Defense Health Research Articles

Standardization of Pulmonary Embolism Evaluation and Management Through Implementation of a Pulmonary Embolism Response Team: A Single-Center Experience at Brooke Army Medical Center.

Pulmonary embolism (PE) is associated with significant rates of morbidity and mortality. Management of PE is complex, and adverse patient events are not uncommon. Brooke Army Medical Center (BAMC) is among several select institutions that have implemented multidisciplinary pulmonary embolism response teams (PERTs) to improve PE outcomes. PERT structure varies among institutions and often involves specialty expertise from a variety of departments within the hospital. PE response teams aim to improve the diagnosis and treatment for patients with acute PE. Here, we report our initial experience with this intervention. We developed a multidisciplinary PERT and implemented a standardized algorithm to guide the evaluation, management, and disposition of patients with acute PE. Patients with PE were identified in the pre-PERT period (2015-2017) and the post-PERT period (2020-2021). A retrospective analysis of clinical characteristics, management strategies, and outcomes was performed for both cohorts. A total of 68 patients with acute PE were analyzed, 38 patients before PERT adoption, and 30 patients post-PERT. Baseline characteristics between the two cohorts were similar. A statistically significant increase in the evaluation for right ventricle dysfunction was noted in the post-PERT cohort, with 80% of patients having pro-brain natriuretic peptide labs obtained compared to 47% in the pre-PERT cohort (P = .005). Furthermore, 97% of patients in the post-PERT cohort had a transthoracic echocardiogram compared to 55% in the pre-PERT cohort (P = .0001). Six patients in the pre-PERT cohort underwent catheter-directed thrombolysis, compared to zero in the post-PERT cohort (P = .006). There were no differences in other treatment modalities. There was no statistically significant difference in length of stay between the two cohorts. To our knowledge, this is the first report describing the successful implementation of a PERT at a military treatment facility to guide the evaluation, management, and treatment of PE. The implementation of the PERT improved the appropriate diagnostic evaluation for patients with intermediate-risk PE and reduced the use of non-guideline-based catheter-directed thrombolysis. This initiative serves as an example of what could be applied across other military treatment facilities within the Defense Health Agency.

Unintended pregnancy among U.S. military active duty servicemembers: Estimates for 2018 and trends since 2005

ObjectivesTo evaluate the prevalence of and factors associated with unintended pregnancy in the past 12 months among women and men in the United States (U.S.) military in 2018, as well as trends in unintended pregnancy between 2005 and 2018. Study designThis was a cross-sectional study using the 2018 Department of Defense Health Related Behaviors Survey of active duty servicemembers. We selected a stratified random sample from members of all military service branches and used weighted logistic regression models to identify associated independent factors. A 9.6% weighted response rate to the online survey resulted in 16,806 active duty servicemembers analyzed; 4993 women aged 17 to 44 years and 11,813 men aged 17 to 45+ years. We used data from five independent surveys: 2005, 2008, 2011, 2015, and 2018 to examine trends over time. ResultsA total of 5.6% (95% CI: 4.5%–6.7%) of servicewomen reported unintended pregnancy and 2.4% (95% CI: 1.9%–2.9%) of servicemen reported to have caused unintended pregnancy. Unintended pregnancy was associated with contraception nonuse, younger age, and being either married or cohabiting. ConclusionThe decrease in prevalence of unintended pregnancy among U.S. servicemembers since 2005 mirrors the general U.S. population. Differing contraception policies during basic training across military services may influence rates of unintended pregnancy. Unintended pregnancies place a large burden on the military healthcare system, as the majority of women serving in the military are of reproductive age, and thus require care before, during, and for years after giving birth. ImplicationsUnintended pregnancy among U.S. military servicewomen relatively mirrors that seen in the U.S. population. Contraceptive policies affect unintended pregnancy throughout servicemembers’ duration of service. As they are more likely to live in states which restrict access to abortion services, servicewomen with unintended pregnancy may face increased obstacles to care.

A Cross-Sectional Analysis of Military Physician Residency Websites.

