ABSTRACT I write on a spring morning in America where we find ourselves, inauspiciously but unsurprisingly, on the brink of a Holy War in the Middle East, spurred on by the very sorts of Christian men who I reported on in my 2025 book, Disciples of White Jesus: The Radicalization of American Boyhood . In such times as these, it can be difficult to take a step back from the chaotic daily headlines and missives of death, from schoolgirls in Iran to American military members serving overseas, to take stock of the underlying theological motivations of the right‐wing politicians dictating such military orders. That's why I'm grateful, however, for this issue of Dialog on the topic of Authoritarianism. I am grateful too for the opportunity to contribute an excerpt of my book that speaks to the manipulation and recasting of Jesus into a violent warmonger, akin to the weaponized and racist theology that undergirded the Crusades of the Middle Ages. I hope that readers see not only the danger of this White Jesus, but also find hope in lifting up instead the authentic, crucified Jesus of the Bible, in whom I place my ultimate faith even in dangerous days such as these. And so I offer this excerpt from my book, Chapter 4.

Objective Multi-target stool DNA (mt-sDNA) testing has demonstrated higher screening adherence compared with other colorectal cancer (CRC) screening modalities. Members of the US military tend to have higher CRC screening rates, but adherence to mt-sDNA testing among service members has not been adequately studied. Methods Mt-sDNA test adherence within one year and time to kit return was measured for individuals aged 45–64 years prescribed mt-sDNA tests through the Defense Health Agency (DHA) from April 26, 2022 to October 26, 2024. Logistic regression analysis was performed to determine demographic factors associated with adherence. Results A total of 62,209 patients were included. Overall, mt-sDNA test adherence was 80.6%. Logistic regression analysis demonstrated that patients with median household income >$125k (odds ratio [OR] 1.17, 95% CI 1.04–1.32, p = 0.007, ref: <$50k), patients with tests prescribed by gastrointestinal specialists (OR 1.55, 95% CI 1.26–1.91, p < 0.001, ref: nurse practitioner/physician assistant), patients who opted for email and text message reminders (OR 1.78, 95% CI 1.62–1.96, p < 0.001, ref: no digital communications), and patients with ≥1 prior returned test (OR 1.92, 95% CI 1.81–2.04, p < 0.001, ref: new patients) had higher odds of adherence. Adherence was high in almost all subgroups, including traditionally underserved populations. Conclusion Among more than 60,000 US military members, retirees, and their family members, 80.6% completed provider-prescribed mt-sDNA tests. Further study of factors leading to higher CRC screening adherence among military members and their families may inform the development of strategies to improve screening adherence in other populations.

The U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DOD) updated the 2019 joint clinical practice guideline (CPG) for the primary care management of asthma. This synopsis provides primary care providers with a summary of the updated 2025 recommendations regarding evaluation and management of veterans and military members with asthma. In 2024, the VA/DOD convened a guideline work group (WG), including clinical stakeholders, to update the joint VA/DOD guideline and conformed to the National Academy of Medicine's tenets for trustworthy CPGs. The WG drafted 12 key questions, reviewed systematically identified literature (20 July 2018 through 15 May 2024), evaluated the evidence, created algorithms, and advanced 21 evidence-based recommendations in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The WG strongly recommended inhaled corticosteroids (ICS) and streamlined management of asthma by suggesting a combination of ICS and rapid-onset long-acting β-agonist as both reliever and controller agents and step-up therapy by increasing ICS and/or adding long-acting anticholinergic agents. The WG also supported the management of symptomatic gastroesophageal reflux disease and obesity for better control of asthma. The WG suggested against the use of indoor air filtration devices. Finally, the WG outlined decision points for referral to a subspecialist.

