This research juridically analyzes the expansion of active of the Indonesian National Army placement in civilian positions under Article 47 of Law No. 3/2025, which raises concerns over the erosion of the 1998 Reformasi spirit that mandated civilian supremacy and strict military-civilian separation. This research aims to answer two problem formulations: first, analyzing the juridical implications of expanding the placement of active TNI soldiers in ministries, institutions, and civilian positions; and second, analyzing such expansion based on the principles of civil supremacy. The methods used are normative legal research with legislative and conceptual approaches, as well as descriptive qualitative data analysis. The results of this study show that the expansion of unconditional placement, resignation or retirement from active service is fundamentally contrary to the principles of civil supremacy and the democratic rule of law. The juridical implications are internal conflicts of norms that reduce legal certainty, the creation of dualism of legal status (military and civil), violations of the principle of meritocracy and equal treatment before the law, and threats to the independence of judicial/law enforcement institutions such as the Supreme Court and the Attorney General's Office. The reconstruction of the norms of Article 47 of the TNI Law is suggested by requiring every soldier who wants to occupy civilian positions to give up their active service status (retire or resign) for the sake of upholding the principle of one man, one job, one loyalty

Suicide remains a public health problem among active duty service members (ADSM). Entrapment, defined as the failed escape from personal (internal) and environmental (external) challenges, and firearms are documented suicide risk factors. However, they have yet to be studied together. The present study had two aims: (1) to examine the direct and interactive effects of entrapment and firearm ownership on suicidal ideation and attempt likelihood, and (2) to explore firearm ownership motivations and storage practices. Participants were ADSM (N = 120) at an outpatient military substance use treatment facility. ADSM completed a questionnaire battery comprising measures of suicidal thinking and behavior, firearm ownership and storage practices, and suicide risk factors. Demographic information was extracted from electronic health records. External entrapment was positively associated with suicidal thinking. Firearm ownership moderated this finding, such that owning a firearm was associated with an unexpected buffering effect on the external entrapment-suicidal ideation link. Among firearm owners, motivations were home protection (93.54%), hunting/sport/hobby (72.6%), other reasons (e.g., training; 14.5%), and for work (6.4%). Firearm owners stored their firearms: locked and unloaded (48.2%), unlocked and loaded (27.4%), locked and loaded (21.0%), and unlocked and unloaded (19.4%). External entrapment appears to be important and uniquely experienced among ADSM. Findings extend the Integrated Motivational-Volitional Model of Suicide, and offer indirect support for the Coping Model of Protective Gun Ownership Protective. Findings may inform the need for nuanced lethal means reduction, such as discussion of safe firearm storage practices, discussing the role of entrapment, and identifying coping skills that may replace personal firearms.

Graduate degree programs in Health Professions Education (HPE) are one method of addressing the challenges associated with transitioning from being a full-time clinician to an educator, leader, and scholar of health professionals. Although previous research has focused on the individual benefits of HPE, such as increased self-efficacy and professional identity, little is known about the organizational impact - specifically on faculty retention rates. This study investigated whether participating in and earning a graduate degree from an HPE program influenced alumni decisions to remain in the Military Health System (MHS). We conducted an anonymous electronic survey of alumni who graduated with a Masters or PhD in HPE from the Uniformed Services University between 2017 and 2024. The survey asked questions about the HPE degree's contribution to their desire to stay in the MHS and included open-ended questions to elaborate on responses. Descriptive statistics were calculated, and thematic analysis assessed the qualitative data to identify key themes and subthemes. Forty recent graduates responded to the survey for a 71% response rate. A majority of active duty military (n = 24/36, 66.7%) and MHS civilian (n = 3/4, 75%) respondents indicated that the HPE degree contributed to their desire to stay in the MHS. Over half of active duty alumni (n = 20/36, 55.6%) stated they had or would stay longer than their current commitment, with nearly half (n = 16/35, 45.7%) attributing this decision at least partially to the degree program and a further 23% (n = 8/35) saying they were unsure. Thematic analysis revealed 3 themes representing mechanisms linking the HPE degree to retention: increased job opportunities (e.g., selection for next academic leadership positions), enhanced job satisfaction (via improved self-efficacy and community integration), and strengthened organizational loyalty and influence (e.g., feelings of gratitude toward the MHS and increased belief in the power to make an organizational impact). Participation in the graduate HPE degree programs positively influenced the retention of health professional faculty by providing pathways to academic leadership, improving professional competence and satisfaction, and fostering organizational commitment. These findings suggest that investing in advanced HPE degrees is an important strategic tool for healthcare organizations seeking to cultivate and retain high-performing health professional faculty, educational leaders, and scholars.

