Military Medicine最新文献

{"title":"Effects of Sleep Extension on Cognitive Performance in Military-Aged Adults: A Systematic Review.","authors":"Bryan K Yu, Talia R Barrow, Elaina J DaLomba, Brian T Gregg, Maria L Barefield, Carly R Cooper","doi":"10.1093/milmed/usaf147","DOIUrl":"https://doi.org/10.1093/milmed/usaf147","url":null,"abstract":"<p><strong>Introduction: </strong>U.S. military service members (SM) rarely achieve enough sleep. Insufficient sleep in this population has been associated with deterioration of adequate cognitive performance necessary for combat effectiveness. Sleep extension is a strategy proposed by the military to counteract the effects of insufficient sleep. No systematic review exists that explores sleep extension's effects on cognitive performance in military-aged adults. The purpose of this study was to systematically review the literature and present evidence for the impact of sleep extension on cognitive performance in military-aged adults.</p><p><strong>Materials and methods: </strong>The reviewers searched EBSCOhost, PsychINFO, and PubMED databases for articles published between 2002 and 2022.The database search resulted in a total of 1,950 articles. Duplication removal and application of exclusion criteria to study titles eliminated 1,741 articles. Of the remaining 209 articles, screening for eligibility using inclusion and exclusion criteria removed 198 articles, resulting in 9 articles for the systematic review. The authors independently assessed the quality of each study's methodological rigor using a 24-item critical appraisal tool.</p><p><strong>Results: </strong>Of the 9 studies included for review, most employed randomized cross-over or randomized control research designs (7/9), and were of moderate quality (8/9). The studies investigated the effects of sleep extension on various domains of cognitive performance and its effect on sleep deprivation or restriction. Reviewed articles revealed that sleep extension had positive effects on sustained attention and reaction time but no beneficial effects on executive functions. Beneficial effects of sleep extension were evident but short-lived in canceling sleep debt or protecting cognitive performance from sleep debt. It is possible that the relatively short-lived benefits of sleep extension found in these studies could have been attributable to pre-existing sleep debt and that perhaps the amount of sleep extension provided was insufficient to overcome or pay-off such debt.</p><p><strong>Conclusions: </strong>This review does not support the use of sleep extension as a sole intervention to mitigate cognitive performance deficits following occurrence of sleep debt for military-aged adults. Future research focused on examining the cognitive effects of sleep extension should include sleep-satiated SMs and account for the unique operational context in which SMs sleep, during the study design.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 Supplement_2","pages":"210-218"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125108","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 Veteran Military Occupational and Environmental Exposure Assessment Tool, Phase III Enhancements.","authors":"Calvin Lu, Patricia Stewart, Charity Breneman, Robert Forsten, Michelle Prisco, Jose Ortiz, Kamila Pollin, Immanuel Samuel, Michelle Costanzo, Sherri Tschida, Thomas Chacko, Ryan Brewster, Lily Reck, Owen Killy, Jeremy Chester, Kyle Pietro, Jennifer Rusiecki, John Charles Lacson, Matthew Reinhard, John Barrett","doi":"10.1093/milmed/usaf293","DOIUrl":"https://doi.org/10.1093/milmed/usaf293","url":null,"abstract":"<p><strong>Introduction: </strong>Service Members often face complex and potentially toxic exposures during their service. Currently, no comprehensive and validated tools exist to cover the full range of military environmental and occupational exposures. To address this gap, the Washington D.C. War Related Illness and Injury Study Center developed the Veteran Military Occupational and Environmental Exposure Assessment Tool (VMOAT) through a 4-phase program, creating a robust survey for clinical use and research.</p><p><strong>Materials and methods: </strong>Following the Phase II pilot VMOAT, Phase III improvements involved a panel of 17 experts in military occupational and environmental medicine. The team reviewed findings from the pilot VMOAT focus group, applied cognitive theory principles, and integrated extensive exposure literature to identify additional stressors. They also evaluated potential sources of survey bias to enhance reliability.</p><p><strong>Results: </strong>Enhancements in Phase III included improving readability and question clarity, optimizing the survey user interface, restructuring and integrating exposure stressors, refining exposure data capture elements, separating health concern questions from exposure reporting to minimize bias, and establishing data structuring to support robust exposure metrics and analyses.</p><p><strong>Conclusion: </strong>The VMOAT enhancements support Department of Defense and Veterans Administration efforts to better understand and improve care for Service Members and veterans by addressing military occupational and environmental exposures systematically. The VMOAT can be used as a self-reported evaluation tool, either independently or supplemented with additional clinical assessments and exposure information. It has significant potential to provide valuable data for occupational and environmental exposure clinical evaluations and research, contributing to improved health outcomes for veterans.