Background: Retirement represents a critical transitional phase for members of the Indonesian military and civil servants, often accompanied by post-power syndrome and retirement depression, which adversely affect psychological stability, musculoskeletal function, and social participation. This study aimed to empirically analyze the effectiveness of physiotherapy interventions based on physical activity combined with psychosocial support in mitigating post power syndrome and retirement depression, while also assessing their alignment with the job demands-resources model and the successful aging theory. Methods: This study employed a quantitative analytical survey involving 200 retired Indonesian military personnel and civil servants (≥1 year post-retirement) selected through simple random sampling. Data were collected using structured Likert-scale questionnaires covering physiotherapy interventions, post-power syndrome symptoms, and mental health indicators. Validity and reliability were confirmed through pilot testing. Data were analyzed using structural equation modelling with partial least squares (SEM-PLS 4) to assess relationships and model fit through outer and inner model evaluations. Results: The results indicate that all constructs met the criteria for validity and reliability (outer loading &gt; 0.70; AVE &gt; 0.50; CR &gt; 0.80; HTMT &lt; 0.85). Physiotherapy interventions demonstrated a significant effect in reducing PPS (β = -0.62; t = 8.522; p &lt; 0.001) and retirement depression (β = -0.67; t = 7.274; p &lt; 0.001), with musculoskeletal function and physical activity engagement acting as significant partial mediators (t = 5.275; p &lt; 0.001). These findings affirmed that integrated physiotherapy interventions enhance retirees’ physical resilience and psychosocial well-being, while also holding strategic relevance for national health policies and strengthening the role of retirees as supportive components within the national defense and security system. Conclusion: This research contributes to advancing physical and mental well-being among the elderly through integrated physiotherapy interventions; however, its cross-sectional design presents a limitation, suggesting future studies adopt longitudinal approaches with broader contextual variables.

ABSTRACT Environmental, social, and governance (ESG) performance has become an important component of firms' long‐term sustainability strategies. This study examines the influence of military‐connected board members on ESG outcomes in Thai listed firms from 2000 to 2022. We find that the presence of military‐connected board members has a positive effect on overall ESG scores, particularly on the environmental component. Economically, a one standard deviation increase in the proportion of military‐connected board members and high‐ranking military board members is associated with 7.1% and 8.2% increases in the environmental score, respectively. Our findings support strategic leadership skills, ethical standards, and disciplined decision‐making hypothesis such that boards with a high ratio of military experience personnel, especially at the general level, are associated with stronger ESG performance. We also find that ESG performance improves significantly when military‐connected boards operate under a military‐affiliated government. Although the study focuses on Thailand, the findings offer broader insights into how board composition and leadership background may influence sustainability across different geographies. Overall, the findings highlight board‐level military experience as a strategic governance resource for advancing ESG performance.

Veterans and Veteran family members experiencing mental health problems face significant barriers when accessing military culturally competent providers trained in evidence-based treatments (EBTs). Telehealth is a low-cost solution that may increase access. Ongoing evaluation is needed to demonstrate the feasibility and acceptability of this emerging practice among military members and their families. Accordingly, authors piloted a telehealth clinic in 2018-19 (before the COVID-19 pandemic). Clinicians in a U.S.-based non-Veterans Affairs outpatient clinic offered military culture informed EBTs (cognitive processing therapy, acceptance and commitment therapy, and the unified protocol for transdiagnostic treatment of emotional disorders) via telehealth to Veterans and Veteran family members. Self-report measures were used to assess psychological symptoms before and after treatment and one month post-treatment. Seventy-one percent of participants (Veteran or family member) completed treatment. Participants reported significant reductions in posttraumatic stress disorder symptoms, depressive symptoms, and psychological distress, and significantly increased physical and psychological quality of life following treatment. Treatment gains were maintained or improved after one month. Participants also reported high satisfaction with treatment and strong alliances with providers. Findings show promise for use of telehealth as a solution for connecting Veterans and Veteran family members to timely, high-quality, specialized care.

Disaster preparedness is increasingly becoming a collaborative effort among multiple stakeholders in Malaysia's disaster management system. Nonetheless, states that are vulnerable to flooding, especially Kelantan, which annually experiences extreme monsoon floods, indicates a need for better preparedness measures. Collaboration has been emphasized; however, there remains a lack of empirical research modeling communication as a mediator within this area of study. Specifically, this study examined how disaster risk assessment and civil–military collaboration can improve disaster preparedness; communication was modeled as a mediator. Underpinning the Crunch Theory, the study posits that successful disaster management requires interdependent efforts involving local knowledge, community networks and military capabilities as opposed to reliance upon agency institutions alone. A quantitative methodological approach utilizing a questionnaire survey of 412 participants representing both military personnel and community members in flood-prone areas of Kelantan were used. Military ranks and community districts represented were randomly sampled to provide representative data across both strata. Descriptive statistics were calculated using SPSS version 29.0 and structural equation modeling (SEM) using SmartPLS version 4.1 were used to analyze the data. The results indicate that risk analysis, civil–military cooperation and communication significantly predict disaster preparedness (p &lt; 0.001), collectively explaining 41% of the variance (R 2 = 0.41). Furthermore, communication functions as a significant mediator, strengthening the influence of both risk analysis and civil–military cooperation on preparedness outcomes. Situational awareness and local knowledge contributed by the community and logistical support, technical expertise and leadership provided by the military are supported by communication that facilitates coordination of these resources. The findings of this study have important policy implications. It fills an identified gap in disaster preparedness research by modeling communication as a mediator and provides additional insights into disaster preparedness from the context of floods in Malaysia. Additionally, the findings of this study can be useful to policymakers at various levels including those of the National Disaster Management Agency (NADMA), the Malaysian Armed Forces and local authorities in developing strategies to strengthen civil-military collaboration, including integrated command structures and community-based early warning systems to develop more resilient communities. Keywords: Civil–military cooperation, communication, disaster preparedness, Malaysia, risk analysis, structural equation modelling

An Exploratory Analysis of Trauma and Substance Use Disorder Inpatient Treatment for Public Safety Personnel, Military Members, and Veterans.