Medical physician residency program websites often serve as the first contact for any prospective applicant. No analysis of military residency program websites has yet been conducted, in contrast to their civilian counterparts. This study evaluated all military residency programs certified by the Accreditation Council for Graduate Medical Education (ACGME) 2021-2022 to determine program website comprehensiveness and accessibility and identify areas for improvement. A list of military residency programs in the USA was compiled using Defense Health Agency Graduate Medical Education resources together with the ACGME database. A total of 15 objective website criteria covering education and recruitment content were assessed by two independent evaluators. Accessibility was also scored. Programs' website scores were compared by geographic location, specialty affiliation, type of institution partnership, and program size. Analysis was performed with descriptive statistics and comparison via an unpaired t-test or Kruskal-Wallis analysis, as appropriate. A total of 124 military residency program websites were evaluated with a range of scores from 0 to 15 out of 15 possible points. Six programs had no identifiable website. All three services were represented with 43% joint-service programs. Content concerning physician education and development was more widely available than content directed toward the recruitment of applicants. The number of residency program websites reporting each content criterion varied greatly, but overall, no single service had a significantly higher score across their residencies' websites. Significant variation occurred among individual specialties (P < .05) but there was no significant difference in surgical and nonsurgical specialties. Civilian-associated programs (18 programs, 14.5%) were associated with significantly greater website comprehensiveness scored best on informatics measures for recruitment and performed 64% better than military-only programs overall. Program information in an accessible website platform allows prospective applicants to gain comprehensive perspectives of programs during the application process without reliance on personal visits and audition rotations. Limitations to in-person experiences, such as those caused by reductions in travel and concern for student safety during the global pandemic caused by the SARS-CoV-2 virus, may be alleviated by accessible virtual information. Our results indicate that there is opportunity for all military residency programs to improve their websites and better recruit applicants through understanding their audience and optimizing their reach online.

The possibility of accounting measurement of the costs of environmental performance of Iraqi industrial companies: Application study at National Company for Chemical and Plastic Industries 2018-2020

The aim of the study is to identify environmental costs and types in industrial companies, particularly the company in question, and to identify the accounting measurement of environmental costs and constraints facing the company in measurement. The study found that some environmental costs can be measured in accounting, environmental liability in the company is limited to the Industrial Protection Department and the Maintenance Department through the distribution of work to its subdivisions (Safety, Control, Civil Defense and Environmental Health), and so on difficulty in identifying and identifying environmental costs and the absence of adequate information provided by the accounting system on environmental activities. The study recommended that care should be taken to enact laws and legislation that protect the environment and disclose the harmful environmental impacts, take care to measure environmental costs and set up a specialized unit in the company to help in measuring them, minimize environmental damage resulting from the companys work and help in selecting suitable alternatives and taking appropriate decisions.

A-15 Impact of Lifetime Blast Exposure on Cognitive and Psychiatric Functioning of Warfighters

Abstract Objective: Some military occupation specialties (MOS) such as Special Forces are at high risk for lifetime blast exposure (LBE). These individuals are at risk for some medical conditions but the impact of LBE on service members and veterans (SMVs) cognitive and psychiatric function is unknown. Methods: 281 SMVs completed an assessment of Attention/Working Memory, Processing Speed, Executive Function, Memory, and Psychiatric function. Average age was 35.86 (SD = 9.84) and 61.2% had at least moderate combat exposure and 32.4% had no history of traumatic brain injury (TBI). 61 participants had no LBE, 113 were in a high-risk MOS and had LBE (M = 211.23, SD = 395.1), and 107 were not in a high-risk MOS but had LBE (M = 92.7, SD =222.9). Results: Cognitively, a small effect for LBE was observed on Processing Speed (p = 0.015, ηp2 = 0.037), but not for the other domains. Psychiatrically, a medium effect was observed (p &amp;lt; 0.001, ηp2 = 0.103). Higher LBE was associated with Somatic Complaints, Low Positive Emotions and Aberrant Experiences. However, after controlling for covariates (sex, ethnicity, post-traumatic stress, combat exposure, alcohol use, and TBI) there was no impact of LBE. Conclusion: LBE may negatively impact processing speed and psychiatric function; however, the relative impact of LBE compared to other factors such as post-traumatic stress, substance abuse, and TBI needs further investigation. The views expressed are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency or any other U.S. government agency. For more information contact dha.TBICOEinfo@mail.mil. UNCLASSIFIED.