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 Supplement_2","pages":"649-655"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125114","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":"Knee Torque and Gait Performance in Veteran Amputees: Biomechanical Insights Into Intact Limb Injury Risk.","authors":"Jose M Frias-Bocanegra, Natalie L Egginton, Daniel T Fong, Patrick C Wheeler, Tom Blankenstein, Mark P Lewis, Alexander Bennett, David J Williams, Sarah A Stapley","doi":"10.1093/milmed/usaf211","DOIUrl":"https://doi.org/10.1093/milmed/usaf211","url":null,"abstract":"<p><p>New recovery pathways to improve and sustain strength and functional outcomes in the veteran amputee population are required to reduce the onset of comorbidities with aging. To date, no comprehensive study has quantified key gait parameters with clinically applied tests and measured lower limb strength in this cohort and their relationship to potential indicators of onset of musculoskeletal (MSK) injuries. This study fills this gap. ADVANCE Study cohorts of unilateral transtibial (UTT; n = 12) and unilateral transfemoral (UTF; n = 10) veteran amputees were matched to military able-bodied controls (n = 10). Participants were tested using 3D motion capture system and force plates permitting analysis of the spatial-temporal intact knee joint kinetic parameters during a 6-minute walking test. An isokinetic dynamometer measured peak knee extension/flexion isometric torque and Hamstring:Quadriceps (H:Q) ratio. UTT amputees displayed a H:Q torque ratio below recommended, an imbalance that may alter their gait functionality within their intact limb. The intact knee extension-flexion torques across the cohorts did not display significant differences, suggesting the extensive military rehabilitation outcomes remained successful 12.5 years post injury. Six-minute walk test (6MWT) analysis demonstrated a similar walking speed and total distance covered between controls and UTT amputees. However, significantly lower values were found for UTF amputees. Ground reaction forces during weight acceptance on the intact side showed no significant differences between cohorts. However, at mid-support and push-off both injured cohorts displayed significantly greater forces in the last 30 s of the 6MWT, indicating kinetic asymmetries. The literature suggests that such differences may indicate unhealthy knee joints. This biomechanical study suggests that the U.K. veteran population conserved exceptional strength levels in their intact limb. However, submaximal exercises representing activities of daily living revealed focus for improvement in amputee gait. This highlights that individualized rehabilitation protocols and tools concentrating on prolonging patient quality of life may delay the early onset of MSK comorbidities.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 Supplement_2","pages":"437-446"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125144","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":"Adapting Human Trauma Injury Coding System for Use With Military Working Dogs to Aid in Canine Body Armor Development.","authors":"Hailey Harroun-White, Kathryn Loftis, Kelly Mann, Jan Price, Autumn Kulaga-Engoren, Matthew Meuli, Claire Tucker, Kelly Hall","doi":"10.1093/milmed/usaf048","DOIUrl":"https://doi.org/10.1093/milmed/usaf048","url":null,"abstract":"<p><strong>Introduction: </strong>The Abbreviated Injury Scale (AIS) is a globally recognized system for classifying human trauma injuries based on anatomical location and severity of injury. It is currently used by the U.S. Military to study combat injuries and develop materiel improvements. No equivalent system exists for scoring canine trauma injuries. A canine-specific AIS will enable the detailed analysis required to develop effective body armor systems for military working dogs (MWDs) and bridge the gap between historic animal tests and mission-focused MWD injury risk mitigation strategies.</p><p><strong>Materials and methods: </strong>An interdisciplinary team edited the 2015 AIS dictionary of 2,006 codes to account for anatomical and physiological differences between the human and canine species. The team then assigned severity scores to each code using published research and clinical expertise.</p><p><strong>Results: </strong>Veterinary adaptation of the human AIS dictionary containing 2,006 codes resulted in an MWD-relevant dictionary consisting of 1,477 codes. Major changes included translation to quadrupedal directional terms, addition of the tail, revision of blood loss parameters, diagnostic criteria for head trauma, and considerations for the limited use of advanced imaging in veterinary medicine.</p><p><strong>Conclusions: </strong>The Veterinary Abbreviated Injury Scale is the first coding system in veterinary medicine based on the anatomical structure and severity of anatomical damage. Integration of the Veterinary Abbreviated Injury Scale into the Joint Trauma System's Military Working Dog Trauma Registry will provide the necessary granularity to address common combat injury patterns with advanced protective materiel solutions.