Military medical readiness plays a significant role in global military operations. While the severity of combat-related trauma is evident, musculoskeletal injuries (MSK's), are the largest medical threat to deployment readiness, and accounted for more than 60% of limited duty days in 2019. Across MSK's, the spine (lumbosacral: 30%; cervical: 22%; thoracic: 10%) accounts for 62% of MSKs. In the military population, there is a tremendous economic impact in training, retaining, and deploying a service member. Return-to-duty (RTD) rates and length of time for the treatment protocols for spine surgery vary significantly in published research. Research suggests RTD rates between 3-17 months following elective traditional open lumbar and cervical spine surgery, with a RTD rate of 64% within 1 year. When examining minimally invasive lumbar spine surgery (MIS), 100% of military personal had a RTD within 3 months. Research has yet to examine the impact of MIS of the cervical spine on the RTD rates of active-duty military. The current study retrospectively examined surgical outcomes, return to duty, and patient-centric outcomes among 156 active duty or reserve military patients who underwent an outpatient minimally invasive (n = 79) cervical spine surgery or an open (n = 77) (Laminotomy/Foraminotomy/Decompression) for the treatment of cervical spinal stenosis. Significant reductions in visual analog scale of 3.31 and neck disability index of 16.01 were observed from preoperative to postoperative time points. 77% of service members RTD in less than 1 month, 19% RTD in 1-2 months and 4% RTD between 2-3 months. There were insignificant differences reported in the open surgery group. MIS has been shown to reduce tissue trauma and patient complications. MIS procedures have resulted in reducing postoperative stress responses and improving the recovery process following surgery. In the active-duty military population this plays an important role in return to duty quickness. Our findings suggest that MIS procedures in an ambulatory surgery center on the cervical spine result in improved patient outcomes and reduced RTD time in active-duty military personnel.

Microfracture offers a joint-preserving treatment for glenohumeral osteochondral defects, although its application to bipolar defects remains understudied, especially among an active-duty servicemember (ADSM) population. To evaluate outcomes after microfracture of bipolar glenoid and humeral head lesions in ADSM aged <55 years. Case series; Level of evidence, 4. ADSM aged <55 years were eligible for inclusion if they underwent microfracture for Outerbridge grade IV bipolar glenohumeral cartilage lesions identified on diagnostic arthroscopy at various locations within the joint and had >5 years of postoperative follow-up. All patients underwent concomitant arthroscopic subacromial debridement and other procedures that did not necessitate extended postoperative immobilization, while those with concomitant rotator cuff or labral repair were excluded. Outcomes included patient-reported outcome measures-specifically, pain on visual analog scale, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons standardized assessment-and range of motion, return to duty, and arthroplasty-free survivorship. In total, 31 patients were eligible for inclusion (mean ± SD age, 45.7 ± 8.1 years; male, 90.3%; mean follow-up, 8.0 ± 1.9 years). On average, glenoid and humeral head lesions measured 247 ± 155 and 201 ± 137 mm2, respectively. All patient-reported outcome measures demonstrated significant improvements postoperatively independent of lesional size (visual analog scale, 8.2 ± 1.8 to 1.7 ± 1.8; Single Assessment Numeric Evaluation, 51.0 ± 18.8 to 80.5 ± 14.9; American Shoulder and Elbow Surgeons, 47.0 ± 11.7 to 85.2 ± 12.5; P < .0001 for all). Internal rotation improved slightly (T10.5 ± 2.4 to T9.1 ± 2.5; P = .0109); otherwise, range of motion remained stable. At final follow-up, 71% (n = 22) returned to full duty and 65% (n = 20) to preinjury level of sport. Two patients (6.5%) experienced symptom progression and underwent total shoulder arthroplasty at 6 and 8 years postoperatively at ages 52 and 62 years, respectively. Microfracture of bipolar glenohumeral osteochondral lesions among ADSM yields significant improvements in pain and shoulder function; however, rates of return to unrestricted duty and former level of sport were limited, and 6.5% of patients ultimately underwent total shoulder arthroplasty 6 to 8 years postoperatively. While microfracture begets symptomatic relief for many young, active patients with bipolar osteochondral lesions and appears to offer several years of improved symptom management, return to full occupational and athletic function remains limited and warrants appropriate patient education and counseling.

