Active Military Service Research Articles

B - 39 Resilience in Active Duty US Military Service Members: Factor Analysis and Prediction of Psychological Symptoms in a Mild Traumatic Brain Injury Sample

Abstract Objective The factor structure of the Connor-Davidson Resilience Scale (CD-RISC) varies between cultures, settings, and samples, yet has not been assessed in an active-duty United States (US) military sample. We used factor analysis to characterize resilience in a generalizable sample of active-duty service members (ADSMs) and explored its associations with self-reported psychological outcomes in ADSMs with a history of mild traumatic brain injury (mTBI). Method Exploratory factor analysis (EFA) of the 25-item CD-RISC was performed on a non-clinical convenience sample of 212 active duty SMs followed by a confirmatory factor analysis (CFA) for model validation. Hierarchical regressions compared the relationships among the resulting factors and total scores on the Post Traumatic Stress Disorder Checklist (PCL-5), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) between subgroups with self-reported history of mTBI (n = 60) and TBI-negative controls (n = 54). Results EFA returned a 4-factor, 19-item solution. After modifications to improve model fit, CFA validated a 4-factor, 17-item solution: Fortitude, Resoluteness, Decisiveness, and Dedication. The interaction of TBI history with the Decisiveness and Dedication factors significantly predicted BDI and PCL-5 total scores (p < 0.05), but not BAI total scores. Fortitude and Resoluteness did not differentially predict any psychological outcomes between groups. Conclusion Four latent factors of resilience that are unique to ADSMs were identified and validated from the 25-item CD-RISC. Decisiveness and Dedication more strongly predicted depressive and PTSD symptoms in ADSMs with a history of mTBI than in controls, suggesting these factors of resilience are especially critical for better psychological outcomes following mTBI in military populations.

Spices and Herbs Increase Vegetable Palatability Among Military Service Members.

Unhealthy eating behaviors are adversely impacting the health and performance of the U.S. armed forces. Vegetable intake, in particular, has been shown to be far below recommended levels in active duty military populations. Previous research in other populations has shown that the addition of spices and herbs can help overcome numerous barriers to vegetable intake. The goal of this study was to determine modifiable barriers to vegetable intake among a sample of active duty military service members at Naval Support Activity Bethesda and evaluate whether the addition of spices and herbs can help surmount these barriers. Monadic sensory testing was conducted that compared typical preparation (butter and salt) of 4 vegetables (broccoli, carrots, cauliflower, and kale) vs. otherwise identical preparation with the addition of spices and herbs. The Menu Item Survey, a 9-point hedonic scale utilized throughout the U.S. Military for recipe development, was the primary outcome of the vegetable sensory testing. Questionnaires were administered to assess barriers to military dining facility vegetable intake. Unpaired t-tests were utilized to compare Menu Item Survey ratings of typical vegetables vs. vegetables with spices and herbs. Descriptive statistics were computed to summarize the results of the barriers questionnaires, and qualitative analysis of open-ended questions was conducted to identify perceived areas of improved vegetable intake. A diverse sample of 70 active duty service members participated in the vegetable sensory testing and provided outcome data. The most common barriers to military dining facility vegetable intake were appearance (42.9%), preparation style (41.3%), and taste (39.7%). Sensory testing revealed that vegetables with spices and herbs were preferred over typical preparations in overall appeal, flavor, and aroma (P <.03). The addition of spices and herbs appears to help overcome key sensory-related barriers to military dining facility vegetable intake. Future comparison of vegetable intake with and without spices and herbs when included in a full meal in a military dining setting is warranted in order to better evaluate the effectiveness in increasing vegetable intake under typical dining conditions.

A narrative review of the international literature on social work within the military

There is a dearth of understanding about the international literature on military social work with active service members. This narrative review spans the literature between 1944 and 2019 in an effort to grow the international military social work knowledge base. Of the 92 countries searched, 24 produced at least one publication about military social work with active military service members. Major themes identified among the articles reviewed included: the general scope of practice, practice in mental health and trauma, practice with special populations, practice with families, interdisciplinary practice and collaboration, ethical issues and dilemmas, and education and training.