ABSTRACT This article provides firsthand accounts of the combat experiences of Ukrainian soldiers, emphasizing the psychological toll of their exposure to morally injurious events during modern combat operations. Case studies illustrate the various contexts in which moral injuries might occur involving both military members and civilians. Other psychological issues that co-occur with moral issues as a result of combat exposures are presented including traumatic stress, profound grief, and various threats to individual identity. The authors include an analysis of the utility of the recent American Psychiatric Association’s (APA) revision of DSM-5-TR that now includes moral issues and how this conceptualization captures the experiences of soldiers fighting in the Russia–Ukraine War. The case studies presented reveal that there remain important experiences and responses that are not fully captured by the new APA conceptualization of moral injury, such as existential ethical crisis, survivor guilt, disruption of one’s role or identity, and the failure of others to uphold societal norms and expectations. Various approaches to facilitate recovery from moral injury are discussed. These approaches include the use of debriefings, remembrance memorials and structured therapeutic interventions. These approaches are intended to facilitate the soldier’s recovery from moral injury by providing immediate emotional relief, and by facilitating the soldier’s cognitive awareness of how morally injurious events can change and shape individual and collective identity. This study highlights the unique challenges faced by military personnel in modern, high-intensity warfare, and the need for early and targeted mental health interventions, including building resilience and promoting psycho-social well-being.

Hereditary spherocytosis and sickle cell disease are two distinct hematologic diseases that affect the morphology of the red blood cell, causing implications related to splenic sequestration. Concurrent disease is very rare, with even fewer reported instances requiring surgical intervention. Furthermore, an individual with a third concomitant hematologic abnormality such as Factor VII deficiency, which degrades the normal clotting cascade, has not previously been reported. We describe an active-duty servicemember with known hereditary spherocytosis, sickle cell trait, and Factor VII deficiency who had recurrent worsening pain crises post-flight. The resulting hepatobiliary and splenic damage that ensued ultimately required splenectomy. These diseases in combination further enhance risks associated with splenic damage and intra-operative bleeding, with special consideration for intra-operative risk management and long-term sequala from end-organ damage. The military population exacerbates these conditions where physical exertion, high-altitude travel, and rapid geographic reassignment are considered the norm. This case of a servicemember with a unique disease triad managed successfully with surgical correction underscores the importance of individualized care planning and consideration of duty readiness.

After the birth of the reform era, the political conditions of the Indonesian state experienced quite big changes, one of which was the limitation of the military's role in political practice in Indonesia. The military's role was returned to the national defense function in order to maintain the professionalism of the Indonesian National Army (INA). The involvement of active military members in civilian positions which is now starting to reappear has given rise to political and legal turmoil which indicates the emergence of dual functions of Indonesia Armed Forces(IAF) as during the New Order era. This harms the goals of reform and the meaning of democracy in Indonesia. This requires providing views on the impact of involvement of military members in civilian positions both from a legal, social and political perspective. Through a statutory regulatory approach, a historical approach, and a conceptual approach using qualitative normative research, we can analyze the impact of military members' involvement in civilian positions in a descriptive analytical manner. The existence of civil-military stability makes government administration strong and of high quality, however, legal uncertainty, weakening of democracy, and inequality in political practices will give rise to injustice and disrupt the nation's welfare.