From the Defense Health Board: Military Accessions and the Continuum of Mental Health Research.

The Defense Health Board conducted a year-long examination of mental health accession screening and related issues. In its August 2020 report, Examination of Mental Health Accession Screening: Predictive Value of Current Measures and Processes, the Board recommends a paradigm shift in how mental health impacts on readiness are understood and addressed. This shift can only occur with the development and implementation of a research plan that follows cohorts of military personnel from recruitment through their military career. The following article describes this research plan as an excerpt of the larger report.

Mobile Resources to Improve the Health and Care of Active-Duty Women

Active-duty women (ADW) represent a rapidly growing population across all military occupations. However, a Defense Health Board (DHB) comprehensive review of available health services in 2020 identified disparities in access and quality of health, medical, and operational support necessary to meet the needs of the ADW community.

Behavioral health and treatment-seeking behaviors among deployed vs. non-deployed service members: How impactful is deployment on well-being?

ABSTRACT Increasing attention has been dedicated to studying behavioral health of non-deployed military personnel. This investigation explored the impacts of a variety of sociodemographic and health factors on key behavioral health outcomes among active duty personnel. A secondary analysis was conducted using 2014 Defense Health Agency Health Related Behaviors Survey data (unweighted n = 45,762, weighted n = 1,251,606). Three logistic regression models investigated factors associated with reporting symptomatology consistent with depression, anxiety, and stress. We found that after adjusting for sociodemographic and other health variables (e.g., sleep), deployment was associated with stress but not anxiety or depression. Although deployed personnel were more likely to report increased levels of stress overall, few differences with respect to the sources of stressors were identified. While behavioral health screening and treatment needs may differ for non-deployed and deployed personnel, programs to support mental and physical well-being among all service members should be robustly promoted.

Enhanced dimensional stability of lightweight SBR/EVA foam by an inorganic scaffold structure constructed in the cell wall

The poor dimensional stability of lightweight rubber-based foam directly restricts its application. The realization of its higher dimensional stability contributes to being widely applied in the automobile industry, military equipment, aerospace, national defense engineering, medical and health care. However, this remains a huge challenge because the crystallization of rubber is too low to counterbalance the internal stresses and strains created by the rubber chains during the foaming process. Hence, An inorganic scaffold structure, containing the organically-modified lamellar montmorillonite (KDMMT) and rod-like attapulgite (KHATP) with a carbon-carbon double bond (>C C<), has been successfully constructed in the cell wall of styrene butadiene rubber/ethylene vinyl acetate (SBR/EVA) foam, which can improve the dimensional stability of SBR/EVA foam and reduce its density. The construction of the inorganic scaffold structure ascribed to a double cross-linking network structure (-C-C- and -C-S x -C-), which is based on the cellular heterogeneous nucleation while taking line tension effects at the melt-nucleator interface into account. The results indicate that when the density of SBR/EVA/KDMMT/KHATP composites foam with the inorganic scaffold structure was 0.24 g/cm 3 , the shrinkage and post shrinkage was reduced by 56.6% and 50.6%, respectively, compared with that of SBR/EVA foam (0.28 g/cm 3 ). Meanwhile, shoe soles constructed from this material have exceptional folding resistance compared to EVA foam. The inorganic scaffold structure was constructed in the cell wall of SBR/EVA/KDMMT/KHATP foam reduced its post shrinkage by 50.6%. • An inorganic scaffold structure was constructed by two shaped inorganic particles. • This structure was constructed in the cell wall based on cell heterogeneous nucleation. • The construction was ascribed to a double cross-linking network structure. • The post shrinkage of SBR/EVA composite foam reduced by 50.6%. • The foam with the inorganic scaffold structure has excellent folding resistance.

