Military Population Research Articles

Examining the association between aggression and suicide attempts among army soldiers.

Suicide is a major concern among active-duty military personnel. Aggression represents a salient risk factor for suicide among civilians, yet is relatively understudied among military populations. Although several theories posit a relation between aggression and suicide with putative underlying mechanisms of social isolation, access to firearms, and alcohol use, researchers have yet to test these potential mediators. This study uses rich, longitudinal data from the Army Study to Assess Risk and Resilience (STARRS) Pre/Post Deployment Study (PPDS) to examine whether aggression longitudinally predicts suicide attempts and to identify mediators of this association. Army soldiers (N = 8483) completed assessments 1 month prior to deployment and 1, 2-3, and 9-12 months post-deployment. Participants reported on their physical and verbal aggression, suicide attempts, social network size, firearm ownership, and frequency of alcohol use. As expected, pre-deployment aggression was significantly associated with suicide attempts at 12-months post-deployment even after controlling for lifetime suicide attempts. Social network size and alcohol use frequency mediated this association, but firearm ownership did not. Findings further implicate aggression as an important suicide risk factor among military personnel and suggest that social isolation and alcohol use may partially account for this association.

PROSPECTIVE DIRECTIONS OF THE DEVELOPMENT OF BIOACTIVE GLASS FIBERS FOR MEDICAL APPLICATION

The urgency of the development and use of glass fibers for the creation of microfiber dressings for the treatment of chronic wounds in combat conditions has been determined. The availability of such materials is especially important in the conditions of hostilities, which are characterized by the need for quick resuscitation of the wounded and the provision of emergency aid on the battlefield. The use of such materials will save life, shorten the rehabilitation period, and speed up the recovery of the military and civilian population. An analysis of the scientific and technical literature on the composition and properties of bioactive glass fibers for medical use was carried out. The compositions and properties of glass fibers for various purposes were analyzed and their possibility of use in the development of bioactive glass fibers for medical use was established. The selection of the compositions of bioactive glass fibers with a prolonged biocidal effect for the rapid healing of wounds and the restoration of bone tissue is substantiated. The mechanism of action of biocidal components and boron ions in the composition of bioglasses on the ability to inhibit the negative effects of pathogenic microorganisms was analyzed. The use of boroaluminophosphate glass fibers for the manufacture of effective dressings for the treatment of wounds in crisis situations in combat conditions will increase the percentage of survival and reduce the duration of treatment due to the direct action of cations and anions of the materials in vivo. The main theoretical principles of the creation of bioactive boroaluminophosphate glass fibers, modified with group II metal cations, which will be characterized by the presence of a strengthened surface layer, and characterized at the same time by high biocompatibility, biocide with prolonged action and non-toxicity, have been determined. The introduction of domestically developed bioactive glass fibers into medical practice will significantly increase the competitiveness of domestic medical materials, as well as ensure defense capability and safety, and contribute to the stabilization of the market in the conditions of sustainable development of the state.

High-Grade B-Cell Lymphoma: An Atypical Mass in the Colon.

Masses in the colon can range from benign to malignant etiologies, with adenocarcinoma being the most common malignancy. Although the most frequently encountered hematologic malignancy in the military population, lymphoma is uncommonly identified during colonoscopy. We present a rare case of an active duty service member with abdominal pain and a large mesenteric mass with extension into the cecum that was a high-grade B-cell lymphoma diagnosed through endoscopy.

Persistence With Human Immunodeficiency Virus Pre-exposure Prophylaxis in an Active-Duty Military Population.