대체복무제의 개선방향에 관한 소고

It is meaningful to look back on the current alternative service system at the present time, three years after the alternative service system was implemented. In particular, considering that there is still controversy over the punishment of the alternative service system, it is necessary to reconsider what direction the alternative service system should have in the future. Currently, alternative service personnel in Korea are serving in correctional facilities for 36 months, twice the length of active military service, which is longer than the maximum difference between the general military service period and the alternative service period in Armenia, which the European Court of Human Rights called punitive. In addition, in Armenia, it was controversial that the place of service should be at the workplace 24 hours a day, even though the place of service was various private institutions such as orphanages, nursing homes, mental health institutions, and facilities for the disabled. In Korea, the form of having to serve in a single place called correctional facilities and camp service can be even more problematic. In fact, although there are no uniformly established standards under international law regarding the period of alternative service, according to the recommendations of the Ministerial Committee within the European Council and the decisions of the UN Human Rights Commission, it is mentioned that the period of alternative service should be within a reasonable range that is non-punitive. In addition, among the countries implementing alternative service, the largest difference in period of less than 1.5 times was found. And the European countries have alternative service institutions in various fields, such as social welfare, health, culture, religion, peace, education, the environment, and emergency rescue, and Korea also needs to prepare a variety of service institutions as possible in addition to correctional facilities. In addition, in terms of diversifying service types, it is necessary to consider a method of distinguishing between the types of service that can be served as non-combatants within the military and the types of alternative service of civilians outside the military. Lastly, considering that there are countries that have abolished the interview survey in the process of applying for alternative service, and this was a measure of respect for the freedom of conscience of conscientious objectors, I think Korea needs to consider discussing it in the long run.

A brief mindfulness-based intervention for stress, pain, emotion and attention regulation in military service members with mild traumatic brain injury.

The primary aim of this study was to conduct an open pilot clinical trial of a brief mindfulness-based intervention for persistent postconcussion symptoms that occur after mild traumatic brain injury in military service members. For many service members, operational tempo and other time constraints may prevent them from completing a standard mindfulness-based stress reduction course. Thus, this study sought to examine the effectiveness of a five-session intervention called mindfulness-based stress, pain, emotion, and attention regulation (MSPEAR). Participants were active duty service members with a history of mild traumatic brain injury (TBI) and persisting postconcussion symptoms, all of whom were recruited from an outpatient TBI rehabilitation program at a military treatment facility. Of the 38 service members that were initially enrolled, 25 completed the 5-session MSPEAR intervention, and 20 returned for a 5-week follow-up evaluation. Questionnaires assessing perceived stress, positive affect, pain interference and catastrophizing, sleep disturbances, perceived behavioral and attention regulation, self-efficacy and satisfaction with life were administered at preintervention, postintervention, and at 5-week follow-up intervals. Neuropsychological testing at preintervention and 5-week follow-up included performance validity measures, attention, working memory, and executive function measures. T-tests were run to compare for questionnaire measures at preintervention (Time 1) to postintervention (Time 2). Repeated analysis of variances were conducted to compare questionnaire and neuropsychological measures at Time 1, Time 2, and at Time 3 which is the 5-week follow-up. Improvements in perceived stress, positive affect, behavioral regulation, metacognition, sleep disturbance, self-efficacy, and satisfaction with life were found immediately after the MSPEAR intervention and were maintained at the 5-week follow-up. Magnification and helplessness aspects of pain catastrophizing improved when comparing preintervention to the 5-week follow-up. Pain interference was not significantly different across study assessment times. Neuropsychological testing revealed improvements in sustained attention, working memory, cognitive flexibility, and inhibitory control when comparing preintervention to the 5-week follow-up assessment. The MSPEAR intervention appears to show promise as a brief and effective therapy for specific postconcussion symptoms after mild traumatic brain injury in military service members. Each of the components of MSPEAR including stress, pain catastrophizing, emotion and attention regulation showed improvements in this study, and bears further investigation in a larger scale, preferably randomized controlled trial in those active duty military service members who experience persisting symptoms after a mild traumatic brain injury.

