RESUMEN
The Department of Defense Hearing Conservation Program provides specific guidance for service components to prevent occupational hearing loss; however, it does not specifically contend with the unique noise exposures observed in the theater of war, such as blasts and explosions. In order to examine the effects of blast injury on hearing sensitivity, we developed a large database composed of demographic, audiometric, point of injury, and medical outcome data, with the primary aim of developing a long-standing and integrated capability for the surveillance, assessment, and investigation of blast-related hearing outcomes. Methods used to develop the dataset are described. Encompassing more than 16,500 Navy and Marine Corps personnel, the Blast-Related Auditory Injury Database (BRAID) includes individuals with a blast-related injury and nonblast control subjects. Using baseline and postdeployment hearing threshold data, a retrospective analysis of the cohort revealed that the rate of hearing loss for the injured servicemembers was 39%. The BRAID will be useful for studies that assess hearing patterns following deployment-related injury, such as blast exposures, that facilitate exploration of health outcomes and whether they are predictive of audiometric disposition and that help establish hearing loss prevention strategies and program policies for affected military commands and servicemembers.
Asunto(s)
Traumatismos por Explosión/epidemiología , Bases de Datos Factuales , Pérdida Auditiva Provocada por Ruido/epidemiología , Pérdida Auditiva Provocada por Ruido/etiología , Personal Militar , Adulto , Audiometría , Traumatismos por Explosión/complicaciones , Explosiones , Femenino , Humanos , Masculino , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: In Afghanistan, care of the acutely injured trauma patient commonly occurred in facilities with limited blood banking capabilities. Apheresis platelets were often not available. Component therapy consisted of 1:1 packed red blood cells and fresh frozen plasma. Fresh, whole blood transfusion often augmented therapy in the severely injured patient. This study analyzed the safety of fresh, whole blood use in a resource-limited setting. METHODS: A retrospective analysis was performed on a prospectively collected data set of US battle injuries presenting to three US Marine Corps (USMC) expeditionary surgical care facilities in Helmand Province, Afghanistan, between January 2010 and July 2012. Included in the review were patients with Injury Severity Scores (ISSs) of 15 or higher receiving blood transfusions. Univariate analyses were performed, followed by multivariable logistic regression to describe the relationship between the treatment group and posttreatment complications such as trauma-induced coagulopathy, infection, mortality, venous thromboembolism, and transfusion reaction. Propensity scores were calculated and included in multivariable models to adjust for potential bias in treatment selection. RESULTS: A total of 61 patients were identified; all were male marines with a mean (SD) age of 23.5 (3.6) years. The group receiving fresh, whole blood was noted to have higher ISSs and lower blood pressure, pH, and base deficits on arrival. Traumatic coagulopathy was significantly less common in the group receiving fresh, whole blood (odds ratio, 0.01; 95% confidence interval, 0.00-0.18). Multivariable models found no other significant differences between the treatment groups. CONCLUSION: The early use of fresh, whole blood in a resource-limited setting seems to confer a benefit in reducing traumatic coagulopathy. This study's small sample size precludes further statement on the overall safety of fresh, whole blood use. LEVEL OF EVIDENCE: Therapy study, level IV.
Asunto(s)
Transfusión Sanguínea/métodos , Causas de Muerte , Procedimientos Quirúrgicos Operativos/métodos , Heridas Relacionadas con la Guerra/terapia , Guerra , Adulto , Afganistán , Análisis de Varianza , Estudios de Cohortes , Bases de Datos Factuales , Estudios de Seguimiento , Humanos , Puntaje de Gravedad del Traumatismo , Modelos Logísticos , Masculino , Personal Militar , Análisis Multivariante , Seguridad del Paciente , Estudios Retrospectivos , Medición de Riesgo , Procedimientos Quirúrgicos Operativos/mortalidad , Tasa de Supervivencia , Reacción a la Transfusión , Resultado del Tratamiento , Heridas Relacionadas con la Guerra/diagnóstico , Heridas Relacionadas con la Guerra/mortalidad , Heridas Relacionadas con la Guerra/cirugía , Adulto JovenRESUMEN
The objective of this study was to analyze trends in preservice characteristics among Marine Corps recruits during the recent operations in Iraq and Afghanistan. Recruits completed a confidential survey during their first week of training at the Marine Corps Recruit Depot in San Diego, California. Demographics, behaviors, and health information were analyzed for trends from 2001 to 2010 using the Cochran-Armitage trend test and F statistic. Data from 131,961 male recruits with a mean age of 19.8 years were analyzed. Overall, entry characteristics remained stable exhibiting only modest changes over the study period. Favorable trends included recent (2009-2010) improvements in body mass index and physical activity levels. Unfavorable trends included increases in smokeless tobacco and caffeine use, and angry outbursts. Although many recruit characteristics remained similar over the past decade, both favorable and unfavorable trends in sociobehavioral characteristics were noted. The ongoing assessment of preservice characteristics is important for detecting emerging trends over time. Findings may guide leadership's understanding of changes to help develop early-service trainings promoting a healthier force and potentially reducing future adverse outcomes.