There is limited data on Human Immunodeficiency Virus Pre-exposure Prophylaxis (PrEP) use and persistence in the military. Despite universal access to care, there is concern that PrEP persistence may be lower in military populations due to logistical challenges and perceived stigma. This study evaluated the persistence rates as well as reasons for PrEP discontinuation in a military cohort. This study evaluated all active-duty service members who received PrEP between 2020 and 2022 at a large military infectious diseases clinic. All charts were examined to determine patient characteristics. Patients who discontinued PrEP were contacted to determine the reason for discontinuation and invited to restart PrEP. In total, 112 service members received PrEP during the study period. The cohort was predominantly male (99%) with a median age 30 [IQR: 26-34] and a median of 2 years [IQR: 0-3] receiving PrEP. The most common indication was multiple sexual partners with less than 100% condom use (88%). At the end of the study, most (79%) patients were still receiving PrEP including 33 (37%) at other facilities. Of the twenty-four service members who were no longer receiving PrEP, 18 (75%), were able to be contacted. No patients contacted were interested in restarting PrEP. In this cohort with universal access to care, PrEP persistence rates were greater than seen in other populations. While the most common reason for discontinuation was changes in sexual behavior, systemic factors still contributed to PrEP discontinuation. Future studies should elucidate the challenges to PrEP care in the military.

Prevalence and risk factors for Achilles tendon rupture in the military population from 2006 to 2015: a retrospective cohort study

IntroductionAchilles tendon rupture (ATR) is a serious musculoskeletal injury that results in substantial functional decline, especially in highly physically demanding occupations such as service in the military. The purpose of...

Complementary, integrative, and standard rehabilitative therapies in a military population with chronic predominantly musculoskeletal pain: a pragmatic clinical trial with SMART design.

There is growing acceptance for combining complementary and integrative health (CIH) therapies with standard rehabilitative care (SRC) for chronic pain management, yet little evidence on the best sequence of therapies. We investigated whether starting with CIH therapies or SRC is more effective in reducing pain impact. Participants were 280 service members with predominantly (88%) musculoskeletal chronic pain referred to an interdisciplinary pain management center who were randomized to a twice weekly program of either CIH therapies (n = 140) or SRC (n = 140) for the 3-week first stage of treatment. The composition of a second 3-week treatment stage depended upon response to the first stage. The primary outcome measure was the impact score (range 8-50) from the NIH Task Force on Research Standards for Chronic Low-Back Pain. Outcomes were measured after 3 and 6 weeks of treatment and at 3- and 6-month follow-ups. Most participants were men (76.8%) and mean age was 34.7 years (SD 8.0). At end of stage 1, pain impact decreased significantly more in the CIH group (29.8 points [SD 7.2] at baseline to 26.3 points [SD 7.9], change of -3.3 points [95% confidence interval, -4.2 to -2.5]) than in the SRC group (30.8 [SD 7.6] to 29.4 [SD 7.8], change of -0.9 points [95% confidence interval, -1.8 to -0.1]; P < 0.001). No significant between-group differences were observed after 6 weeks of treatment nor at 3- or 6-month follow-ups. Complementary and integrative health therapies may provide earlier improvement in pain impact than SRC, but this difference is not sustained.

Gender Differences in "Making Weight" Behaviors Among U.S. Iraq and Afghan War Veterans: Implications for Future Health.

Objective: Failure to "make weight" carries significant consequences for military personnel including additional training burdens, stigma, possible demotion, or even separation from service. The aim of this study was to examine potential gender differences in, and investigate relationships between, military making weight behavior and obesity, eating pathology, and mental health later in life. Method: Iraq and Afghanistan war era Veterans (N = 1,126, 51.8% women) completed the Making Weight Inventory (MWI), a measure of making weight behaviors engaged in during military service, and validated measures of eating behavior and mental health. Analyses compared participants who engaged in at least one making weight behavior (MWI+) versus those who did not (MWI-). Results: Overall, 41% (n = 462) of the sample was categorized as MWI+. The most frequently endorsed making weight behavior was excessive exercise (35.7%). Among those who were MWI+, there was a significantly greater proportion of women (58.2% versus 47.3%, p < 0.001). The MWI+ group had higher rates of obesity (52.4% versus 26.2%) and had significantly higher levels of dietary restraint, emotional eating, food addiction, depression, anxiety, and posttraumatic stress disorder than the MWI- group (p's < 0.001). Conclusions: Military making weight behavior was associated with female gender, higher weight, eating pathology, and mental health later in life. Collectively, these findings suggest these factors may place female service members at a disadvantage for career advancement and salary. Efforts to better understand and address extreme making weight efforts in military populations, particularly in female service members and Veterans, are warranted.

