Military Medicine最新文献

{"title":"Letter from the CEO Dr John Cho.","authors":"","doi":"10.1093/milmed/usae565","DOIUrl":"10.1093/milmed/usae565","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"59-61"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142951509","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":"Development and Evaluation of the Maintenance Office Duty Test: An Alternate Form of the Charge of Quarters Duty Test for Assessing Executive Function After Mild Traumatic Brain Injury to Inform Duty-Readiness After Concussion.","authors":"Mary Vining Radomski, Ginger Carroll, Leslie Davidson, Aaron Eakman, Kristina Kath, Rob Kreiger, Amy Meyers, Stacey Rabusch, Laurel Smith, Chris Tripp, Timothy Wolf","doi":"10.1093/milmed/usae391","DOIUrl":"10.1093/milmed/usae391","url":null,"abstract":"<p><strong>Introduction: </strong>After mild traumatic brain injury, service members may experience difficulty with executive functions, which could interfere with return to duty and life roles. Because performance-based multitasking assessments are sensitive to executive dysfunction, a team of military and civilian rehabilitation researchers developed the Charge of Quarters Duty Test (CQDT) to help inform duty readiness after concussion; it is a multitasking test based on a military task scenario that challenges executive functions, such as foresight and planning, set shifting, and prospective memory. Although previous study indicates that CQDT has reliability and known-groups validity, like other multitasking tests, it should not be readministered after rehabilitative care because of learning effects. The purpose of this study was to develop an alternate form of the CQDT and evaluate its equivalence to the CQDT.</p><p><strong>Materials and methods: </strong>A measurement development study was conducted in which subject matter experts on the study team used an iterative approach to create an alternate form. To evaluate equivalence, a repeated measures design was employed in which each participant performed one or both test versions twice and acted as their own control.</p><p><strong>Results: </strong>The study team created the Maintenance Office Duty Test (MODT), the alternate form of the CQDT. A convenience sample of 40 adults performed both the MODT and CQDT approximately 2 weeks apart; 4 had a history of military service and 16 had a history of acquired brain injury. We compared mean scores and standard deviations of each test's 4 subscores using matched-pair t-tests and found that scores were not statistically different, suggesting that the 2 tests are equivalent. In addition, matched-pair t-tests were used to compare Time 1 and Time 2 subscores when (1) participants performed the 2 test versions (CQDT and MODT) and (2) participants performed the same test twice. None of the differences in Time 1 and Time 2 subscores were statistically significant when participants performed the 2 test versions. However, when participants performed the same test twice, three of the four Time 1 and Time 2 scores were significantly different, with Time 2 reflecting improved performance and possible learning effects (performance accuracy P = .013; total number of rule breaks P = .015; performance time P = .002).</p><p><strong>Conclusions: </strong>The MODT appears to be an equivalent form of the CQDT that mitigates learning effects that often accompany performance of multitasking assessments. Having developed and validated the equivalence of the CDQT's alternate form, military rehabilitation clinicians have an expanded set of clinical tools by which to identify possible executive dysfunction and evaluate service members' response to rehabilitative care via pre- and post-rehabilitation testing after mild traumatic brain injury.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"601-608"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976089","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":"Heart Rate Variability in Military Pilots During Flight: A Scoping Review.","authors":"Amanda Brandello Farias Soares, Marcelo Furtado de Almeida, Emerson Franchini, Fabrícia Geralda Ferreira, Fábio Angioluci Diniz Campos","doi":"10.1093/milmed/usae390","DOIUrl":"10.1093/milmed/usae390","url":null,"abstract":"<p><strong>Introduction: </strong>Piloting an aircraft is a complex multitasking activity that involves managing information in a nonautomatic way and generates a high workload (psychological, cognitive, and physical) for the pilot. The excess of these demands can result in decreased performance and may impair flight safety. Heart rate variability (HRV) has been used in recent studies as a method to investigate operator's workload in complex environments. This measure can assess the stress and recovery ability of the autonomic nervous system. However, a better understanding of flight influence on the pilot's autonomic modulation is necessary. Therefore, this scoping review aims to systematically map the studies related to changes in the autonomic modulation in military pilots during flight, in order to characterize their workload at different times and flight profiles.