Chronic pain is common among military service members, retirees, and families, yet non-pharmacologic options in primary care are limited. This pilot study evaluated the feasibility, and outcomes of Brief Cognitive Behavioral Therapy for Chronic Pain (BCBT-CP) delivered by integrated Behavioral Health Consultants (BHCs) in a Military Health System (MHS) clinic. This prospective, observational pragmatic pilot study recruited 44 Department of Defense beneficiaries (M age = 44.5years [SD = 9.3years]; 75% female; 50% Caucasian; 47.7% military family members, 38.6% retirees) with chronic pain (≥ 12weeks). As part of usual care, participants received BCBT-CP, a modular skills-based intervention delivered within the Primary Care Behavioral Health model. Measures included the Defense and Veterans Pain Rating Scale (DVPRS), the Pain, Enjoyment of Life, and General Activity (PEG-3) scale, and the Behavioral Health Measure (BHM-20), assessed at baseline, during treatment, and 3- and 6-months after the baseline assessment. Feasibility was high, with 44 of 45 approached patients enrolling in the study. These participants attended a median of 3 appointments (IQR 2-6) over 52days (IQR 22-110.5). Significant improvements were observed on DVPRS pain intensity (p < .001) and interference with activity, sleep, and stress. PEG total and subscales also improved (p < .05). No significant changes were detected on the BHM-20. Follow-up outcome data suggested partial loss of gains due to small sample size and attrition. Using BHCs to implement BCBT-CP in MHS primary care is feasible and improves short-term pain outcomes. Larger trials should test strategies to sustain benefits.

BackgroundCurrent guidelines recommend follow-up testing for syphilis to confirm treatment efficacy. Syphilis rates are higher in the United States military compared to the general population. Despite these higher rates of infection, previous data on military blood donors demonstrated less than one-third received a follow-up rapid plasma reagin (RPR) test within one year after diagnosis. It is unknown if this low follow-up rate exists across different military cohorts.Table 1.Demographic Information of 41 Individuals Diagnosed with Syphilis at Joint Base San Antonio January 2022-August 2024Table 2.Factors Associated with Follow-up Rapid Plasma Reagin Test After Syphilis DiagnosisMethodsA retrospective chart review occurred for all active-duty military members with a positive RPR test via reverse algorithm at Joint Base San Antonio between January 2022 and August 2024. Any positive RPR during the study period treated with antimicrobials was considered a true infection. Each chart was reviewed to determine demographic information, testing indication, staging, and follow-up. Patients who received a repeat RPR between 60 days and 365 days were considered to have received a follow-up RPR. A comparison was made between those who received a repeat RPR ordered and those who did not at 365 days. Nominal comparisons were made by Fisher’s Exact Test, and continuous variables were compared by Mann-Whitney U test.ResultsDuring the study period there were 121 detectable RPR tests in 77 individuals, with 41 (33.8%) determined to be new cases of syphilis. Patients were predominantly male and enlisted. Approximately half were living with HIV or receiving HIV pre-exposure prophylaxis (Table 1). The majority (80%) of cases were staged as latent infections. Of the patients with syphilis, 35 (85%) either had at least one year follow-up after diagnosis or had a repeat RPR ordered (Table 2). The majority (74%) of these individuals had a follow-up RPR ordered within a year. Factors associated with receiving a follow-up RPR included older age, living with HIV, receiving HIV pre-exposure prophylaxis, having a history of syphilis, or receiving testing in the infectious diseases clinic. Patients with late latent syphilis had the lowest follow-up rates.ConclusionThis study demonstrated a higher rate of follow-up testing than was previously seen in military blood donors. Future interventions should target those with late latent syphilis, as they had the lowest follow-up testing rates.DisclosuresAll Authors: No reported disclosures

COVID-19 Impact on Adolescent Vaccination Administration Rates in the U.S. Military Health System.

Abstract War disrupts millions of lives, particularly in low- and middle-income countries (LMICs), where armed conflicts are most frequent. While much is known about war’s detrimental effects on physical and psychological health, its long-term impact on productive aging remains unclear. This study investigates how early-life war exposure affects productive aging among older Vietnamese war survivors and examines the moderating role of past military service and war trauma exposure. Data come from the Vietnam Health and Aging Study (N = 2,447 war survivors aged 60+). Latent class analysis identifies patterns of engagement across five domains: work, in-kind support, caregiving, community involvement, and self-development. Multinomial logistic regressions assess relationships between war exposure intensity, military role, and engagement patterns. Our analyses identify five patterns of later-life productive engagement: High Engagers, Altruistic, Low Engagers, Civic Developers, and Active Workers. Greater exposure intensity is associated with profiles indicative of higher levels of engagement. Military roles moderate this relationship, with formal military veterans more likely to belong to the Active Workers class under high exposure conditions, while informal military members are more likely to be classified as Low Engagers. To promote productive aging in conflict-affected LMICs, policymakers should consider the long-term impacts of early-life war exposure and past military service. Addressing inequalities and introducing interventions earlier in the life course could enhance effectiveness.