ABSTRACT Exposure therapy for posttraumatic stress disorder (PTSD) is efficacious for treating patients with multiple traumatic events. However, individuals with PTSD with exposure to multiple traumatic events are theorized to experience differences in emotional reactivity and fear extinction processes compared to those exposed to a single traumatic event. Thus, there is concern that individuals exposed to multiple traumatic events respond to exposure therapy differently than individuals reporting a single traumatic event. This study examined the impact of trauma frequency on exposure therapy processes, including within-session habituation, between-session habituation, and treatment outcomes in a sample of male veterans and active-duty military with combat-related PTSD engaging in Trauma Management Therapy (N = 81). Individuals in both groups demonstrated significant improvements in PTSD symptoms from pre- to post-treatment. Of primary interest, individuals presenting with multiple traumatic events and single traumatic events demonstrated similar within- and between-session habituation, length and number of exposure sessions, rates of fear activation, and symptom reduction. The only significant difference observed was slower within-session habituation during the first Trauma Management Therapy session for individuals exposed to multiple traumatic events compared to individuals exposed to a single traumatic event. Results indicate that PTSD resulting from multiple traumatic events are as responsive to exposure therapy as those whose PTSD was caused by a single event. These preliminary results suggest that clinicians can utilize evidence-based exposure therapies to treat veterans and military personnel with multiple traumatic event histories.

Background: The post-acute sequelae of SARS-CoV-2 infection represent a growing public health concern. While associations between COVID-19 and metabolic disorders have been reported, less is known about this risk in young, healthy populations. This study aimed to quantify the risk of developing new-onset metabolic disorders following SARS-CoV-2 infection among U.S. active-duty service members. Methods: We conducted a propensity score-matched cohort study using U.S. Military Health System data between July 2020 and June 2021 of active-duty service members (ADSM) aged 18 to 65 years old. COVID-19 infections were identified through ICD-10 codes or laboratory results. A 1:2 matched cohort compared 103,789 COVID-19 exposed individuals with 207,578 controls. Outcomes included incident diagnoses of type 2 diabetes mellitus (T2DM), hypertension (HTN), hyperlipidemia (HLD), metabolic dysfunction-associated steatotic liver disease (MASLD), and metabolic syndrome (MetS) within one year. Cox proportional hazards models calculated adjusted hazard ratios (aHR) while controlling for obesity and overweight status. Results: The median age for both those with and without COVID-19 infection was 26 years (interquartile range 22–33 years), with males comprising the majority of participants (81.1% male, 18.9% female). COVID-19 infection was associated with significantly increased hazards for incident HTN (aHR 1.09; 95% CI, 1.01–1.18), HLD (aHR 1.30; 95% CI, 1.10–1.54), and MASLD (aHR 1.36; 95% CI, 1.15–1.60). However, no significant increased risk was observed for T2DM or MetS. Conclusions: COVID-19 infection was associated with significantly increased risk of developing HTN, HLD, and MASLD, highlighting important long-term metabolic consequences in a young, healthy population.

ABSTRACT Violent extremism is a significant threat to the international community. Many different types of individuals could become radicalized, and afterwards, they might support the development and execution of a violent plot to further some radical ideology. A prominent concern involves individuals with prior military experience engaging in violent extremism. Military experience presumably provides the knowledge and skills that would enable effective execution of a complicated violent plot. However, this assumption remains largely untested and may not hold true for several reasons, including the potential for civilians to acquire comparable skills through non-military sources. The current study utilized the Profiles of Individual Radicalization in the United States (PIRUS) database to examine differences in plot details between civilians, active-duty military, and veteran personnel. Analyses were divided into three primary areas: role within the plot, plot execution, and consequences. Results indicated that veterans were more likely to be leaders within radicalized plots, whereas active-duty personnel were more likely to be followers. Additionally, there were several differences regarding anticipated fatalities for radicalized behaviour between civilians, veterans, and active-duty service members. Taken together, this evidence provides several considerations for future work in preventing radicalization and understanding differences in radicalized behaviour due to military experience.