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 Supplement_2","pages":"20-25"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125147","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":"Vection Measured During the 2023 Military Health Service Research Symposium Using a Virtual Reality Headset.","authors":"Leonard A Temme, Ryan Nagy, Kevin Andres, Isaiah Persson","doi":"10.1093/milmed/usaf209","DOIUrl":"https://doi.org/10.1093/milmed/usaf209","url":null,"abstract":"<p><strong>Introduction: </strong>Vection, a stationary individual's illusion of self-motion, is a form of spatial disorientation (SD) typically provoked visually. In aviation, SD is a failure to correctly sense one's position, motion, and/or attitude in relation to the earth's surface and its gravitational vertical. The Virtual Reality Vection System (VRVS) induces vection with visual virtual reality (VR) technology. During MHSRS 2023, USAARL demonstrated the VRVS at its Command Booth, which included an approved, exempt protocol to conduct a vection experiment on site. This exploratory study is reported here.</p><p><strong>Materials and methods: </strong>The Vive Pro Eye VR headset presented the computer-controlled vection stimuli. Each trial included 2 45-second frames of moving black dots separated by a 15-second blank field. Frame 1 presented 250 randomly spaced dots moving uniformly to the right at 40°/second, illustrating the 100% vection perception. Frame 2 also presented 250 dots moving at 40°/second, but the number of uniformly moving dots was randomly selected from the set {0, 50, 100, 150, 200, 250} while the complement number of dots moved randomly. Data collected were vection duration and magnitude experienced during Frame 2 relative to the 100% Frame 1 vection percept. The subject's button press (BP) and linear potentiometer (LP) settings registered the vection duration and magnitude, respectively.</p><p><strong>Results: </strong>Average BP and LP values were systematically dependent on the number of uniformly moving dots, increasing from 0 to 50 and then to 100 dots, then remaining relatively constant to 200 dots, then further increased with 250 dots, thus demonstrating a systematic psychophysical dependence of vection on quantifiable stimulus motion characteristics.</p><p><strong>Discussion and conclusion: </strong>The VRVS successfully used consumer-grade VR technology to execute a quantitative psychophysical pilot study of vection under the uncontrolled conditions of the MHSRS Exhibit Hall. Virtual reality technology can be expected to play an increasing role in supporting research designed for computer-controlled studies at remote sites.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 Supplement_2","pages":"424-430"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125238","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 Military Working Dog Records to Assist With Exposure-Informed Care.","authors":"Justin G Bergeron, Elizabeth Heitz, Sharon Daye, Elise LaDouceur, Julie Fitzgerald, Terra D Vincent-Hall","doi":"10.1093/milmed/usaf179","DOIUrl":"https://doi.org/10.1093/milmed/usaf179","url":null,"abstract":"<p><strong>Introduction: </strong>Military working dogs (MWDs) are deployed to and work in the same environments as Service members and, therefore, are exposed to the same hazards. To better understand the potential consequences of military-related exposures on health, the Exposure Science Program, Department of Veterans Affairs partnered with Army Veterinary Services and the Joint Pathology Center to create the Deceased MWD Database (DMWDD). This database includes all MWDs that had completed veterinary records from January 1991 onward, with demographics, deployment information, and pathology findings of 2,922 MWDs.</p><p><strong>Materials and methods: </strong>The DMWDD was searched for records completed between September 11, 2001, and May 18, 2023, with at least one confirmed deployment to Afghanistan (n = 303). Information from these MWDs was collated, including primary pathologic diagnoses and neoplasia in organs, such as lungs, kidneys, brain, pancreas, and liver. Odds ratios (ORs) were calculated comparing Afghanistan-deployed MWDs with MWDs with no history of OCONUS deployments or permanent duty stations that died during the study period (n = 621).</p><p><strong>Results: </strong>Military working dogs that deployed to Afghanistan had 1.55 times the odds of having neoplasia as their primary diagnosis at necropsy versus MWDs that did not leave the United States (95% CI: 1.11, 2.16) in fully adjusted models. Additionally, Afghanistan-deployed MWDs had 1.60 times the odds of having metastatic neoplasia (95% CI: 1.11, 2.30) in their primary diagnosis. At the organ level, Afghanistan-deployed MWDs had increased odds for neoplasia in the liver (OR = 1.87, 95% CI: 1.17, 2.98), lungs (OR = 2.26, 95% CI: 1.43, 3.57), prostate (OR = 3.03, 95% CI: 1.28, 7.20), and pancreas (OR = 3.48, 95% CI: 1.41, 8.60).</p><p><strong>Conclusions: </strong>The current analysis indicates a possible association between deployment to Afghanistan and increased odds of neoplasia in MWDs. These findings are consistent with certain presumptive cancers defined in the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act related to deployments supporting the recent conflicts. Additionally, increased odds were noted for prostate cancer in dogs that deployed to Afghanistan, which may represent an additional condition for which Veterans who deployed to this location should be surveilled since it is not currently service-connected. The DMWDD data will be further interrogated to identify other potential adverse health outcomes for specific service locations, both CONUS and OCONUS. Identifying adverse health outcomes early is of paramount concern, and the DMWDD will generate hypotheses that can direct future research into the long-term health of military cohorts.