0831 Identifying Sleep-Related Breathing Disorders in Underserved Demographics Using Commercial Portable Monitoring Devices: A Case Report

Abstract Introduction An estimated twenty-five percent of American women are at high risk of having obstructive sleep apnea (OSA). However, male sex is the predominantly reported risk factor. Women are less likely to report “classic” symptoms such as snoring that prompt referral for sleep evaluation. This dichotomy potentially represents a disparity in clinical evaluation and treatment of OSA in women. Consumer digital health devices are frequently used to monitor sleep in people with and without sleep disturbances. They are generally highly sensitive yet have lower specificity when compared with formal actigraphy or polysomnography. They may be used in conjunction with physician evaluation to guide decision-making. Report of Cases: A 33 year-old female with a pertinent past medical history of obesity (BMI 37.83 kg/m ), depression, chronic pain, and anxiety was referred to our sleep center with a multi-year history of excessive daytime fatigue and non-restorative sleep that persisted despite healthy habits counseling and unremarkable lab evaluation. She ultimately presented her primary care physician with biometric data collected by her Garmin watch and Oura ring. This data, which included a reported low SpO of 83%, motivated a referral to Sleep Medicine. Her presentation Epworth Sleepiness Scale (ESS) score and Insomnia Severity Index (ISI) were 14 and 17, respectively. Polysomnography revealed an AHI of 32.6/hr, oxygen nadir of 79%, ODI of 28.7/hr, and a 97.2% sleep efficiency. PLMS index was 23.2/hour but did not contribute to sleep fragmentation and there was increased proportion of stage N3 sleep (28.2%). Severe OSA was treated with APAP. The two month follow-up ESS and ISS improved to 9 and 4, respectively. Device data revealed greater than 6 hours of consistent nightly use with a residual AHI of 3.1/hr. She subjectively stated APAP “has been a life changer” personally and professionally, as well as spousal report of resolution of snoring. Her consumer devices similarly reported improved sleep measures. Conclusion Minorities and women may be underserved in evaluation, diagnosis, and treatment of OSA. Portable monitoring using readily available consumer biometric devices may be a viable strategy for patients to further identify high risk features and prompt referral by primary care. Support (If Any) This work was supported by the Defense Health Agency, Defense Medical Research and Development Program, Clinical Research Intramural Initiative for Military Women’s Health (DM170708; Mysliwiec) and the Air Force Research Laboratory, Wright Patterson Air Force Base, Ohio (FA8650-18-2-6953; Peterson).

The Nigerian Military Public Health Response to COVID-19: A 14-Month Appraisal.

The COVID-19 pandemic has caused significant morbidity and mortality since its emergence in December 2019. In Nigeria, the government inaugurated the Presidential Task Force on COVID-19 to coordinate resources while the Nigeria Centre for Disease Control led the public health response. The Nigeria Ministry of Defence Health Implementation Programme (MODHIP), in partnership with the US Army Medical Research Directorate - Africa/Nigeria, responded immediately to the pandemic by establishing a public health emergency operations center to coordinate the military response in support of national efforts. MODHIP has 5 functional units and 6 pillars that coordinate testing, surveillance, case management, risk communication, logistics, research, and infection prevention and control. It developed an incident action plan and each pillar had its own terms of reference to guide specific response activities while preventing duplication of efforts within the military and the Nigeria Centre for Disease Control. In addition, awareness and sensitization sessions were conducted on preventive practices for COVID-19 and infrastructure was provided for hand hygiene and screening at all military facilities. Military laboratories were configured for SARS-CoV-2 testing while selected military health facilities were equipped and designated as COVID-19 treatment centers. Research proposals aimed at better understanding the disease and controlling it were also developed. The traditional combat role of the military was redirected to complement this public health emergency response. In this article, we highlight gaps, opportunities, and lessons to improve military participation in public health emergency response in the future. More funding and multisectoral collaboration with civilian institutions are key to strengthening military public health emergency preparedness and response capabilities.