Moral Injury in Correctional Health Care.

Due to the complex nature of correctional facilities, correctional health care professionals (CHPs) are at high risk of experiencing the harms of helping such as burnout, vicarious trauma, and post-traumatic stress disorder (PTSD). Although traditionally applied to military populations, the construct of moral injury has gained increasing application to health care and bears relevance to correctional health care. This qualitative study examines the prevalence of moral injury among CHPs while considering the moral dilemmas and ethical challenges of delivering care in a carceral environment. Employing an interpretative phenomenological analysis (IPA), 25 semi-structured interviews were conducted with a diverse sample of CHPs, selected through nonprobability, purposive sampling. Rigorous thematic analysis, guided by IPA principles, was used. The data revealed five key themes: moral injury is an occupational hazard for correctional health care workers; incidental versus cumulative moral injury; role of institutional betrayal; the intersectional relationship among moral injury, PTSD, and burnout; and the road to moral repair. These themes offer insights into the prevalence and effects of moral injury in correctional health care while offering solutions to navigating moral injury. These findings contribute to a deeper understanding of the complex ethical and psychological dynamics within correctional health care settings and explore implications for practice, policy, and future research.

The Val66Met variant of brain-derived neurotrophic factor is linked to reduced telomere length in a military population: a pilot study

In military populations, gene-environment interactions can influence performance and health outcomes. Brain-derived neurotrophic factor (BDNF) is a central nervous system protein that is important for neuronal function and synaptic plasticity. A BDNF single nucleotide polymorphism, rs6265, leads to an amino acid substitution of valine (Val) with methionine (Met) at codon 66 (Val66Met), which may influence an individual’s response to occupational stress, and predispose military members to psychological disorders. Telomere length (TL), a novel measure of biological aging, can be used as a biomarker of stress. Accordingly, telomere shortening may be a surrogate indicator of physiological weathering due to chronic disease and stressful life events. To increase our understanding about the potential effect of the Val66Met mutation on the human stress response, we evaluated the relationships between Val66Met, TL, and mental health symptoms in a military population. In this pilot study (N = 164), we observed an association between Val66Met and reduced TL (p = 0.048). There was no relationship between Val66Met and mental health symptoms. These results support the investigation of gene-environment interactions, and their potential influence on TL due to occupational stress such as military service.

Associations among psychological health problems, intimate-relationship problems, and suicidal ideation among United States Air Force active-duty personnel

ABSTRACT Linkages among psychological health problems, intimate relationship distress, and suicide risk have been widely studied, but less is known about how these factors interact, especially in military populations. With steady increases in suicide rates among active military and post-service members (SMs), it is critical to better understand the relation among known risk factors. The current study addresses this gap by testing a model hypothesizing that the association between intimate-relationship problems and suicidal ideation is mediated by individual mental health symptoms. We tested this model on a sample of 862 active-duty Air Force members in committed relationships. The sample consisted of 35.0% women and 64.8% men, with an average age of 21.9 years and a mean relationship length of 2.8 years. Findings supported the hypothesized statistical mediation model. Results indicated that relationship problems contribute to psychological health problems, which, in turn, are related to suicidal ideation. These findings may help direct suicide intervention and prevention protocols that consider intimate relationship distress as a significant risk factor. Limitations and further implications for policies regarding suicide prevention in the armed forces are discussed.

Development and validation of prediction models for prehospital triage of military trauma patients.