Treatment Initiation as a Marker of Quality of OSA Care Among Active-Duty Military Personnel in the U.S.

Atrial fibrillation (AF) in military members can impair military readiness and increase military care system burdens. Atrial fibrillation clinical care quality measures have not been assessed in military populations and facilities. This study aims to assess the AF management of United States active duty military service members according to guideline clinical quality measures. Ambulatory active duty personnel with AF diagnoses between 2004 and 2019 were analyzed in reference to the published AF clinical performance measures. Three hundred eighty-six service members with AF were identified and analyzed. Nine of 11 outpatient clinical performance and quality measures were evaluated. Only 41% of encounters reported CHA2DS2-VASc scores with an increase in reporting to 64% for the more recent years 2014-2019. Nineteen of 22 (86%) personnel with indications for long-term anticoagulation received appropriate medical therapy. One hundred percent of 115 patients treated with warfarin were appropriately monitored with monthly INRs. Two patients with LVEF <40% were appropriately prescribed beta blockers. Two of 2 personnel with mechanical prosthetic valves were prescribed appropriate anticoagulation with warfarin. Thirty-one percent were inappropriately prescribed both an antiplatelet and an anticoagulant in the absence of coronary or vascular disease. Shared decision-making discussion regarding anticoagulant therapy was documented in 82%. Active duty military personnel prescribed warfarin are appropriately monitored. Quality improvement processes can improve CHA2DS2-VASc score reporting, appropriate anticoagulation prescriptions, and shared decision-making discussions for military personnel with AF to reduce military health care system burdens and better outcomes for service members.

Food insecurity affects a large portion of the United States population. Many subsets of the population are affected disproportionately, including active duty service members and their families. The unique challenges of military service can contribute to food insecurity and affect readiness, recruitment and retention. The overall goal of this scoping review is to identify all recent peer-reviewed literature related to food insecurity and active duty military families, aiming to identify recent literature and explore key areas including demographics, screening methods, risk factors, the relationship between food insecurity and mental health, available mitigation strategies, barriers to accessing support, and the impact on military readiness, recruitment, and retention. This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) Protocols 2020 statement. A search strategy was created to obtain all evidence relevant to food insecurity in active duty military families. A Boolean search was conducted from May 1, 2014 to May 1, 2024 within the databases PubMed, Embase, CINAHL, PsycINFO, and Web of Sciences. Out of 159 articles, a total of 13 articles were included in the scoping review. The studies provided demographic trends, validated screening tool evaluation, determinants of unique military barriers and risk factors, association with mental health conditions, available mitigation strategies and the effects on readiness, recruitment and retention. Comparison with civilian data was identified to better define this at-risk community. In total, 106,363 active duty military families were represented in this review. The literature revealed food-insecure active duty military families were more likely to be junior enlisted, unmarried, single income households, high school as the highest level of education, include an unemployed spouse, and be a household with children. Associations with financial impact, spousal employment, and mental health were highlighted. Solutions for food insecurity included the utilization of resources, including Supplemental Nutrition Assistance Program and Women, Infants, and Children. Impact on military readiness was also identified. A large portion (27.7%) of U.S. active duty service members and their families are food insecure. Food insecurity has the potential to affect both mental and physical health, as well as readiness, recruitment and retention of service members. Continued research for this phenomenon and education of both medical providers and service members on available resources are integral to the mitigation of food insecurity in this vulnerable population.