</p><p><strong>Materials and methods: </strong>A literature search was conducted using MEDLINE (by PubMed), SCOPUS, and LILACS databases. Recent records (2002-2022) that analyzed HRV in military pilots during flight were included. Meanwhile, studies in which piloting activity was not performed were excluded. The study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline extension for Scoping Reviews and the Updated Methodological Guidance for the Conduct of Scoping Reviews.</p><p><strong>Results: </strong>A total of 298 records were obtained, of which 19 were included in the scoping review. The studies analyzed flights performed in high- and low-performance aircrafts, helicopters, and flight simulators, using time domain, frequency domain, and nonlinear HRV indices. Real and simulated flights produced significant autonomic changes. Some flights elicited autonomic nervous system responses that persisted up to 5 h after landing. During real flight, the most sensitive indices for identifying variations in pilot workload were root mean square of successive differences between normal heartbeats, standard deviation of interbeat interval of normal sinus beat (SDNN), ratio of low-frequency to high-frequency power, and Poincaré plot standard deviation perpendicular to the line of identity (SD1), whereas the interbeat interval (RR), SDNN, SD1, and Poincaré plot standard deviation along the line of identity (SD2) were the most sensitive indices when comparing segments of simulated flight with different levels of difficulty.</p><p><strong>Conclusions: </strong>This scoping review provided insight into the influence of flight on autonomic modulation in military pilots. Some key themes were highlighted: Increased sympathetic activity during flight, sensibility of different domains of HRV to flight demands, and autonomic changes during recovery time. Future research efforts may allow us to enhance the understanding of pilot's workload limits and to elucidate the optimal postflight recovery time.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e515-e522"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976090","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":"Considerations to Optimize Structurally Responsive Work Environments for U.S. Military Specialty Physicians.","authors":"Erin Tracy, Laura Tilley, Jeanne Patzkowski, Kathryn M Eliasen, Arlene Hudson, Krista B Highland","doi":"10.1093/milmed/usae395","DOIUrl":"10.1093/milmed/usae395","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Recruitment, training, and retention of wartime critical specialty physicians may be stymied by discrimination and abuse. It is unclear to what extent the US combat specialty physicians witness or experience discrimination and abuse, whether they or others intervene, and if they would subsequently discourage people from entering their field.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;The present study surveyed US active duty anesthesiologists, emergency medicine physicians, and orthopedic surgeons (N = 243; 21% response rate). A generalized linear model evaluated the extent to which gender, specialty, service, and number of witnessed/experienced negative/stigmatizing comment/event types were associated with burnout. A bootstrapped mediation analysis evaluated whether gender and burnout were mediated by the number of comment/event types.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The sample was majority non-Latine White (87%) and men (66%) with tri-service and specialty representation. The most commonly reported negative/stigmatizing comment/event types were related to pregnancy (62%) and parental leave (61%), followed by gender and assigned sex (42%), lactation (37%), and sexual harassment (35%). Of the respondents who witnessed/experienced such comments/events, self-intervention was reported after comments regarding lactation (43%), assigned sex and gender (42%), race and ethnicity (41%), pregnancy (41%), parental leave (37%), and sexual harassment (24%). Witnessing another person intervene was reported after sexual harassment (25%) and comments/events regarding race and ethnicity (24%), pregnancy (20%), assigned sex and gender (19%), lactation (19%), and parental leave (18%). Nonintervention was reported after comments/events related to parental leave (42%), pregnancy (38%), sexual harassment (26%), lactation (26%), assigned sex and gender (26%), and race and ethnicity (22%). Respondents reported moderate-to-high intervening likelihood, importance, and confidence. Respondents reporting neutral to extremely agree on prompts indicating that pregnant active duty physicians are trying to avoid deployment (P = .002) and expect special treatment that burdens the department (P = .007) were disproportionately men (36% and 38%, respectively) compared to women (14% and 18%, respectively). The highest proportion of neutral to extremely agree responses regarding discouraging specialty selection were reported in relation to transgender and gender diverse students (21%), followed by cisgender female students (18%); gay, lesbian, or bisexual+ students (17%); cisgender male students (13%); and racial and ethnic minoritized students (12%). In the