The introduction of wireless sensors will enable military care providers to continuously and remotely assess/monitor vital signs. Prediction models are needed to use such data adequately and aid military care providers in their on-scene decision-making to optimise prehospital triage and improve patient outcomes. A prospective cohort comprising data from eight Emergency Medical Services and seven inclusive trauma regions was used to develop and validate prediction models that could aid military care providers in their prehospital triage decisions. Healthy (American Society of Anesthesiologists physical status classification 1 or 2) admitted adult trauma patients (aged ≥16 and ≤50 years), who suffered from a trauma mechanism that could occur to military personnel and were transported by ambulance from the scene of injury to a hospital, were included. A full model strategy was used, including prehospital predictors that are expected to be automaticly collectible by wireless sensors or to be incorporated in a personalised device that could run the models. Models were developed to predict early critical-resource use (ECRU), severe head injury (Abbreviated Injury Scale (AIS) ≥4), serious thoracic injury (AIS ≥3) and severe internal bleeding (>20% blood loss). Model performance was evaluated in terms of discrimination and calibration. Prediction models were developed with data from 4625 patients (80.0%) and validated with data from 1157 patients (20.0%). The models had good to excellent discriminative performance for the predicted outcomes in the validation cohort, with an area under the curve of 0.80 (95% CI 0.76 to 0.84) for ECRU, 0.83 (0.76 to 0.91) for severe head injury, 0.75 (0.70 to 0.80) for serious thoracic injury and 0.85 (0.78 to 0.93) for severe internal bleeding. All models showed satisfactory calibration in the validation cohort. The developed models could reliably predict outcomes in a simulated military trauma population and potentially support prehospital care providers in their triage decisions.

Clinical and Radiographic Outcomes Following Anatomic Coracoclavicular Ligament Reconstruction Using Four-Strand Taped Suspensory Fixation in an Active-Duty Military Population

BackgroundAcromioclavicular (AC) joint injuries are common in young, active populations. However, there is a paucity of literature reporting surgical outcomes following the treatment of AC joint injuries in the military population. Therefore, the purpose of this study was to evaluate the clinical and radiographic outcomes of active-duty military members who underwent arthroscopic-assisted anatomic coracoclavicular ligament reconstruction using a four-strand suspensory fixation with taped sutures for treatment of high-grade AC joint injuries with a minimum 1-year follow-up. MethodsA retrospective review was performed on all patients with Rockwood grade IIIB-V AC joint separations who underwent anatomic coracoclavicular ligament reconstruction using a four-strand suspensory fixation with taped sutures at a single military treatment facility between January 2015 and May 2022. Clinical outcome measures included the Single Assessment Numeric Evaluation (SANE) score and patient satisfaction using the Likert Scale (LS). Radiographic outcomes were measured by classifying the amount of residual AC joint separation on postoperative radiographs utilizing the Rockwood classification. ResultsCoracoclavicular ligament reconstruction a using four-strand suspensory fixation with taped sutures was performed in 15 consecutive patients, all of which were active-duty military males with a mean age of 35.8 years. Preoperatively, there were 10 patients with grade IIIB injuries, 1 patient with a grade IV injury, and 4 patients with grade V injuries. The average preoperative SANE score was 40.0. The average length of time from injury to surgery was 46.5 weeks. Patient reported outcomes were available for 12 of the 15 patients (80%) at an average of 4.9 years postoperatively with an average postoperative SANE score of 77.1 (p=0.0002); 11 of these 12 patients (92%) reported they were either satisfied or extremely satisfied with the outcome of the surgery. Postoperative radiographs were available for 14 of the 15 patients (93%) at an average of 2.7 years postoperatively revealing 13 patients had maintained grade I reduction while 1 patient had a grade III separation. ConclusionCoracoclavicular ligament reconstruction a using four-strand suspensory fixation with taped sutures resulted in significantly improved radiographic and patient reported outcomes in this retrospective review of active-duty military members with grade IIIB-V AC joint separations.