Asunto(s)
Conductas Relacionadas con la Salud , Personal Militar/estadística & datos numéricos , Selección de Personal/tendencias , Adolescente , Campaña Afgana 2001- , Ira , Índice de Masa Corporal , Humanos , Guerra de Irak 2003-2011 , Masculino , Personal Militar/psicología , Actividad Motora , Medicina Naval , Tabaco sin Humo/estadística & datos numéricos , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: Longitudinal cohort studies are highly valued in epidemiologic research for their ability to establish exposure-disease associations through known temporal sequences. A major challenge in cohort studies is recruiting individuals representative of the targeted sample population to ensure the generalizability of the study's findings. METHODS: We evaluated nearly 350,000 invited subjects (from 2004-2008) of the Millennium Cohort Study, a prospective cohort study of the health of US military personnel, for factors prior to invitation associated with study enrollment. Multivariable logistic regression was utilized, adjusting for demographic and other confounders, to determine the associations between both deployment experience and prior healthcare utilization with enrollment into the study. RESULTS: Study enrollment was significantly greater among those who deployed prior to and/or during the enrollment cycles or had at least one outpatient visit in the 12 months prior to invitation. Mental disorders and hospitalization for more than two days within the past year were associated with reduced odds of enrollment. CONCLUSIONS: These findings suggest differential enrollment by deployment experience and health status, and may help guide recruitment efforts in future studies.
Asunto(s)
Estudios de Cohortes , Atención a la Salud/estadística & datos numéricos , Personal Militar , Aceptación de la Atención de Salud , Guerra , Adolescente , Adulto , Femenino , Humanos , Masculino , Personal Militar/estadística & datos numéricos , Selección de Paciente , Estudios Prospectivos , Negativa a Participar , Adulto JovenRESUMEN
OBJECTIVE: To determine if deployment to recent military operations or other health, demographic, or military-related characteristics were associated with employment after military service. METHODS: Former US active duty military service members participating in the Millennium Cohort Study, a population-based sample of US military personnel that began in July of 2001, were prospectively followed from the time of baseline health reporting to self-reported employment status after military separation. RESULTS: Of the 9099 separated personnel meeting inclusion criteria, 17% reported unemployment after military service. In multivariable modelling, prior deployment experiences, with or without reported combat, and post-traumatic stress disorder (PTSD) were not significantly associated with employment status postservice. Among those who routinely retired from service with a pension, positive screens for depression (OR, 1.67; 95% CI, 1.05 to 2.63) and panic/anxiety (OR, 1.63; 95% CI, 1.10 to 2.43) were significantly associated with subsequent unemployment. Poor physical health, female sex, black race, lower education and disabling illnesses/injuries were also predictive of postservice unemployment. CONCLUSIONS: After stratifying for reason for military separation, mental disorders like depression or panic/anxiety and poor physical health may have greater impact than prior deployment experiences or PTSD on the ability to find or maintain employment postservice. These findings may guide support for veterans most in need of job placement services after military service.
Asunto(s)
Trastornos de Ansiedad , Ansiedad , Depresión , Trastorno Depresivo , Estado de Salud , Personal Militar , Desempleo , Negro o Afroamericano , Intervalos de Confianza , Escolaridad , Femenino , Humanos , Masculino , Personal Militar/psicología , Análisis Multivariante , Oportunidad Relativa , Pensiones , Estudios Prospectivos , Factores Sexuales , Trastornos por Estrés Postraumático , Desempleo/psicología , Estados UnidosRESUMEN
BACKGROUND: In light of increased concerns about suicide in the military, institutional review boards have mandated increased scrutiny of the final item on the depression screening tool, the PHQ-9, which asks about suicidal thoughts. Since real-time monitoring of all individual responses in most observational studies is not feasible, many investigators have adopted the PHQ-8, choosing to remove the ninth item. This study compares the performance of the PHQ-8 with the PHQ-9 in a population-based sample of military or nonmilitary subjects. METHODS: The Millennium Cohort Study administers a self-reported questionnaire that includes the PHQ-9 at 3-year intervals to current and former U.S. military personnel. PHQ-9 responses of 143,705 Millennium Cohort members were investigated. Cross-sectional comparisons of the PHQ-9 and PHQ-8 and prospective analyses to detect a 5-unit change in these measures were performed. RESULTS: Greater than substantial agreement was found between the PHQ-8 and 9 instruments (kappas, 0.966-0.974 depending on survey cycle). There was similarly high agreement between the PHQ-8 and 9 in detecting a 5-point increase (κ=0.987) or decrease (κ=0.984) in score. LIMITATIONS: One potential limitation of this study is that participants completed the PHQ-9, and PHQ-8 scores were extrapolated from the PHQ-9. In addition, the Millennium Cohort may not fully represent the U.S. military; though previous evaluations have shown the cohort to be a well-representative sample. CONCLUSIONS: Since excellent agreement was detected between the PHQ-8 and PHQ-9 instruments, the PHQ-8 would capture nearly all the same cases of depression as the PHQ-9 in populations similar to the one in this study.