Bridging the Gap: The Vital Role of Nursing in Caring for Military Members and Veterans and Their Families.

In 2011, a national call from The White House set in motion an initiative for action called Joining Forces to serve America's military families. This initiative, led by then-First Lady Michelle Obama and Dr. Jill Biden, was intended to unite public and private sectors to ensure active military service members, veterans, and their families had the educational, employment, and wellness resources they needed to succeed. Although the nursing profession started to respond to this call to action, it was never embraced as a priority. With nearly three million active-duty personnel, nearly one million reservists, more than 18 million veterans, and millions more families of our military and veteran community, it is time for the largest health care workforce to lead the care and wellness of our military and veteran community. [J Contin Educ Nurs. 2024;55(5):217-219.].

Правовой статус офицеров уездной полицейской стражи Российской империи

The article is devoted to the problem of legal regulation of the activities of officers of the police guard of the Russian Empire, whose positions were introduced in 1906 as part of one of the “micro-reforms” of the county police. On the basis of a significant array of archival materials (some of which are being introduced into scientific circulation for the first time), the regulatory support for the establishment and recruitment of police officers, their awarding and promotion to ranks, social guarantees, horse stock and uniforms is being considered. Special attention is paid to the duties of managing the combat unit of the police guard. The conclusion is made about the duality of the legal status of the officers of the guard, who were considered to have been on active military service and, according to their rights and duties, were, in many respects, in equivalent conditions with representatives of a Separate corps of gendarmes.

Responsible leadership in a military organization (in the light of opinion surveys of professional soldiers)

Military leadership is currently an extremely popular and important aspect of managing human resources in difficult, changeable, and unpredictable conditions. The solutions used in modernly managed, well-organized, subsidized, and ethically militarized systems become a point of reference and a model for organizations that encounter perturbations in the management of the organization’s human resources. The most important of them are certainly the sense of trust of subordinates in their superiors and the leaders’ responsibility for the level of staff development. The aim of the research undertaken was to verify the thesis that can be formulated in this affirmative sentence: “A modern commander should be honorable, self-confident, and have the ability to influence his subordinates and shape friendly interpersonal contacts in the group he reports.” The literature search in the field of leadership and questionnaire research were aimed at answering the main research question: “What mental properties and behavioural features should characterize a responsible leader in military organizations?”. The work uses the diagnostic survey method, and the interview was conducted using a multi-factor survey questionnaire on a 30-person study group consisting of professional soldiers aged 25–40. The adopted age range of the study group corresponds to the period of active military service, from the age of graduation to the year of termination of active military service. The Multifactor Leadership Questionnaire is composed of two scales, creating a total of 37 randomly ordered statements in the form of single-choice questions. To analyze the distribution of answers, ranks were used to assess the degree of their compliance with the respondents’ beliefs. Based on the conclusions from the conducted research, we have grounds to believe that professional soldiers expect their leader to be helpful to their subordinates and to ensure that the soldiers are motivated to act and perform their tasks. An important behavior that is expected from the commander is the desire to have a common mission in achieving the goal. Based on the research results, it was found that an undesirable feature is the inconsistency of commanders when pointing out the mistakes of their subordinates, who do not devote interest and time to learning how to avoid mistakes and to improve the competence of their subordinates.

Effects of hands‐on mind‐body therapy on posttraumatic stress disorder among Danish military veterans: A randomized clinical trial