Establishing Clinical Significance for Patients Undergoing Arthroscopic Repair of Type II SLAP Lesions.

Type II superior labrum anterior to posterior (SLAP) lesions may be treated with either arthroscopic repair or biceps tenodesis. There are no previous reports of measures of clinically significant improvement after arthroscopic repair of SLAP lesions. To establish the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) for patients undergoing arthroscopic repair for type II SLAP lesions. Case series; Level of evidence, 4. A total of 69 arthroscopic repair procedures for isolated type II SLAP lesions were performed in a military population. The mean age was 28.1 ± 4.7 years, 97.1% were male, and the mean follow-up was 99.5 ± 19.7 months. The MCID, PASS, and SCB were calculated for each patient-reported outcome measure, consisting of the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain, using anchor- and distribution-based models. Factors associated with achieving a clinically relevant improvement were also determined. The MCID, PASS, and SCB for each measure were as follows: 7.7, 70, and 34 for the ASES score, respectively; 10.4, 80, and 45 for the SANE, respectively; and 1.0, 4, and 6 for the VAS pain, respectively. At least 85% of patients achieved the MCID for each measure; however, PASS rates were lower, with 50.7% for the SANE and 69.6% for both the ASES score and VAS pain. The ASES score had the highest percentage of patients achieving the SCB at 44.9%, followed by the SANE (26.1%) and VAS pain (10.1%). Greater forward flexion at final follow-up was associated with achieving the MCID and PASS for both the ASES score and SANE. Internal rotation stiffness at final follow-up was negatively associated with achieving the PASS for the VAS pain. Combat arms military occupational specialty was associated with a lesser likelihood of achieving the SCB for the ASES score. Clinical metrics of improvement were defined for the ASES score, SANE, and VAS pain using the MCID, PASS, and SCB for patients undergoing arthroscopic repair of type II SLAP lesions. Better final range of motion was positively associated with achieving improvement, while high-intensity military duty was negatively associated.

Nonoperative Treatment of Isolated Posterior Glenohumeral Instability in an Active Military Population: Effect of Glenoid and Acromial Morphology

Background: Nonoperative management of posterior shoulder instability is common. However, limited data are available to assess the pathomorphologic factors associated with its failure. Purpose/Hypothesis: The purpose of this study was 2-fold: (1) to determine glenohumeral pathomorphologic features predictive of nonoperative management failure of posterior instability; and (2) to determine the relationship between nonoperative management failure and posterior glenoid bone loss (pGBL) progression. It was hypothesized that greater posterior acromial height (PAH) would adversely affect nonoperative survivorship and that shoulders treated nonoperatively would have pGBL progression compared with those undergoing surgical stabilization. Study Design: Case-control study; Level of evidence, 3. Methods: This was a retrospective review of a consecutive series of patients with isolated posterior shoulder instability, defined as isolated posterior labral tear on magnetic resonance imaging (MRI) with corresponding physical examination findings, who underwent nonoperative management for 6 months and had no previous related surgical history. The primary outcome of interest was the failure of nonoperative management, defined as the inability to return to full military duty or requiring surgical intervention. The morphologic features assessed for association with nonoperative management failure included pGBL, glenoid version, acromial morphology, and posterior humeral head subluxation. We secondarily sought to determine the progression of pGBL on serial MRI scans. Cox proportional hazard analysis was used to evaluate risk factors for failure. Results: In this study, 42 of 90 (46.7%) patients had failed nonoperative management and went on to receive an arthroscopic stabilization procedure. The group with failed treatment demonstrated a greater humeral head subluxation ratio than those with successful nonoperative management (0.65 ± 0.2 vs 0.62 ± 0.2; P = .038). Cox proportional hazard analysis identified pGBL, greater PAH, less posterior acromial coverage, and posterior humeral subluxation as significant risk factors for failure. Of those with failed nonoperative management, 17 had repeat MRI scans at a mean of 488.2 ± 87 days after index MRI for comparison, demonstrating a statistically significant progression of pGBL (index MRI, 2.68% ± 1.71%) versus after nonoperative treatment failure (6.54% ± 1.59%; P = .003). Conclusion: Failure occurred 47% of the time in patients who underwent nonoperative management for isolated posterior glenohumeral instability for a minimum of 6 months, and it was associated with a greater posterior humeral head subluxation, less posterior acromial coverage, greater PAH, and greater amounts of glenoid retroversion on index MRI. Additionally, those who had repeat MRI approximately 1 year after the index MRI demonstrated greater pGBL compared with the index MRI.