Canada faces pressing challenges that threaten its economic stability, national security, and military readiness. Growing American nationalism and isolationism heighten the dangers of Canada's over-dependence on the United States, while economic reconstruction, a housing crisis, and increasing geopolitical threats in the North and Arctic demand urgent attention. Despite mounting international pressure, Canada's military investment remains insufficient even for its most basic necessities. Canada's Auditor General recently reported that the military itself is facing its own housing crisis, with aging and deteriorating facilities and thousands of military members without residential housing. Can there be an integrated national strategy that aligns military expansion with economic development? At critical moments in history, military mobilization has driven economic transformation in Canada, and this study proposes leveraging Canada's military to address the national housing crisis.

ABSTRACT This article explores what we have learned about Critical Military Studies (CMS) from bringing a critical lens to culture change efforts within the Canadian military. Funded by the Department of National Defence (DND), from 2022 to 2025, we ran the Transforming Military Cultures (TMC) Network, comprised of Canadian and international academics, defence scientists, military members, and veterans with an interest in advancing military culture change. Critiquing and challenging the organization we were funded by was often contradictory and always complex work. In this article, we reflect on the social, political, and institutional context of our engagement with DND/CAF. We describe the unique risks, tensions, and possibilities that arose, including the backlash and silencing we experienced when publishing our work in the Canadian Military Journal. We argue that CMS scholarship requires us to navigate the ongoing dynamic of the military’s institutional commitment and resistance to culture change alongside growing political polarization. Our work has reinforced the importance of CMS’s call to work within spaces of contradiction rather than avoiding the complexities of engaged scholarship. While we encountered limitations and pushback as CMS scholars engaged with the military, we argue that there still is value in working in this space of contradictions. We conclude by reflecting on what our experiences reveal about the possibilities and limitations of CMS in this particular moment in time and location within North America.

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.

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in male service members and veterans. This study assessed the 10-year ASCVD risk in male military service members and veterans using the model construct of the VA women CVD risk score and the 2013 ACC/AHA ASCVD risk calculator using direct military health system and Veterans Affairs (VA) Electronic Health Records (EHR) data extracted from national VA corporate data warehouse (CDW) database. Research hypothesis: Military exposure at earlier life may lead to poorer health and ultimately decreased longevity. We hypothesize that military services in earlier life may alter aging trajectory and ASCVD risk—elevated risk of ASCVD events at a younger age than 40. Methods: We retrospectively followed 3.6 million Non-Hispanic (N-H) White (n=2,823,446) and Black (n=734,940) male military service members aged 20-79 from 2012 to 2024 (development cohort). Risk factors and ASCVD events (non-fatal myocardial infarction, non-fatal stroke, cardiac arrests, and cardiac deaths) were identified using diagnostic and procedural codes from Electronic Health Records (EHR) data. Following the same constructs of the VA women CVD risk score and the 2013 ACC/AHA ASCVD risk calculators, coefficients for risk factors were estimated for men by applying time-varying Cox models to the study male development cohort data. Results: N-H Black male service members, on average 3 years younger than their white counterparts, had significantly higher systolic blood pressure, total cholesterol, HDL-C, and were more likely to be treated with anti-hypertensive medications (Tables 1 and 2). We found a log-linear association of aging with increased risk of 10-year ASCVD event in military service male members starting at ages as young as 20 years old (Figure 1.A.) across both N-H White and Black groups in contrast with the ACC/AHA ASCVD risk score (Figure 1.B.). The VA CVD risk model performed well in predicting ASCVD events at 10 years for men (C statistics N-H White 0.72 and N-H Black 0.71), while the ACC/AHA ASCVD risk calculator showed a moderate performance (C statistics N-H White 0.69; N-H Black 0.69). Conclusions: Our results point to a log-linear association of aging with increased ASCVD risk in military males starting at age 20. We call to action the need to create a better cardiovascular risk calculator that adequately assesses young male (&lt;40 years old) military service members’ ASCVD risk.

To introduce a supplement highlighting the multifaceted challenges and strengths of military families and to emphasize their essential role in individual military readiness, retention, and overall force resilience. For more than 30 years, the Tri Service Nursing Research Program (TSNRP) has been vital to supporting research that impacts military nursing science and evidence-based practice programs. Furthermore, TSNRP fosters an environment of collaboration among the Air Force, Army, and Navy in developing inquiry relevant to the military member and their families. This unique community of uniformed nurse scientists strives to maintain a continuum of research and evidenced-based practice with a focus of operational readiness, performance, and innovation. This supplement showcases research that ultimately impacts readiness and retention of the member and their family. The articles within highlight the powerful ways military families support their service members and underscore the vital role these families play in sustaining the military's strength and resilience. Join us as we explore these themes in greater depth.