AbstractPosttraumatic stress disorder (PTSD) affects many military veterans. Given limited success of and barriers to conventional treatments, increasing interest is being paid to mind‐body therapy approaches. However, little evidence exists on whether these have the potential to treat traumatic stress. The aim of this study was to compare 6 months of hands‐on mind‐body therapy as an add‐on to treatment as usual (TAU) with TAU alone. Participants with PTSD resulting from active military service were randomly assigned to the intervention group or treatment‐as‐usual (TAU) group. The intervention group received 24 hands‐on manipulative mind‐body therapy sessions during 6 months as add‐on to TAU. The primary outcome was the PTSD Checklist‐Military version (PCL‐M) at 6 months (postintervention). Outcome measurements were obtained at four time points; baseline, 3 months (midway), 6 months (postintervention), and 12 months (follow‐up). Intention‐to‐treat analysis was done masked to allocation. A total of 42 participants were randomized (22 control, 20 intervention). In the intervention group, two discontinued the mind‐body therapy. At postintervention, participants who had received mind‐body treatment demonstrated greater reduction in PTSD severity (PCL‐M scores between‐group mean difference: −11.1, 95% CI −17.9 to −4.2, p = 0.002, effect size d = 1.06). At follow‐up, PCL‐M scores were not statistically significant between groups (between‐group difference: −4.65, 95% CI −11.8 to 1.50). Post hoc analysis showed that number of participants remitting from PTSD from baseline to follow‐up was 25% in the intervention group and 0% in the control group. Our study showed that hands‐on mind‐body therapy over 6 months produced clinically significant decrease in PTSD symptoms. The large reduction in symptoms was not maintained 6 months after the intervention period. Further research on mind‐body therapy as adjunctive PTSD treatment is warranted.

Association of 5-HTTLPR With Post-Traumatic Stress Disorder in US Service Members

Objective Post-traumatic stress disorder (PTSD) is a mental disorder that manifests after exposure to a stressful traumatic event, such as combat experience. Accumulated evidence indicates an important genetic influence in the development of PTSD. The serotonin transporter (5-HTT) gene has been identified as a candidate for PTSD and a polymorphism of the serotonin transporter-linked promoter region (5-HTTLPR) is associated with the disorder in the general population. However, whether it is associated with PTSD in active military service members has not been investigated. This study aimed to investigate the relationship between 5-HTTLPR and PTSD in service members. Methods Leucocyte genomic DNA was extracted from service members, including those with PTSD (n = 134) or without PTSD (n = 639). The 5-HTTLPR polymorphism was detected by means of 2 stages of TaqMan fluorescent PCR assay. PTSD symptoms and symptom severity were assessed using the PTSD Checklist (PCL), a 17-item, DSM-based, self-report questionnaire with well-established validity and reliability. PTSD was determined based on endorsement of DSM-IV criteria and a PCL total score ≥ 44. Results Significant differences in biallele distribution were observed between PTSD and controls (χ2 = 7.497, P = .024). The frequency of SS, SL, and LL genotypes in the PTSD group was 0.17, 0.56, and 0.27 respectively, compared to the frequencies of 0.27, 0.43, and 0.29 in non-PTSD controls. Carriers of the L allele had higher scores for reexperiencing and arousal symptoms on the PCL, compared to SS homozygote carriers (P < .05). The triallele genotypes showed no significant differences in distribution between the PTSD and control groups (P > .05) and no relationship with PTSD symptom severity. The interaction of triallelic genotypes of 5-HTTLPR and traumatic life events was associated with re-experiencing, avoidance, and arousal (P < .05 for all). Multiple regression analysis revealed significant correlations between both biallelic and triallelic genotypes of 5-HTTLPR, the interaction of the number of stressful lifetime events, and 5-HTTLPR genotypes with PCL total score (P < .001). Conclusion Our findings suggested that 5-HTT might play a minor role in PTSD, and the interaction between 5-HTTLPR and the environment had effects on PCL score, complementing and emphasizing 5-HTT for PTSD, especially in the military population.

Reconsidering Vestibular/Ocular Motor Screening Cutoff Scores forConcussion.