Asunto(s)
Depresión/diagnóstico , Tamizaje Masivo/instrumentación , Personal Militar/psicología , Encuestas y Cuestionarios , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Personal Militar/estadística & datos numéricos , Estudios Prospectivos , Reproducibilidad de los Resultados , Ideación SuicidaRESUMEN
Limited prospective studies exist that evaluate the mental health status of military health care professionals who have deployed. This study used prospective data from the Millennium Cohort Study with longitudinal analysis techniques to examine whether health care professionals deployed in support of the operations in Iraq and Afghanistan were more likely to screen positive for new-onset posttraumatic stress disorder (PTSD) or depression after deployment than individuals from other occupations. Of 65,108 subjects included, 9,371 (14.4%) reported working as health care professionals. The rates of new positive screens for PTSD or depression were similar for those in health care occupations (4.7% and 4.3%) compared with those in other occupations (4.6% and 3.9%) for the first and second follow-up, respectively. Among military personnel deployed with combat experience, health care professionals did not have increased odds for new-onset PTSD or depression over time. Among deployed health care professionals, combat experience significantly increased the odds: adjusted odds ratio = 2.01; 95% confidence interval [1.06, 3.83] for new-onset PTSD or depression. These results suggest that combat experience, not features specific to being a health care professional, was the key exposure explaining the development of these outcomes.
Asunto(s)
Trastornos de Combate/epidemiología , Depresión/epidemiología , Personal Militar/psicología , Trastornos por Estrés Postraumático/epidemiología , Afganistán , Estudios de Cohortes , Femenino , Personal de Salud , Humanos , Incidencia , Irak , Masculino , Estudios Prospectivos , Encuestas y Cuestionarios , Estados UnidosRESUMEN
PURPOSE: The characteristics of U.S. military personnel who use dietary supplements have not been well described. This study aimed to determine whether deployment experience and physical activity were associated with the use of bodybuilding, energy, or weight-loss supplement among U.S. military personnel. METHODS: Self-reported data from active-duty, Reserve, and National Guard participants of the Millennium Cohort Study collected from 2007-2008 (n = 106,698) on supplement use, physical activity, and other behavioral data were linked with deployment and demographic data. We used multivariable logistic regression sex-stratified models to compare the adjusted odds of each type of supplement use among those with deployment experience in support of operations in Iraq or Afghanistan and those engaged in aerobic or strength-training activities. RESULTS: Overall, 46.7% of participants reported using at least one type of supplement, and 22.0% reported using multiple supplements. Male deployers were more likely to use bodybuilding supplements, whereas female deployers were more likely to use weight-loss supplements. Physically active and younger subjects reported all types of supplement use. Men and women reporting 5 or less hours of sleep per night were more likely to use energy supplements. CONCLUSIONS: The high prevalence of supplement use and important characteristics found to be associated with their use, including deployment, physical activity, and suboptimal sleep, suggest focus areas for future research and adverse event monitoring.
Asunto(s)
Suplementos Dietéticos/estadística & datos numéricos , Ejercicio Físico , Personal Militar/estadística & datos numéricos , Entrenamiento de Fuerza/estadística & datos numéricos , Adulto , Factores de Edad , Fármacos Antiobesidad/uso terapéutico , Estudios de Cohortes , Bebidas Energéticas/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores Sexuales , Trastornos del Sueño-Vigilia/epidemiología , Estados Unidos , Pérdida de Peso , Adulto JovenRESUMEN
BACKGROUND: Most previous attempts to determine the psychological cost of military deployment have been limited by reliance on convenience samples, lack of pre-deployment data or confidentiality and cross-sectional designs. AIMS: This study addressed these limitations using a population-based, prospective cohort of U.S. military personnel deployed in support of the operations in Iraq and Afghanistan. METHOD: The sample consisted of U.S. military service members in all branches including active duty, reserve and national guard who deployed once (n = 3393) or multiple times (n = 4394). Self-reported symptoms of post-traumatic stress were obtained prior to deployment and at two follow-ups spaced 3 years apart. Data were examined for longitudinal trajectories using latent growth mixture modelling. RESULTS: Each analysis revealed remarkably similar post-traumatic stress trajectories across time. The most common pattern was low-stable post-traumatic stress or resilience (83.1% single deployers, 84.9% multiple deployers), moderate-improving (8.0%, 8.5%), then worsening-chronic post-traumatic stress (6.7%, 4.5%), high-stable (2.2% single deployers only) and high-improving (2.2% multiple deployers only). Covariates associated with each trajectory were identified. CONCLUSIONS: The final models exhibited similar types of trajectories for single and multiple deployers; most notably, the stable trajectory of low post-traumatic stress preto post-deployment, or resilience, was exceptionally high. Several factors predicting trajectories were identified, which we hope will assist in future research aimed at decreasing the risk of post-traumatic stress disorder among deployers.