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 Supplement_2","pages":"320-326"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125244","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":"A Framework for Advancing Burn Assessment With Artificial Intelligence.","authors":"Md Masudur Rahman, Mohamed E L Masry, Surya C Gnyawali, Yexiang Xue, Gayle Gordillo, Juan P Wachs","doi":"10.1093/milmed/usaf198","DOIUrl":"10.1093/milmed/usaf198","url":null,"abstract":"<p><strong>Introduction: </strong>Burn injuries are a significant challenge in clinical and military settings, requiring accurate and timely assessment to guide treatment. Traditional methods for determining burn depth, a key factor in severity, rely heavily on subjective evaluation, leading to variability and delays in decision-making. Advances in Artificial Intelligence (AI) offer solutions to improve diagnostic accuracy and standardization. This study aims to evaluate the diagnostic performance of an AI model for burn depth assessment by comparing its outputs against a gold standard-focusing on image-based diagnosis of burn type and depth.</p><p><strong>Materials and methods: </strong>This study analyzed 29 burn patients, under an Institutional Review Board-approved protocol (IRB# 12,689) at the Eskenazi Burn Center, Indianapolis. Digital images of burns were collected and classified into 3 burn depth categories: first-degree, second-degree, and third-degree. The AI model was fine-tuned on 131 annotated digital images, augmented to 1,200 using techniques such as rotation, flipping, and brightness adjustment. Style transfer using a machine learning models (called GAN) was used to further enhance the dataset by simulating burn variations. Zero-shot (meaning no previous training) segmentation, employing pretrained foundation models, was used to localize burn regions without task-specific training.</p><p><strong>Results: </strong>The proposed AI prediction model achieved 79% accuracy in classifying 3 burn depth categories. Data augmentation improved performance, while segmentation demonstrated strong utility, particularly in identifying burn regions effectively in diverse scenarios. Style transfer augmented the dataset by simulating realistic burn appearances, further enhancing model robustness. Zero-shot segmentation, meaning it identified burn areas without any prior training on similar images, successfully localized burn regions, aligning with clinical expectations.</p><p><strong>Conclusions: </strong>This study highlights the potential of AI in improving burn depth classification and segmentation. The results demonstrate that integrating AI-driven models into clinical care can enhance diagnostic accuracy, efficiency, and scalability, offering transformative tools for clinical and military applications in burn care. These methods provide a foundation for automated and standardized burn assessment, improving outcomes across diverse settings.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 Supplement_2","pages":"387-393"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discovery of Respiratory Pathogens in People Living With HIV in the African Cohort Study.","authors":"Tao Li, Matthew A Conte, Jaykumar Gandhi, Michael Panciera, Neha Shah, Duff Emma, Jonah Maswai, Heather L Friberg, Natalie D Collins, Julie Ake, Jun Hang","doi":"10.1093/milmed/usaf180","DOIUrl":"10.1093/milmed/usaf180","url":null,"abstract":"<p><strong>Introduction: </strong>Respiratory infection outbreaks pose a threat to the readiness of the United States and allied armed forces. Predicting and preventing such outbreaks requires understanding of the epidemiology of potential respiratory pathogens in communities where service members live and work. We conducted pan-viral surveillance of respiratory specimens from people living with HIV or without HIV but under the risk enrolled in the U.S. Military HIV Research Program's African Cohort Study to determine the prevalence and possible clinical presentation of viruses in this population.</p><p><strong>Methods: </strong>The African Cohort Study is an open-ended prospective cohort study that enrolls people with and without HIV aged ≥15 years at 12 clinical sites in Kenya, Tanzania, Uganda, and Nigeria. The study follows participants every 6 months and collects social, demographic, clinical, and laboratory data. A total of 131 respiratory samples, collected from March 2022 to February 2023 from participants in South Rift Valley Province, Kenya, who had symptoms of respiratory illness or a positive COVID-19 test, were analyzed using a pan-viral hybridization metagenomic next-generation sequencing approach. Libraries were sequenced on the Illumina Next-generation Sequencing System NovaSeq 6000. Sample data were run through several pathogen discovery pipelines.</p><p><strong>Results: </strong>Full genome and partial genome sequences were assembled for several respiratory viruses including SARS-CoV-2, human coronavirus HKU1, human adenovirus 62, human metapneumovirus, human mastadenovirus B (coinfection with SARS-CoV-2), human mastadenovirus C (coinfection with SARS-CoV-2), and human parechovirus 3 (coinfection with adenovirus 62). The results showed that SARS-CoV-2 lineages correspond with lineages circulating during March 2022 to February 2023 and revealed additional viral respiratory pathogens and viruses known to be associated with HIV.