Vestibular/Ocular Motor Screening (VOMS) is often part of a comprehensive evaluation to identify acute mild traumatic brain injury. Most of the reports describe the use of the VOMS in adolescents/young adults and not in older adults or military service members. The purpose of this study was to describe VOMS findings in healthy civilians and active duty military service members up to the age of 50 years. Seventy-seven healthy civilians between 18 and 50 years of age (22 males, age 31.8 [9.0] years) participated across three sites in addition to 40 healthy active duty service members (25 males, age 27.5 [4.9] years) from one site. Demographics, Neurobehavioral Symptom Inventory scores, mean near point convergence (NPC) distance, and Total Symptom Change (TSS) scores from the VOMS were evaluated. For civilians, the group mean NPC distance was 4.98 (3.8) cm. For military service members, the group mean NPC distance was 6.17 (4.57) cm. For civilians, the mean TSS was 1.2 (2.3) with 53.2% reporting 0 TSS, 27.3% reporting one TSS, and 19.5% reporting two or more TSS. For military service members, the mean TSS was 0.20 (0.72) with 92.5% reporting 0 TSS, 0% reporting one TSS, and 7.5% reporting two or more TSS. Age did not correlate with the mean NPC distance and TSS in healthy civilians and active duty military service members. Reconsideration of the Military Acute Concussion Evaluation, Version 2 cutoff value for abnormal mean NPC distance may be warranted to improve diagnostic accuracy in both civilian and military adult populations. Similarly, re-evaluating criteria for interpreting the TSS results of the VOMS, specifically in civilians, may be warranted.

Lifetime Traumatic Brain Injury and Risk of Post-Concussive Symptoms in the Millennium Cohort Study.

Traumatic brain injury (TBI) is prevalent among active duty military service members, with studies reporting up to 23% experiencing at least one TBI, with 10-60% of service members reporting at least one subsequent repeat TBI. A TBI has been associated with an increased risk of cumulative effects and long-term neurobehavioral symptoms, impacting operational readiness in the short-term and overall health in the long term. The association between multiple TBI and post-concussive symptoms (PCS), however, defined as symptoms that follow a concussion or TBI, in the military has not been adequately examined. Previous studies in military populations are limited by methodological issues including small sample sizes, the use of non-probability sampling, or failure to include the total number of TBI. To overcome these limitations, we examined the association between the total lifetime number of TBI and total number of PCS among U.S. active duty military service members who participated in the Millennium Cohort Study. A secondary data analysis was conducted using the Millennium Cohort Study's 2014 survey (n = 28,263) responses on self-reported TBI and PCS (e.g., fatigue, restlessness, sleep disturbances, poor concentration, or memory loss). Zero-inflated negative binomial models calculated prevalence ratios (PRs) and 95% confidence intervals (CIs) for the unadjusted and adjusted associations between lifetime TBIs and PCS. A third of military participants reported experiencing one or more TBIs during their lifetime with 72% reporting at least one PCS. As the mean number of PCS increased, mean lifetime TBIs increased. The mean number of PCS by those with four or more TBI (4.63) was more than twice that of those with no lifetime TBI (2.28). One, two, three, and four or more TBI had 1.10 (95% CI: 1.06-1.15), 1.19 (95% CI: 1.14-1.25), 1.23 (95% CI: 1.17-1.30), and 1.30 times (95% CI: 1.24-1.37) higher prevalence of PCS, respectively. The prevalence of PCS was 2.4 (95% CI: 2.32-2.48) times higher in those with post-traumatic stress disorder than their counterparts. Active duty military service members with a history of TBI are more likely to have PCS than those with no history of TBI. These results suggest an elevated prevalence of PCS as the number of TBI increased. This highlights the need for robust, longitudinal studies that can establish a temporal relationship between repetitive TBI and incidence of PCS. These findings have practical relevance for designing both workplace safety prevention measures and treatment options regarding the effect on and from TBI among military personnel.

Military Doctors are Members of the Scientific Council of the Russian Academy of Sciences for Radiobiology

From the moment of its creation in 1962 to the present, the Scientific Council of the Russian Academy of Sciences for Radiobiology (originally the Scientific Council at the USSR Academy of Sciences on the complex problem “Radiobiology”) has paid great attention to the damaging effects of radiation and medical radiation protection. Already the first composition of the Council included scientists who received significant experience in the field of radiobiology during active military service in educational, scientific and clinical institutions of the USSR Ministry of Defense – T.K. Dzharakyan, P.G. Zherebchenko, G.A. Zedgenidze, A.S. Mozzhukhin, V.P. Paribok. The first chairman of the Bureau of the Council was the outstanding Soviet radiobiologist A.V. Lebedinsky, who previously led radiobiological research at the Kirov Military Medical Academy. Over the years, the Council included current and retired military doctors – I.G. Akoev, E.A. Zherbin, V.I. Legeza, A.N. Grebenyuk. The Deputy Chairman of the Council, President of the Radiobiological Society of the Russian Academy of Sciences is currently I.B. Ushakov, who for a long time headed scientific institutions specialized for military radiobiology – the State Research Test Institute of Aviation and Space Medicine of the Ministry of Defense of the Russian Federation and the State Research Test Institute of Mi-litary Medicine of the Ministry of Defense of the Russian Federation. Throughout the existence of the Council, military doctors took an active part in its work, formed and supervised relevant research in the field of military radiobiology and medical radiation protection.