This scoping review examined the bidirectional impact of spirituality on active duty military service members and Veterans with combat-related Posttraumatic Stress Disorder (PTSD). The rationale for this work was to characterize how spirituality influences this population, considering moderators such as social support and resilience, as well as social determinants of health (SDoH), adverse childhood experiences, and family religious experiences in order to (1) explore the associations between spirituality and PTSD outcomes, (2) screen for spirituality and religiosity, (3) provide integrated care models that incorporate spiritual guidance, and (4) where possible, work to address modifiable factors. Objective: To characterize the impact of spirituality on active duty military and Veterans with combat-related PTSD. Eligibility Criteria: Articles were included if they examined active duty military or Veterans diagnosed with combat-related PTSD and assessed spirituality. Sources of Evidence: A systematic search was conducted on July 23, 2024, across Academic Search Premier, APA PsycINFO, APA PsycArticles, Atla Religion, CINAHL Ultimate, Cochrane Central Register of Controlled Trials, MEDLINE, and SocINDEX. Charting Methods: Data extraction followed the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and was conducted using Covidence. A data extraction template was developed to compare study aims, population, eligibility criteria, combat exposure, PTSD and mental health diagnoses, spiritual and religious variables, and validated measures. The template also captured pre- and post-deployment factors, including spirituality before combat exposure, educational, marital status, and other demographic or social variables. Key outcomes included PTSD symptom severity, posttraumatic growth, moral injury, and resilience. Moderators such as positive social factors, SDoH, adverse childhood experiences, and service era were also recorded. Studies were grouped thematically and geographically to identify patterns across military populations and research frameworks. A total of 59 studies met inclusion criteria, with 50 (84.7%) being cross-sectional, reflecting the predominance of observational research. Randomized controlled trials accounted for 3 (5.1%), although cohort studies were limited to 4 (6.8%). Research primarily focused on U.S. Veterans, with limited global representation from Bosnia and Herzegovina, Canada, Croatia, Iran, Mexico, and Sri Lanka. The most commonly used measures followed a framework of combat exposure, moral injury, PTSD, spirituality, and posttraumatic growth. Mixed associations between religious/spiritual (R/S) factors and mental health were observed. Positive religious coping, organizational religious activities, and religious service attendance generally predicted better mental health, whereas negative religious coping and spiritual struggles consistently predicted worse mental health. However, paradoxical findings were also observed, such that greater intrinsic religiosity and pre-military religious commitment predicted worse posttraumatic outcomes in some studies. Spirituality was variably associated with PTSD severity but more consistently linked to moral injury, resilience, and posttraumatic growth. Given the limited number of studies and variability in findings, it is not possible to draw definite conclusions about associations between R/S and combat-related PTSD at this time. Findings highlight the need for longitudinal and interventional studies and support development of spiritually integrated, culturally informed care models to improve outcomes for diverse military and Veteran populations.

IntroductionPrior research suggests that olfactory dysfunction may occur following a traumatic brain injury (TBI) due to structural injury to the olfactory peripheral or central networks. Olfaction may also be affected in posttraumatic stress disorder (PTSD) due to traumatic re-experiencing. Given the relevance of both TBI and PTSD to the military and veteran populations, the purpose of this study was to evaluate whether the University of Pennsylvania Smell Identification Test (UPSIT) would be useful in differentiating TBI from significant PTSD symptom burden in a sample of post-deployed active-duty military and veterans.MethodsA sample of 276 participants with UPSIT data and passing scores on validity measures completed a larger study on neurocognition of predominantly post-deployed veterans of the wars in Afghanistan and Iraq. TBI history was ascertained by medical records or a self-report questionnaire; PTSD symptoms were measured using the PTSD Checklist-Military version (PCL-M) and the Traumatic Stress scale (ARD-T) of the Personality Assessment Inventory. Those with a history of TBI (+TBI) were compared with those without (–TBI) on total UPSIT score; severity of injury and number of injuries were also evaluated. Furthermore, those with and without significant PTSD symptoms (+PTSD and –PTSD) were compared on UPSIT total scores. Finally, group comparisons were conducted to assess whether PTSD demonstrated a significant effect above and beyond TBI.ResultsHistory of TBI was associated with lower UPSIT scores (–TBI M = 34.02, +TBI M = 32.76, z = −2.38, p = 0.017, r = 0.14); however, the effect size was small and driven by the difference between moderate/severe TBI and –TBI (moderate/severe M = 31.78). Number of mild TBIs was not associated with UPSIT scores: The presence of PTSD symptoms and symptom clusters were not significantly associated with UPSIT scores. PTSD symptoms showed no additional effects on poorer olfaction scores above and beyond TBI.DiscussionOlfactory identification was significantly reduced in those with a history of TBI, suggesting that olfaction may be useful in the assessment of these individuals for potential treatment needs. Veterans with significant PTSD symptoms, however, did not display different olfactory ability compared with those without, regardless of TBI status.

