development of prevention and risk mitigation strategies and policies on barracks configurations.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e2079-e2086"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036033","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":"Fielding an Expeditionary Prolonged Casualty Care Kit: What We Carry Matters.","authors":"Zaiba Shafik Dawood, Marjorie R Liggett, Toby P Keeney-Bonthrone, Rachel M Russo, Jessie W Ho, Jennifer Gurney, Daniel C Couchenour, Joshua M Tobin, Walter Clark, Aleezeh Shaikh, Allyson Greenberg, Maxime A Visa, Hasan B Alam","doi":"10.1093/milmed/usaf129","DOIUrl":"10.1093/milmed/usaf129","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Prolonged Casualty Care (PCC) is an extension of Tactical Combat Casualty Care (TCCC), which provides prehospital care when evacuation is delayed and care is resource constrained and suboptimal. Current medical rucksacks are designed to maximize medical equipment, without sustainment items like food, clothing, and essential communication equipment. This leaves limited room for PCC expendable supplies and equipment to expand upon existing TCCC loadouts. The multi-day premise of PCC requires both extended medical and general survival items, for which existing medical kits are poorly suited and not optimized. In this study, we sought to systematically create a Prolonged Field Care Kit (PFAK) capable of providing field medics with medications and equipment adjuncts for PCC as well as a specialized long-range medical rucksack (LMR) to house the PFAK, TCCC, and sustainment items.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Baseline design elements from conventional rucksacks were obtained and modified to address known limitations. Initial prototypes for the PFAK and LMR were created. These were modified following informal discussions with various and multiple end users from both U.S. conventional and Special Operations Forces. Feedback regarding the second iteration prototype was obtained systematically through written surveys regarding strengths, weaknesses, and potential changes that could be made. Qualitative data were analyzed using MAXQDA software.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Using informal feedback, we deduced that the first PFAK prototype lacked internal compartmentalization and could not accommodate the volume of intravenous fluid needed for PCC. Moreover, the LMR was prone to damage by external factors such as rainwater. The second prototype addressed these flaws and written feedback was obtained from medics (n = 10), nurses (n = 11), and medical doctors (n = 3) on its applicability. Positive feedback received on the second prototype included daypack detachability, overall organization, versatility, and design of the LMR and PFAK. However, most survey participants felt that the LMR was too complex and that its heaviness could limit its field use. After the feedback obtained, the finalized PFAK weighed 18 pounds and had a volume of 30 L. The LMR containing the PFAK and other mixed sustainment and TCCC equipment has a length of 30 inches and weighs 110 pounds with all items intact.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;PCC will require thoughtful equipping to enable prehospital providers to manage multiple, potentially complex casualties; existing military medical backpacks are not currently optimized for this scenario. Our group created the first-of-its-kind PFAK, as well as the LMR to house it. The final prototypes of our LMR and PFAK are versatile, well organized, and significantly improve upon current backpack options for PCC. However, field testing and further improvement through qualitative analysis ar","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e2032-e2038"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275260","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}