primary model, the number of witnessed/experienced comment/event types was associated with greater burnout (0.13, 95% CI 0.06-0.20, P = .001), but women did not report significantly different levels of burnout than men (0.20, 95% CI -0.10 to 0.51, P = 0.20). The number of comment/event types m","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e744-e750"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036303","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":"Optimizing Soldier Counseling: Multi-Source, Mixed-Method Evaluation of a Developmental Counseling Training for Mid-Grade Level Leaders.","authors":"John Eric M Novosel-Lingat, Michelle A Kirk, Melissa C Coaxum, Pierre L Harris, Kourtney B Sappenfield, Will U Hertzman, Shardonnai T Sims, Yvonne S Allard, Susannah K Knust","doi":"10.1093/milmed/usae405","DOIUrl":"10.1093/milmed/usae405","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;In accordance with ADP 6-22-001 and ATP 6-22.1, counseling is the process routinely executed by Army leaders to develop, mentor, and coach subordinate Soldiers and Army civilians within their organization. When implemented effectively, the counseling process can be utilized to produce capable, resilient, and satisfied subordinates who are prepared and motivated to meet mission-essential responsibilities. Training opportunities that specifically focus on optimizing this key leader competence, particularly with non-commissioned officers, are limited. The Directorate of Prevention, Resilience and Readiness (Headquarters, Department of the Army, G-9) offers a specific training, the Counseling Enhancement Workshop, and requested an evaluation to determine the effectiveness of the current training and identify opportunities for improvement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A longitudinal 360-degree approach was deployed as a common multisource methodology intended to produce triangulated feedback from participants, as well as their subordinates and supervisors. Quantitative surveys and qualitative structured interviews were conducted. Performance psychology professional facilitators who train this workshop were also administered a questionnaire to capture instructional feedback. Measures include a knowledge assessment of the workshop content, Counseling Self-Efficacy Survey, as well as original measures related to the workshop experience. Completed written developmental counseling forms and observations from the evaluation team were also reviewed to ensure fidelity of the training implementation and delivery. The current study reports on survey responses from participants and facilitators.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Results suggested a strong and positive correlation between the pre- and post-workshop Counseling Self-Efficacy Scale. Because of a small sample size, data were analyzed as planned but interpreted with caution because of limited validity. There was a significant increase between the pre- and post-tests knowledge comprehension test scores. Facilitators reported confidence in teaching resilience skills, but not coaching Soldiers to apply those skills as part of the developmental counseling process.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The Army counseling process can be utilized to produce capable, resilient, and satisfied subordinates who are prepared and motivated to meet mission-essential responsibilities. Quantitative results on the content of the CEW present opportunities for meaningful training that increases leaders' confidence in delivering counseling sessions, as well as mastering specific skills that benefit the subordinate Soldier and improve unit health. Furthermore, performance psychology professionals provided feedback on focus areas to meet the instructional objective of the training more efficiently and effectively. Ultimately, the counseling process is considered the most impo","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e700-e707"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080875","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":"Rebound Hyperthermia in Exertional Heat Stroke.","authors":"Preston J DeHan, Shelley A Flores, Blair B Rhodehouse, Joseph J Kaplan, David W DeGroot","doi":"10.1093/milmed/usae393","DOIUrl":"10.1093/milmed/usae393","url":null,"abstract":"<p><p>Exertional heat stroke (EHS) is a life-threatening condition requiring rapid reversal of hyperthermia to prevent poor health outcomes. Current treatment protocols aim for a cooling rate of 0.15 C/min using various modalities. This case report details a 22-year-old male who, despite initial successful cooling measures, experienced rebound hyperthermia, necessitating the use of endovascular cooling (EVC). The patient collapsed during a 19.3 km (12-mile) ruck march in Fort Moore, Georgia, with an initial core temperature of 41.6ºC. Conventional cooling methods, including ice sheets and chilled intravenous saline, adequately cooled the patient to target temperatures; however, discontinuation of cooling methods resulted in rebound hyperthermia. Endovascular cooling was eventually initiated, resulting in euthermia after 36 hours of continued