Background:Hallux valgus can severely limit physical function in demanding professions like military service. Traditional open surgeries have shown limited success in achieving rapid recovery and full functional return. The primary objective of this study was to assess functional outcomes of active-duty service members who have undergone minimally invasive bunion surgery.Methods:Eighteen active-duty service members with mild to moderate hallux valgus deformities who underwent minimally invasive bunion correction between 2020 and 2022 were retrospectively reviewed.Results:Minimally invasive bunion surgery demonstrated significant improvements in self-reported outcomes of the Foot and Ankle Outcome Scores from pre- to post-procedure (total score: 57.0 vs 95.0 respectively, P > .001) including all subscales of symptoms, pain, activities of daily living, sports and quality of life. Additionally, radiographic analyses revealed marked corrections pre- to post-procedure in intermetatarsal angle (12.0 vs 7.5 degrees, P < .001), hallux valgus angle (25.5 vs 12.0 degrees, P < .001), and tibial sesamoid position (5.0 vs 2.0 degrees, P < .001), with 12 of 13 patients achieving full bone consolidation by their 6-month follow-up. Complications were minimal, with only 1 case requiring further intervention. Approximately half of the patients (8/18) did not require any limited duty, and 13 of 18 remained on active duty at final follow-up (median of 13 months).Conclusion:These findings underscore the potential of minimally invasive surgery in high-impact populations, although further research with larger cohorts is recommended to confirm long-term outcomes and functional durability in high-stress settings.Level of Evidence:Level III, retrospective comparative study.

Mental Health of US Children With Vision Impairment: An Analysis of the National Health Interview Survey.

Objectives: Recent evidence has suggested that subcritical bone loss can result in a higher rate of recurrent instability as well as inferior outcomes following an arthroscopic soft tissue Bankart procedure. Several options to manage subcritical bone loss exist including the addition of a Infraspinatus Remplissage or a bone transfer procedure. The purpose of this study is to compare the outcomes between the arthroscopic Bankart repair plus Remplissage to an open Latarjet for the treatment of anterior shoulder instability in patients with glenoid bone loss from 13.5-20% in an active-duty military population. We hypothesize that there will be no difference in recurrence rate or patient reported outcomes between the two procedures. Methods: A retrospective matched cohort comparison of patients who underwent anterior glenohumeral instability procedures with subcritical bone loss was performed. Inclusion criteria included symptomatic anterior shoulder instability, subcritical glenoid bone loss (13.5-20%), recurrent instability with at least two instability episodes, surgical treatment with arthroscopic Bankart repair plus Remplissage or open Latarjet, and minimum follow-up of 2 years. Outcomes assessed included recurrent instability (defined as postoperative dislocation or subjective subluxation), military physical restrictions, WOSI, and SANE scores. Results: Fifty patients were included, 25 of whom underwent an arthroscopic Bankart repair plus Remplissage and 25 patients treated with an open Latarjet. The average bone loss was 18.2% and 19.4%, respectively. Overall, five patients experienced recurrent instability, 3 in the arthroscopic Bankart group and 2 in the open Latarjet group. The average post-operative SANE score for arthroscopic Bankart/Remplissage group was 86.1% and open Latarjet group was 84.2% (p&lt;0.1). The average post-operative WOSI score for the arthroscopic Bankart plus Remplissage group was 66.2% and open Latarjet group was 67.5% (p=0.1). There was no difference in the number patients placed on permanent physical restrictions in the arthroscopic Bankart plus Remplissage group (5) compared with open Latarjet (3) (p&lt;0.1). There were 4 complications other than recurrent instability in the Latarjet cohort compared to 0 in the arthroscopic Bankart plus Remplissage cohort (p=0.05). Conclusions: In patients with subcritical glenoid bone loss (defined as 13.5% to 24%), there was no difference in recurrent instability between an arthroscopic Bankart plus Remplissage compared to an open Latarjet. Additionally, there was no difference in post-operative SANE or WOSI scores, complications, or the number of patients placed on permanent military restriction.