Poster 106: Association Between Glenoacromial Spacing and the Risk for Shoulder Instability

Objectives: Biomechanical studies have shown how the muscular dynamics about the shoulder are affected by the relative glenoid and acromion positions. Some believe these dynamics may play a role in predisposing shoulders to develop either osteoarthritis or rotator cuff disease. It is unclear if these dynamics also place individuals at increased risk for shoulder instability. To address these gaps in the literature, our objectives were to establish normative values for shoulder morphology in young physically active military service members and determine the influence of shoulder morphology, specifically the critical shoulder angle (CSA) and acromial index (AI) on rotator cuff strength and risk of shoulder instability. Methods: A subset of 160 US Service Academy cadets (25 Female, 18.81 ± 0.95 years, 177.01 ± 8.14 cm, and 72.52 ± 12.12 kg) were analyzed from a larger prospective cohort study, including all participants who sustained a shoulder instability injury during the 4-year follow-up period (n=36, all anterior). The remaining participants served as healthy controls. Upon entry to the primary study, baseline bilateral shoulder magnetic resonance imaging (MRI) and rotator cuff strength data were collected. Baseline MRIs were used to assess critical shoulder angle (CSA) defined as the angle formed between the glenoid plane at the inferior most glenoid to the lateral most aspect of the acromion and acromial index (AI) defined as glenoacromial distance (GA) divided by the glenohumeral distance (GH). Additionally, isometric internal rotation (IR) and external rotation (ER) strength was assessed at both 0° and 45° of glenohumeral abduction. Normative values for healthy shoulder morphology were reported by limb dominance. Multivariate linear regression models were used to estimate the association between shoulder morphology and strength. Finally, odds ratios (OR) were calculated using multivariate logistic regression models to estimate the likelihood of shoulder instability based on shoulder morphological outcomes. All multivariable models statistically controlled for the influence of potential confounding variables, including sex, height, weight, and limb dominance. Results: Normative baseline values for CSA, AI, glenohumeral distance and glenoacromial distance were established in young physically active military service members. In multivariate modeling, a positive relationship was detected between GH and ER strength at 45° abduction (Coefficient = 0.35, 95% CI: 0.04, 0.67), and between GA and IR strength at both 0° abduction (Coefficient = 4.29, 95% CI: 0.01, 8.56) and 45° abduction (Coefficient = 4.48, 95% CI: 0.81, 8.14). A positive relationship was detected between shoulder morphology and the likelihood of sustaining a shoulder instability injury (CSA: OR = 1.29, 95% CI: 0.97, 1.72; GA: OR = 14.63, 95% CI: 1.03, 206.98). These results indicate every 1° increase in CSA was associated with being 29% more likely to suffer a shoulder instability injury, while every 1cm increase in GA was associated with being 14 times more likely to suffer a shoulder instability injury. No other significant relationships were detected. Conclusions: Shoulder morphology was observed to play a role in both rotator cuff strength and the likelihood of glenohumeral instability injury. Interestingly, glenoacromial distance, specifically, was associated with both ER and IR strength, and the likelihood of shoulder instability. One theory is the larger the glenoacromial distance, the greater the moment arm for the anterior and posterior deltoid to act on the humerus. This increased mechanical advantage and resultant shear at the glenohumeral joint may be what contributes to the increased risk for instability. Another theory is the laterally placed acromion could be providing a fulcrum for the humerus to dislocate. Shoulder instability is a complex problem with many contributing factors and the glenoacromial scapular morphology may be yet another risk factor contributing to relative rotator cuff weakness and risk of shoulder instability in young active- duty military service members.