Comparison of Tuberculosis Cases in Military Personnel Versus Civilians: A Retrospective Descriptive Study.

Tuberculosis (TB) remains a leading cause of death from infectious diseases worldwide. Military personnel are particularly vulnerable to TB because of the factors like deployments to endemic regions and close-quarters living. This study aims to compare the characteristics and outcomes of symptomatic TB cases between military and civilian patients treated at 2 French military hospitals, with a specific focus on diagnostic delay. This retrospective observational study included patients over 18 years old with culture-confirmed symptomatic TB treated between 2008 and 2021. Military patients (Group A) were compared to civilian patients (Group B), matched by age and sex. Data collected included demographic details, diagnostic delay, clinical presentations, and treatment outcomes. Statistical analyses were performed using chi-squared tests and Mann-Whitney tests, with significance set at P < .05. A total of 17 military and 38 civilian patients were included in the study. The median diagnostic delay was shorter for military patients at 49 days, compared to 64 days for civilians, although this difference was not statistically significant (P = .42). In the military group, 59% had been deployed to TB endemic regions, with 35% showing symptoms during operational missions. Clinical presentations and microbiological findings were similar between the two groups. Notably, two military patients were infected with Mycobacterium canettii, likely linked to deployments in Djibouti, where this strain is endemic. The military population showed a significant burden of physical sequelae, with 25% experiencing lasting physical impairments post-treatment. Tuberculosis presentation and outcomes in military and civilian patients were generally comparable. Early diagnosis remains essential to minimize disease severity and operational impact, particularly in military settings.

Stressful Events and Oral Health Related Quality of Life Aboard: A Longitudinal Study

Stressful events may affect self-perceived general and oral health. While the working environment is known to expose military personnel to chronic stress, oral health reports in these populations is limited. This longitudinal study aimed to investigate the association of Oral Health Related Quality of Life (OHRQL) and stress in the military population aboard a training ship for 6 months. Three hundred and twenty-eight individuals were enrolled at baseline and three hundred and one at follow-up (six-month later). Completed questionnaires on Oral Health Impact Profile (OHIP-14) and Perceived Stress Scale (PSS-14) were assessed for analysis. Socio-demographic characteristics were also obtained. Multivariate Poisson regression analysis showed that PSS-14 predicted higher OHIP-14 scores at baseline and follow-up. At follow-up, besides PSS-14 (RR: 2.03; 1.42-2.90), being part of the crew group represented an increase of 87% on the OHIP-14 scores (RR:1.87; 1.27-2.74). Older individuals were 24% less likely to present higher OHIP-14 scores (RR:0.76; 0.58-0.99) than younger ones. OHRQL has worsened over time in this military population aboard (4.41±5.76 versus 5.95±6.88) and stress was an associated factor of that. The need to adjust management styles was highlighted as well as the need to prepare the staff to navigate stressful situations more effectively.