use. During his hospital admission, the patient was evaluated thoroughly for underlying etiologies contributing to his rebound hyperthermia. This workup did not yield any concerning pathology, except for bilateral foot cellulitis noted on physical examination, which was subsequently managed with antibiotics. Despite initial complications, the patient recovered within 5 days and returned to duty after 2 months. Several case reports have been published regarding the use of EVC in the management of EHS. These reports, however, describe its use in initial management of EHS or in cases where hyperthermia was refractory to other conventional cooling methods. To our knowledge, this is the first report of its kind highlighting its successful implementation in rebound hyperthermia. Early recognition and initiation of cooling measures are critical in EHS cases. Future directions include developing EHS-specific EVC protocols for patients experiencing refractory or rebound hyperthermia.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e881-e885"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109390","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":"Correction To: Identifying Improvements in Treating Extremity Musculoskeletal Injuries During Prolonged Care.","authors":"","doi":"10.1093/milmed/usae495","DOIUrl":"10.1093/milmed/usae495","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e900"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469925","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":"Utilizing And If I Perish: Frontline U.S. Army Nurses in World War II to Examine Past, Present, and Future Military Nursing Readiness: A Thematic Analysis.","authors":"Angela B Samosorn, Tonya Y White, Christine G Leyden","doi":"10.1093/milmed/usaf052","DOIUrl":"https://doi.org/10.1093/milmed/usaf052","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;In the last 2 decades of counterinsurgency operations in Iraq and Afghanistan, the United States experienced its lowest number of battlefield casualties. Although lessons learned in recent counterinsurgency operations may be relevant for large-scale combat operations (LSCO), it is prudent to revisit the lessons learned from LSCO of World War II medical personnel. This project explored the perceptions and experiences of present-day military nurses to understand readiness as it relates to future LSCO through the historical lens of military nurses' experiences serving in World War II, as told in And If I Perish: Frontline U.S. Army Nurses in World War II.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This project was determined exempt from an institutional review board. A panel discussion examined the parallels of past, present, and future readiness considerations for military nurses preparing for LSCO. A panel of 6 military nurses discussed the book and their own experiences as military nurses. Because the dataset consisted of a single interaction between the authors and panel members, thematic analysis was used to examine the panel discussion transcript. Initial coding framework was supported by prominent themes relating to readiness found throughout the book (Table 1).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Additional coding identified 8 patterns (Table 2). Three key themes emerged: (1) there is a mismatch between the concept and the operationalization of readiness, (2) nurses require digital and data literacy for integrating medical support technology, and (3) mindset must be recognized as a skillset.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Training and decision-making in well-resourced environments do not always translate to performance in austere environments. The autonomy, and teamwork, of nurses in deployed environments can be greater than executing similar work within a medical treatment facility. Military nursing leaders should seek to determine if the needs of individual nurses are the same in a resource-rich environment versus an austere environment, which could impact readiness. Further, the lack of comparable combat-like injury exposure in the medical treatment facility hinders readiness. Additionally, the intersection of health care, tactics, and cyber advances in warfare place technology at the forefront of the battlefield. Information is a commodity and those who can receive, rapidly interpret, and utilize data for action will have a greater potential of success. However, digital and data literacy are not tracked as metrics for readiness. Finally, the neuroplasticity of the brain fosters cognitive growth, and challenging multiple assumptions of knowledge, skills, and attributes (KSA) could be beneficial for military nurses. The military is accustomed to thinking about performance and readiness from a KSA standpoint, creating a solid foundation for the inclusion of theoretical models, such as cognitive readiness","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557296","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":"Uniformed Medical Student Perspectives About Mental Health: Thematic Analysis of Written Reflections.","authors":"Aubrey G Parker, Lianne M Marquez, Lisa Cruz, Virginia Randall, Jeffrey L Goodie, Jeanmarie B Rey","doi":"10.1093/milmed/usaf053","DOIUrl":"https://doi.org/10.1093/milmed/usaf053","url":null,"abstract":"<p><strong>Introduction: </strong>Medical students, including uniformed medical students, are at greater risk of depression, anxiety, and burnout compared to their age-matched peers, yet relatively few medical students choose to seek help from mental health professionals. This study aimed to evaluate medical students' reflective writings to identify common themes and attitudes around mental health-for both the medical students themselves and how they view their future patients.