0325 A Comprehensive Evaluation of Sleep Disorders in Male and Female U.S. Military Personnel

Abstract Introduction Sleep disorders are increasingly recognized in military personnel. However, no study has comprehensively evaluated male and female service members with clinically significant sleep disturbances. While, insomnia and obstructive sleep apnea (OSA) are the two most recognized sleep disorders, some studies have suggested that comorbid insomnia and OSA, also known as COMISA, potentially is the most frequent sleep disorder. Further little is known regarding the co-occurrence of nightmares, shift work disorder, depression, anxiety, and posttraumatic stress disorder (PTSD) in this population. Methods Participants were 309 active duty service members (females n = 113, male n = 196) in all branches of the military who underwent a clinically indicated sleep evaluation in a military sleep disorders center. All underwent an attended in-lab polysomnogram, were diagnosed with insomnia, OSA, or COMISA and completed self-report measures. Participants completed the Nightmare Disorder Index and Shift Work Disorder Index, and non-sleep questionnaires using the PCL-5 for post-traumatic stress disorder (PTSD), the PHQ-9 for depression, the GAD-7 for anxiety, and History of Head Injuries for traumatic brain injury (TBI). Results COMISA was diagnosed in 36.8% of the sample, insomnia in 32.7%, and OSA in 30.4%. Males were significantly more likely to have COMISA or OSA and females were more likely to have insomnia. Polysomnographic variables were consistent with the respective sleep diagnoses. Forty service members (12.9%) met criteria for nightmare disorder; those with OSA were significantly less likely to have nightmares. Shift work disorder was present in 49 (15.9%) and did not differ between sleep diagnoses. PTSD was present in 57 (18%) and those with COMISA were significantly more likely to have PTSD. A history of head injuries was reported by 38.2% and there was no difference in rates between the sleep disorder groups. Conclusion The most frequent sleep disorder profile in service members with sleep disturbances was COMISA, which was associated with significantly higher rates of PTSD and anxiety. Conversely, OSA alone was not associated with higher rates of any comorbid disorders. Nightmare disorder and shift work are relatively prevalent in military personnel with sleep disorders. Support (If Any) This work was supported by the Defense Health Agency, Defense Medical Research and Development Program, Clinical Research Intramural Initiative for Military Women’s Health (DM170708; Mysliwiec), and the Air Force Research Laboratory, Wright Patterson Air Force Base, Ohio (FA8650-18-2-6953; Peterson). The views expressed herein are solely those of the authors and do not represent an endorsement by or the official policy or position of the U.S. Air Force, the U.S. Army, the Defense Health Agency, the Department of Defense, the Department of Veterans Affairs, or the U.S. Government.

Data-driven readiness: A preliminary report on cataloging best practices in military civilian partnerships.

Between conflicts, many of the combat casualty care lessons learned are lost as the nation shifts priorities and providers leave the military. Solutions are needed to bridge the knowledge gap created by interwar periods. One of the foremost solutions is partnerships between civilian trauma centers and the military health system. Over the past two decades, a myriad of military-civilian partnerships (MCPs), which vary in their composition, duration, and focus, was created. The objective of this report is to describe the initial attempt of the Department of Defense to catalog existing MCPs to inform both civilian and military stakeholders. This initial catalog is intended as a reference to aid in future MCP development and facilitate the synchronization of efforts to improve trauma care delivery and readiness. Using methodology from the Institute of Defense Analysis, the total number of eligible trauma centers in the United States was determined. The Institute of Defense Analysis determined eligibility-based American College of Surgeons Trauma Center verification or state trauma center designation. Each military service provided their list of MCPs, which were categorized. Military-civilian partnerships were cataloged by various characteristics and program components. Key variables include number and type of personnel trained, duration of training, and focus, for example, team versus individual focused and training versus maintaining proficiency focused. A total of 1,139 hospitals in the United States are potentially eligible for MCPs. There are at least 87 unique partnerships; the majority are part-time sustainment MCPs. The Air Force has the largest number of providers in MCPs. There are many challenges to maintain accurate and up to date data on MCPs. With the collated information, the Defense Health Agency, military services, special operations community, and civilian partners will be better empowered to optimize the readiness value of their programs and better prepare our military medical providers for the nation's and military's future needs.

Integrated Health Record Viewers and Reduction in Duplicate Medical Imaging: Retrospective Observational Analysis.