The COVID-19 pandemic challenged healthcare personnel worldwide. This study investigated the mental health of active duty military healthcare workers (HCWs) during the COVID-19 pandemic. We conducted a retrospective monthly cross-sectional analysis of active duty military enlisted and officer HCWs' mental health encounter data from January 2018 to February 2023. Encounters for anxiety disorders, depressive disorders, reactive stress disorders, and suicidal attempt/ideation (SI) and self-harm were evaluated. Trends and trend changes in monthly rates of these 4 outcomes were evaluated using Joinpoint analysis. Poisson regression models evaluated the effect of time on the rates of these outcomes stratified by enlisted or officer status. A total of 171,862 (122,413 enlisted, 49,449 officers) HCWs were included. Mental health utilization by both enlisted and officer HCWs had an upward trend for anxiety disorders, depressive disorders, reactive stress disorders, and suicidal attempt/SI and self-harm during the COVID-19 pandemic. Over the full study period, both enlisted and officer HCWs had significantly higher rates of all 4 outcomes in the second and third years of the pandemic. Female gender and older age were associated with higher rates across all outcomes, with the exception of SI and self-harm where the rates were higher among younger individuals. Military healthcare providers experienced a significantly increased mental health burden during and following the COVID-19 pandemic. Females and older personnel were particularly vulnerable. These findings emphasize the need for targeted interventions to support these critical personnel during and after crises, such as resiliency training, peer support, and readily accessible mental healthcare services.

<i>Author affiliations are listed at the end of this article.</i>

This study aimed to examine the acute health effects of wildfire smoke exposure on active-duty military personnel at Joint Base Lewis-McChord (JBLM). We conducted a time-stratified case-crossover study (2018-2024) using conditional logistic regression to compare emergency department (ED) visits on wildfire smoke versus nonsmoke days. Two PM 2.5 thresholds were used (≥35.4 and ≥20.4 μg/m 3 ). Analyses were adjusted for daily average temperature and lagged exposures (lags 0-7). Both high and moderate PM 2.5 exposures are linked with increased odds of respiratory and behavioral health ED visits at specific lags. Even exposures within the moderate range were associated with increased odds of adverse health events. Acute wildfire smoke exposure raises concern for increases in ED visits among an otherwise healthy military population, highlighting the need for on-base air quality monitoring and targeted risk mitigation.

Background: Chronic respiratory symptoms are reported after military deployment in support of combat operations. The spectrum of clinical lung diseases was initially defined by the Study of Active Duty Military for Pumonary Disease Related to Environmental Deployment Exposures (STAMPEDE) III. Does cardiopulmonary exercise testing (CPET) performed during this evaluation demonstrate differences based on established clinical diagnoses? Methods: Military personnel with chronic respiratory symptoms underwent a standardized evaluation as reported in the STAMPEDE III study. CPET was performed on a treadmill using a Bruce protocol, and all participants exercised to maximal exertion. Standard cardiac and respiratory CPET parameters were compared based on diagnosis, pulmonary function testing, and underlying comorbidities. Historical control patients included asymptomatic, nondeployed military personnel with normal imaging and spirometry who previously performed identical CPET testing. Results: In total, 356 participants from STAMPEDE III (38.3 ± 8.7 years) completed a single CPET study during the standardized evaluation. Values were compared with 108 nondeployed controls (28.8 ± 3.9 years). Participants versus controls demonstrated a significant reduction in exercise capacity based on time (10:09 ± 1:51 vs 12:58 ± 2:11, P < .001), metabolic equivalents (10.9 ± 1.7 vs 12.8 ± 1.7, P < .001), and V̇O2 peak (mL/kg/min) (37.3 ± 7.1 vs 46.7 ± 6.9, P < .001). In the comparison of respiratory parameters, both minute ventilation/maximum voluntary ventilation (0.80 ± 0.18 vs 0.69 ± 0.15) and breathing reserve percentage (20.3 ± 17.5 vs 25.9 ± 13.1) identified significant differences (P < .05) driven by asthma and lower airway categories, whereas breathing frequency and tidal volume/inspiratory capacity were not different. Differences in exercise capacity were influenced by the presence of post-traumatic stress disorder/traumatic brain injury, mental health disorders, and body mass index >30 kg/m2. Conclusions: The use of CPET for postdeployment pulmonary diagnoses showed a decrease in exercise capacity compared with normal controls. Although several ventilatory parameters were elevated in asthma and lower airway diseases, individuals diagnosed with only exertional dyspnea did not demonstrate changes. Propensity matching confirmed that CPET does not suggest undiagnosed respiratory disease during a normal postdeployment pulmonary evaluation.