LIETUVOS NUOLATINĖS PRIVALOMOSIOS PRADINĖS KARO TARNYBOS KARIŲ STEREOTIPINĖS NUOSTATOS DĖL MOTERŲ KARIŲ

The present paper discusses the role of gender equality policy in the military. The aim is to find out, paying due attention to unconscious bias, whether or not soldiers enrolled in mandatory initial military service in Lithuania support any stereotypes regarding women, and if so, then what are the stereotypes they adhere to, and what are the stereotypes that women in mandatory initial military service are confronted with. The paper analyses gender equality issues in the following two important contexts: the democratic value of gender equality in military service, and the need and readiness of the military to accommodate different genders. The latter context forms a stark contrast with the former two, especially given the traditional point of view that military service is meant to ensure effective security and defence, rather than the effective implementation of gender equality. The paper analyses how stereotypical attitudes towards women as a gender support the above-mentioned tradition. Based on the results of empirical research, stereotypes have proven to be still maintained by soldiers in the target group. The dominant stereotypical attitude is that active military service may be putting women at greater risk of harassment and sexual abuse. Female soldiers in the target group are confronted with stereotypical attitudes. They link the reasons underlying the overall support of stereotypical thinking to the age of the individuals concerned, their inherited stereotypical attitudes, and their education.

Initial report on special operations clinical training at a civilian academic medical center.

Military-civilian partnerships for combat casualty care skills training have mostly focused on traditional, combat surgical team training. We sought to better understand US Special Forces (SF) Medics' training at West Virginia University in Morgantown, West Virginia, a Level 1 trauma center, via assessments of medical knowledge, clinical skills confidence, and technical performance. Special Forces Medics were evaluated using posttraining medical knowledge tests, procedural skills confidence surveys (using a 5-point Likert scale), and technical skills assessments using fresh perfused cadavers in a simulated combat casualty care environment. Data from these tests, surveys, and assessments were analyzed for 18 consecutive SF medic rotations from the calendar years 2019 through 2021. A total of 108 SF Medics' tests, surveys, and assessments were reviewed. These SF Medics had an average of 5.3 years of active military service; however, deployed experience was minimal (73% never deployed). Review of knowledge testing demonstrated a slight increase in mean test score between the precourse (80% ± 14%; range, 50-100%) when compared with the postcourse (82% ± 14%; range, 50-100%). Skills confidence scores increased between courses, specifically within the point of injury care ( p = 0.09) and prolonged field care ( p < 0.001). Technical skills assessments included cricothyroidotomy, chest tube insertion, and tourniquet placement. This study provides preliminary evidence supporting military-civilian partnerships at an academic Level 1 trauma center to provide specialty training to SF Medics as demonstrated by increase in medical knowledge and confidence in procedural skills. Additional opportunities exist for the development technical skills assessments. Therapeutic/Care Management; Level IV.

Дворянство Казанской губернии второй половины XVIII века: чиновный состав и размер душевладения

The study is based on the materials preserved in the Fund 1355 (Economic Notes to the plans of the General Land Survey of the Russian Empire) of the Russian State Archive of Ancient Acts (RGADA). These economic notes, compiled at the turn of the XVIII-XIX centuries, indicate the rank of landowner, and the number of souls according to the 5th revision. Service records (form lists) from the Fund 1349 of the Russian State Historical Archive (RGIA), years 1798-1802, had been used for the description of Kazan bureaucracy. At the end of the XVIII century, according to the 5th revision in the Kazan province, there were 1010 landowners, of which 465 were women. Most of the landowners were retired, this shows that the nobles actively used their right not to serve, granted to them by the Manifesto of 1762. Of those who served, a little more than half were in the state service, or served in garrisons, which they entered after active military (army or guards) service. Most of them retired in officer ranks. No more than 7.5 percent of nobles had general ranks of 1-5 classes. More than 20 percent of Kazan nobles owned at least a hundred souls, large landowners owning more than 500 souls compiled 5 percent. Many landowners (more than 19 percent) owned estates in other regions of the Russian Empire, most of all such estates were in the Nizhny Novgorod province. There were about 3 percent of titled nobles. The number of Kazan nobles educated at the Kazan gymnasium varies from 6 percent (in 1781) to 4 percent at the end of the 18th century. Moreover, this number of students of the Kazan gymnasium exceeds the total number of pupils of other educational institutions (primarily cadet corps). Median numbers show that nobles entered the service on average at the age of 14 (most - from 12 to 16), and received the first class rank at 21, more than half - from 18 to 24 years old. The vast majority of nobles entered military service, and then retired; a small part continued to serve in the civil service.