BackgroundHealth information exchange and multiplatform health record viewers support more informed medical decisions, improve quality of care, and reduce the risk of adverse outcomes due to fragmentation and discontinuity in care during transition of care. An example of a multiplatform health record viewer is the VA/DoD Joint Longitudinal Viewer (JLV), which supports the Department of Veterans Affairs (VA) and Department of Defense (DoD) health care providers with read-only access to patient medical records integrated from multiple sources. JLV is intended to support more informed medical decisions such as reducing duplicate medical imaging when previous image study results may meet current clinical needs.ObjectiveWe estimated the impact of provider usage of JLV on duplicate imaging for service members transitioning from the DoD to the VA health care system.MethodsWe conducted a retrospective cross-sectional study in fiscal year 2018 to examine the relationship between providers’ use of JLV and the likelihood of ordering duplicate images. Our sample included recently separated service members who had a VA primary care visit in fiscal year 2018 within 90 days of a DoD imaging study. Patients who received at least one imaging study at VA within 90 days of a DoD imaging study of the same imaging mode and on the same body part are considered to have received potentially duplicate imaging studies. We use a logistic regression model with “JLV provider” (providers with 1 or more JLV audits in the prior 6 months) as the independent variable to estimate the relationship between JLV use and ordering of duplicate images. Control variables included provider image ordering rates in the prior 6 months, provider type, patient demographics (age, race, gender), and clinical characteristics (Elixhauser comorbidity score).ResultsProviders known to utilize JLV in the prior 6 months order fewer duplicate images relative to providers not utilizing JLV for similar visits over time (odds ratio 0.44, 95% CI 0.24-0.78; P=.005). This effect is robust across multiple specifications of linear and logistic regression models. The provider’s practice pattern of ordering image studies and the patient’s health status are powerful confounders.ConclusionsThis study provides evidence that adoption of a longitudinal viewer of health records from multiple electronic health record systems is associated with a reduced likelihood of ordering duplicate images. Investments in health information exchange systems may be effective ways to improve the quality of care and reduce adverse outcomes for patients experiencing fragmentation and discontinuity of care.

Regulation of Plant Tannin Synthesis in Crop Species.

Plant tannins belong to the antioxidant compound family, which includes chemicals responsible for protecting biological structures from the harmful effects of oxidative stress. A wide range of plants and crops are rich in antioxidant compounds, offering resistance to biotic, mainly against pathogens and herbivores, and abiotic stresses, such as light and wound stresses. These compounds are also related to human health benefits, offering protective effects against cardiovascular and neurodegenerative diseases in addition to providing anti-tumor, anti-inflammatory, and anti-bacterial characteristics. Most of these compounds are structurally and biosynthetically related, being synthesized through the shikimate-phenylpropanoid pathways, offering several classes of plant antioxidants: flavonoids, anthocyanins, and tannins. Tannins are divided into two major classes: condensed tannins or proanthocyanidins and hydrolysable tannins. Hydrolysable tannin synthesis branches directly from the shikimate pathway, while condensed tannins are derived from the flavonoid pathway, one of the branches of the phenylpropanoid pathway. Both types of tannins have been proposed as important molecules for taste perception of many fruits and beverages, especially wine, besides their well-known roles in plant defense and human health. Regulation at the gene level, biosynthesis and degradation have been extensively studied in condensed tannins in crops like grapevine (Vitis vinifera), persimmon (Diospyros kaki) and several berry species due to their high tannin content and their importance in the food and beverage industry. On the other hand, much less information is available regarding hydrolysable tannins, although some key aspects of their biosynthesis and regulation have been recently discovered. Here, we review recent findings about tannin metabolism, information that could be of high importance for crop breeding programs to obtain varieties with enhanced nutritional characteristics.

Student-Centred Approach in Medical Education

The knowledge and the beliefs on medical education influence the teaching-learning approach used by medical educators and their perception of students' ability to be active learners. This paper highlights the student-centred teaching methods used by the medical educators of the Faculty of Medicine and Defence Health, National Defence University of Malaysia for undergraduate medical student teaching, their medical education approach in teaching and their perception on students' performance.