</p><p><strong>Conclusions: </strong>These preliminary results suggest that continued genomic surveillance efforts are needed for data-driven decisions on force health protection, prevention of emerging respiratory infections, and mitigation of impacts on military readiness caused by infectious diseases.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 Supplement_2","pages":"327-332"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updates in Human Papillomavirus Vaccination to Improve Medical Readiness in Active Duty Service Members.","authors":"Erica R Hope, Zachary A Kopelman, Kathleen M Darcy, Emily R Penick","doi":"10.1093/milmed/usae559","DOIUrl":"10.1093/milmed/usae559","url":null,"abstract":"<p><p>Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and is associated with the development of genital warts, precancerous lesions, and cancers of the oropharynx, anus, penis, vulva, vagina, and cervix. HPV-associated diseases are preventable through vaccination. An Australian nationwide vaccination program will effectively eliminate cervical cancer as a public health concern by the year 2035. Despite safety and efficacy data, vaccination against HPV is not mandatory for military service members. Active duty service women are more likely to test positive for HPV when compared to dependents, and veterans diagnosed with HPV-associated cancers have higher health care resource utilization and costs. Even if a patient has a prior HPV infection, vaccination at the time of HPV diagnosis or following treatment can reduce recurrence of HPV and dysplasia. In addition, patients with a history of cancer have a higher incidence of secondary HPV-associated malignancies and should be offered vaccination or re-vaccination if they received a hematopoietic stem-cell transplant. Improving HPV vaccination rates within the military health system requires a multidisciplinary approach. Providers should use every opportunity to recommend HPV vaccination, including recommending HPV vaccines for individuals who do not have a record of HPV vaccination. The electronic health record can be utilized to generate prompts for vaccine reminders, and clinics should stock HPV vaccines to allow for easy administration. Additionally, adoption of an opt-out policy for HPV vaccines rather than mandatory vaccination may be an acceptable alternative to increase HPV vaccination while allowing active duty service members to retain autonomy.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"238-242"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864826","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":"Hypopituitarism Screening in Patients with Traumatic Brain Injury in the Primary Care Setting at the Minneapolis Veterans Affairs Health Care System.","authors":"Ammar Ahmed, Sindhura Inkollu, Aditya Chauhan, Anders Westanmo, Nacide Ercan-Fang, Shalamar Sibley","doi":"10.1093/milmed/usae563","DOIUrl":"10.1093/milmed/usae563","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic brain injury (TBI) is a significant health issue among veterans and poses a substantial risk for pituitary injury. Consensus guidelines recommend that patients who have sustained a TBI should undergo a baseline pituitary hormonal evaluation after the primary brain insult. Patients with abnormal screening test results or with symptoms of hypopituitarism should be referred to endocrinology for a full assessment. Currently, there are no reported data on the screening rates of hypopituitarism in veterans with TBI. This pilot study was conducted to determine the frequency of screening for hypopituitarism in veterans with TBI in a primary care clinic setting.</p><p><strong>Materials and methods: </strong>We conducted a single-center retrospective cohort study of patients with a diagnosis of TBI who were seen by their primary care physicians at the Minneapolis Veteran Affairs Health Care System over a 1-year period. A random sample was generated using computerized random generator software of patient data, including demographics, TBI-related information, and pituitary hormone levels, which were collected from the panel of primary care providers. We used 2 sets of screening criteria, one by Ghigo et al. published in 2005, and the second by Tan et al. published in 2017, to define hypopituitarism screening adequacy in our cohort of TBI patients. Institutional Review Board approval was obtained.</p><p><strong>Results: </strong>None of the 50 patients who met the criteria for screening based on the 2005 recommendations were screened for hypopituitarism. Only 2 of the 26 patients who met the criteria for screening based on the more recent 2017 recommendations were screened for hypopituitarism.</p><p><strong>Conclusion: </strong>We report that the screening rate for hypopituitarism in TBI patients is exceedingly low in the primary care setting, even with the less rigorous newer screening recommendations. Measures should be taken to improve screening of hypopituitarism to decrease morbidity and improve the quality of life in patients with a history of TBI.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1792-e1798"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024097","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}