Psychometric Properties of the Self-Injurious Thoughts and Behaviors Interview-Short Form Among U.S. Active Duty Military Service Members and Veterans.

We assessed the interrater reliability, convergent validity, and discriminant validity of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF) in a sample of 1,944 active duty service members and veterans seeking services for posttraumatic stress disorder (PTSD) and related conditions. The SITBI-SF demonstrated high interrater reliability and good convergent and discriminant validity. The measurement properties of the SITBI-SF were comparable across service members and veterans. Approximately 8% of participants who denied a history of suicidal ideation on the SITBI-SF reported suicidal ideation on a separate self-report questionnaire (i.e., discordant responders). Discordant responders reported significantly higher levels of PTSD symptoms than those who denied suicidal ideation on both response formats. Findings suggest that the SITBI-SF is a reliable and valid interview-based measure of suicide-related thoughts and behaviors for use with military service members and veterans. Suicide risk assessment might be optimized if the SITBI-SF interview is combined with a self-report measure of related constructs.

Stigma and Barriers in Health Care Among a Sample of Transgender and Gender-Diverse Active Duty Service Members.

Transgender and/or gender-diverse (TGD) persons are vulnerable to stigma and health care inequities; however, data are particularly limited among TGD active duty military service members despite ongoing changes to service policies. TGD-related stressors may impede access to and utilization of health care due to fear of potential discrimination and distress, thereby adversely impacting military readiness. We examined stigma and barriers in health care and associations with physical and mental health in an online sample of 177 active duty service members who self-identified as TGD. To assess associations between stigma and barriers in health care with mental and physical health, linear regressions were conducted adjusting for age, gender identity, race, and rank. Over half (65%) of the participants reported at least 1 instance of stigma and/or barrier in health care. Stigma and barriers to health care were significantly associated with greater self-reported depressive symptoms (β=0.20, P =0.03), anxiety (β=0.21, P =0.03), stress (β=0.30, P =0.001), and poorer overall mental health (β=-0.23, P =0.007), after adjusting for covariates. Nearly one-quarter of participants had not disclosed their gender identity to their primary care clinician. Findings suggested that stigma and barriers to affirming health care were prevalent among active duty service members identifying as TGD, specifically, difficulty accessing gender-affirming care and negative assumptions from clinicians. These experiences may adversely affect mental health and impede the quality of health care received by a population already vulnerable to health inequities. Given recent changes to military policy, efforts may be warranted to improve access to timely, affirming care and clinician training.

Relationships Among Rumination, Resilience, Mindfulness, and Perceived PTSD Symptoms in Military Veterans Returning to College: A Cross-Sectional Study.

The influx of military Veterans with posttraumatic stress disorder (PTSD) returning to college following active military service presents an unmanageable trend for many secondary educational institutions in the United States. The current study aimed to determine relationships among rumination, resilience, mindfulness, and perceived PTSD symptoms in college student Veterans. To this end, 133 college student military Veterans registered in a U.S. university responded to an online survey. Results revealed that rumination has a direct effect on perceived PTSD symptoms and mediates the relationship between mindfulness and perceived PTSD symptoms, and that resilience moderates the relationship between mindfulness and perceived PTSD symptoms through rumination as the mediator. These findings imply that designing and developing mindfulness-based interventions for college student Veterans with PTSD requires concerted efforts targeted at improving ruminative thinking and enhancing resilience. [Journal of Psychosocial Nursing and Mental Health Services, 61(6), 43-50.].