PD11-03 ACCURACY AND RACIAL/ETHNIC REPRESENTATION OF PROSTATE CANCER SCREENING VIDEOS ON YOUTUBE AND TIKTOK

You have accessJournal of UrologyCME1 May 2022PD11-03 ACCURACY AND RACIAL/ETHNIC REPRESENTATION OF PROSTATE CANCER SCREENING VIDEOS ON YOUTUBE AND TIKTOK Max Abramson, Nathan Feiertag, Darius Javidi, Stacy Loeb, and Kara Watts Max AbramsonMax Abramson More articles by this author , Nathan FeiertagNathan Feiertag More articles by this author , Darius JavidiDarius Javidi More articles by this author , Stacy LoebStacy Loeb More articles by this author , and Kara WattsKara Watts More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002537.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Black men have higher incidence and mortality from prostate cancer than white men, and Hispanic men have an increased risk of advanced stage disease. Health-related videos on social media have increased markedly in recent years, and a vast majority of Black and Hispanic adults use social media. We investigated the content quality and racial/ethnic representation of prostate cancer screening videos on YouTube and TikTok. METHODS: The top 50 videos for the search term “prostate cancer screening” on both YouTube and TikTok were retrieved in a cache-cleared browser. Three reviewers analyzed all videos using validated criteria for the quality of consumer health information (DISCERN and PEMAT). High quality was defined as: DISCERN ≥4, PEMAT understandability ≥75%, and PEMAT actionability ≥75%. Additionally, a published Likert scale was used to demonstrate the level of misinformation compared to American Urological Association and National Comprehensive Cancer Network guidelines. Perceived race and ethnicity of people in the videos were assessed by consensus approach. RESULTS: Median number of views was lower on YouTube than TikTok (909, range: 12-221,003 vs 23,150, range: 640-13,900,000). Perceived Black and Hispanic representation was present in 10% and 6% of YouTube videos, and 20% and 12% of TikTok videos, respectively. High-risk racial/ethnic groups were explicitly discussed in 46% of YouTube videos and 8% of TikTok videos. 98% of YouTube videos and 100% of TikTok videos had low to moderate quality consumer health information, and 88% of YouTube videos and 100% of TikTok videos had moderate to high levels of misinformation based on screening guidelines. CONCLUSIONS: Social media videos about prostate cancer screening are widely viewed but do not provide quality consumer health information. Black and Hispanic men remain underrepresented on both platforms, and high-risk racial groups were not discussed in most videos despite the importance for screening criteria. The low understandability, low actionability, significant misinformation, and a lack of diversity in online videos may contribute to disparities in prostate cancer screening. Source of Funding: Funding for SL: Department of Defense Health Disparity Research Award, the Prostate Cancer Foundation and the Edward Blank and Sharon Cosloy-Blank Family Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e189 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Max Abramson More articles by this author Nathan Feiertag More articles by this author Darius Javidi More articles by this author Stacy Loeb More articles by this author Kara Watts More articles by this author Expand All Advertisement PDF DownloadLoading ...

Baseline NK cell frequencies are greater in individuals with asymptomatic SARS-CoV-2 infection compared to those that develop symptomatic illness

Abstract As NK cells are critical for control of viral infections, we tested the hypothesis that individuals with asymptomatic SARS-CoV-2 infection have greater NK cell frequencies prior to infection than individuals with mild, symptomatic infection. Marine recruits who elected to participate in the COVID-19 Health Action Response for Marines (CHARM) study were prospectively followed for two months twice weekly using PCR testing for SARS-CoV-2 infection and symptom questionnaires. Peripheral blood mononuclear cells obtained prior to infection during enrollment in the study and at various time points post-infection from 47 participants diagnosed with asymptomatic infection and 49 with symptomatic infection were analyzed by flow cytometry for frequencies of total NK cells, NK cell subsets, and surface expression of activating and inhibitory receptors. Consistent with our hypothesis, frequencies of total (CD3−CD14−CD19−CD56+) NK cells were significantly greater at baseline in asymptomatic compared to symptomatic participants (10.4% vs 8.3%, p = 0.015). This difference was due to increased frequencies of mature (CD56dimCD16+) NK cells in asymptomatic individuals (76.3% vs 69.8%, p = 0.049). No differences were observed in baseline frequencies of immature (CD56brightCD16−) or adaptive (CD56dimCD16+NKG2C+CD57+) NK cells, or in surface expression of activating (NKG2C, NKG2D) or inhibitory (NKG2A, KIR2DL1, KIR2Dl2/L3/S2, KIR3DL1) receptors. Frequencies of total and mature NK cells decreased significantly post-infection, reaching a nadir at 3–4 weeks. In contrast, frequencies of immature NK cells increased by 4 weeks. These results suggest that NK cells may play a protective role against symptomatic SARS-CoV-2 infection. This work was supported by a grant from the Defense Health Agency through the Naval Medical Research Center (work unit number 9700130).