</p><p><strong>Materials and methods: </strong>Written reflections on the topic of mental health were completed during a required pre-clerkship reflective practice course. Third- and fourth-year medical students were asked whether the reflections they had completed could be used for analysis. Qualitative analyses were conducted to identify themes. The study was deemed exempt by the USU Institutional Review Board.</p><p><strong>Results: </strong>Written reflections from 50 uniformed medical students were reviewed. Four themes were identified: Mental health is health, caring for the caregiver, defining bias, and mental health and the mission.</p><p><strong>Conclusions: </strong>Written reflection created an opportunity for medical students to discover their own perspectives on mental health and potential barriers to accessing mental health care. Medical schools should seek opportunities to incorporate reflective writing into the curriculum.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557286","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":"Neonatal Intensive Care Outcomes in the Military Health System: Comparison of Military and Civilian Hospital Births.","authors":"Thornton S Mu, Celeste J Romano, Clinton Hall, Gia R Gumbs, Ava Marie S Conlin, Rasheda J Vereen, JoAnna K Leyenaar, David C Goodman","doi":"10.1093/milmed/usaf043","DOIUrl":"https://doi.org/10.1093/milmed/usaf043","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Military Health System (MHS)-insured newborns receive care in military and civilian hospitals. Differences in delivery location and corresponding payment schemas raise questions regarding possible health system effects on utilization and outcomes. We hypothesize that newborn utilization and clinical outcomes differ between military and civilian hospitals and that the differences may be more pronounced among lower risk newborns (i.e., late preterm and non-preterm infants).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;The newborn cohort comprised live births captured in DoD Birth and Infant Health Research program data from October 2015 through December 2020. Population characteristics, hospital measures, and newborn clinical outcomes were examined using administrative medical data. Descriptive statistics for birth hospitalization and post-discharge events were calculated by the birth hospital (military or civilian) and gestational age cohort (very preterm, 23-31 weeks; moderate preterm, 32-33 weeks; late preterm, 34-36 weeks; and non-preterm ≥37 weeks). Risk-adjusted Poisson regression models compared select birth hospitalization events by birth hospital type, accounting for differences in the newborn population with regard to predicted mortality and diagnoses/procedures associated with the use of special care. Adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) were stratified by gestational age cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 470,175 singleton live births were included, and the majority of births occurred at civilian vs. military hospitals (63.2% vs. 36.8%), with civilian hospitals caring for a higher percentage of preterm infants (7.2% vs. 5.4%). The use of ancillary imaging studies was higher across all gestational age cohorts at civilian hospitals, whereas hospital admission or an emergency room visit within 30 and 90 days of discharge from the birth hospitalization was more likely to occur among infants born at military hospitals. Compared with newborns born at military hospitals, late preterm and non-preterm infants born at civilian hospitals demonstrated an increased risk for longer birth hospitalizations (late preterm aRR = 1.21, 95% CI, 1.17-1.25; non-preterm aRR = 1.04, 95% CI, 1.03-1.05), more special care days (late preterm: aRR = 1.38, 95% CI, 1.31-1.45; non-preterm: aRR = 1.22, 95% CI, 1.17-1.28), and neonatal intensive care unit admission (late preterm: aRR = 1.31, 95% CI, 1.27-1.35; non-preterm: aRR = 1.42, 95% CI, 1.38-1.45); differences were not observed for very and moderate preterm infants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this study of MHS-insured newborns, we observed longer lengths of stay, more special care days, and increased neonatal intensive care unit admissions among late preterm and non-preterm infants born at civilian vs. military hospitals. Across all gestational age cohorts, we observed lower rates of ancillary imaging studies and higher rates of ","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492767","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}