Military Health System Opioid, Tramadol, and Gabapentinoid Prescription Volumes Before and After a Defense Health Agency Policy Release

Clinical practice guidelines (CPGs) and health system policies to mitigate inappropriate opioid prescribing practices may have an extended impact on low-dose opioid (e.g., tramadol) and non-opioid (e.g., gabapentinoid) pain medication prescribing practices. To evaluate changes in opioid, tramadol, and gabapentinoid prescribing rates from January 2016 to February 2020 within the Military Health System, including the degree to which prescribing rates changed after release of a US Defense Health Agency Procedural Instruction. In this observational health services research study, opioid, tramadol, and gabapentin prescription dispense events of US Military Health System beneficiaries enrolled in care at military treatment facilities prior to US Defense Health Agency Procedural Instruction release (January 2016-May 2018) were used to forecast values from the post-intervention period (June 2018-February 2020). The median opioid and tramadol prescribing rates decreased from January 2016 to February 2020, aside from tramadol prescribing in Surgery Clinics, which increased. Gabapentinoid prescribing rate changes were mixed. In Bayesian time series models, the forecasted proportion of patients receiving each of the three medications, regardless of age group or clinic type, did not significantly vary from the actual prescribing rates in the post-intervention period. Overall, CPGs and policies targeting opioid prescribing practices may have provided the maximal impetus for providers to re-evaluate their prescribing practices, as the policy did not appear to change the slope in prescribing rates. However, it is unclear whether the policies mitigated the likelihood of plateaus in prescribing rates. Further work is needed to assess the degree to which providers simultaneously altered other non-opioid pain medication prescribing practices, self-management recommendations, and non-pharmacological therapy referrals.

Military service branch differences in alcohol use, tobacco use, prescription drug misuse, and mental health conditions

IntroductionRates of substance use and mental health conditions vary across military service branches, yet branches also differ notably in terms of demographics and deployment experiences. This study examines whether branch differences in substance use and mental health outcomes persist after adjustment for a comprehensive set of demographic and deployment-related factors. MethodsData on 16,699 Armed Forces Active Duty service members were from the 2015 Department of Defense Health Related Behaviors Survey. Service branch-specific prevalences were estimated for self-reports of heavy episodic drinking (HED), possible alcohol use disorder (AUD), current smoking, e-cigarette use, smokeless tobacco use, prescription drug misuse, probable post-traumatic stress disorder (PTSD), probable depression, and probable anxiety. Using logistic regression, we assessed whether branch differences persisted after adjusting for an extensive array of demographic factors (among full sample) and deployment/combat factors (among ever-deployed subgroup). ResultsHED, AUD, smoking, e-cigarette use, smokeless tobacco use, depression, and anxiety were highest in the Marine Corps; prescription drug misuse and PTSD were highest in the Army. HED, AUD, smoking, smokeless tobacco use, PTSD, depression, and anxiety were lowest in the Air Force; e-cigarette use and prescription drug misuse were lowest in the Coast Guard. Demographics and deployment/combat experiences differed across branches. After adjustment, service members in the Army, Marine Corps and Navy exhibited nearly 2–3 times the odds of multiple mental health conditions and substance use behaviors relative to the Air Force. ConclusionService branch differences were not fully explained by variation in demographics and deployment/combat experiences.