Determinants of oral health among Iranian soldiers: a structural equation modeling study

BackgroundMilitary personnel often face unique challenges in maintaining optimal oral health. This study investigated the oral health status, caries experience, and associated factors among a sample of Iranian soldiers, employing a structural equation modeling (SEM) approach to explore the complex interplay of socioeconomic and behavioral determinants.MethodsA cross-sectional study was conducted among 658 male soldiers aged 18–30 years from three military barracks in Fars province, Iran. Data were collected through a structured instrument and clinical oral examinations. The study employs the DMFT index, which measures caries experience based on decayed, missing, and filled teeth, along with the Simplified Oral Hygiene Index (OHI-S) to assess overall oral health status. Structural equation modeling was employed to analyze the complex relationships between socioeconomic factors, oral health behaviors, and oral health outcomes.ResultsThe mean DMFT score was 3.57 ± 5.91, and the mean OHIS score was 0.56 ± 1.42. SEM analysis revealed that socioeconomic status (SES) indirectly influenced DMFT and oral hygiene scores, mediated by drug use, oral hygiene practices, dietary sugar consumption, and dental visit frequency. Lower toothbrushing frequency was significantly associated with higher DMFT (Estimate = -0.064, p < 0.001) and OHIS scores (Estimate = -0.637, p < 0.001). Drug use (smoking, qalyan, alcohol) was linked to poorer oral health outcomes, while more frequent dental visits were associated with lower DMFT and OHIS scores.ConclusionThis study reveals the complex interplay between socioeconomic conditions, oral health behaviors, and oral health outcomes among Iranian soldiers. The findings highlight the need for targeted interventions to address modifiable risk factors and improve access to preventive dental care within military settings. Future longitudinal studies are warranted to elucidate further the causal pathways between these factors and oral health outcomes in military populations.

Utility of the Vestibular/Ocular Motor Screening in Military Medicine: A Systematic Review.

The Vestibular/Ocular Motor Screening (VOMS) was created as a brief clinical screening tool for identifying vestibular and ocular motor symptoms and impairments post-concussion. It was found to have predictive validity in correctly identifying concussed athletes from healthy controls. In 2018, the Military Acute Concussion Evaluation 2 (MACE2) replaced the original Military Acute Concussion Evaluation (MACE); the most prominent change between the MACE and MACE2 was the addition of the VOMS. Despite its adoption into military medicine, it is not known if the addition of the VOMS to the MACE2 is acutely helpful, and if it provides additional information for diagnosis, prognosis, and/or management. The purposes of this systematic review were: (1) to determine the utility of the VOMS in correctly identifying concussed individuals, particularly as it pertains to military medicine; (2) to explore the extent to which the VOMS can inform concussion prognosis; and (3) to establish the value of the VOMS as a measure for monitoring the evolution of symptoms throughout a service member's course of care. A comprehensive search of PubMed was performed from January 1, 2014 through August 16, 2023. Articles were included if they researched concussion or a related health condition or healthy controls and administered the VOMS. Articles were excluded if they discussed health conditions other than concussion; did not administer the VOMS; or were written in languages other than English. The tools used to assess methodological quality and risk of bias varied according to study design. Articles were classified into three primary domains: diagnosis, prognosis, and/or rehabilitation/recovery over time. A total of 231 articles were retrieved and 3 were duplicates, leaving 228 articles for review. Of the 228 articles screened, 100 relevant full-text articles were assessed for eligibility. Fifty-nine articles met our inclusion and exclusion criteria while the other 41 articles were rejected. Thirty-two articles helped to inform diagnosis, 15 prognosis, and 16 rehabilitation/recovery over time. The VOMS had excellent internal consistency and moderate to good test-retest reliability; however, a false-positive rate of 21.9% was found. Most studies indicated that a positive VOMS was associated with a delayed recovery. Several studies indicated that VOMS scores improved with targeted, active interventions and/or a symptom-guided progressive return to activity. The greatest limitation was the paucity of published evidence in the military population. More research is needed on the use of the VOMS in service members.

Alterations in Endogenous Stem Cell Populations in the Acute Phase of Blast-Induced Spinal Cord Injury.

Blast-induced spinal cord injury (bSCI) is prevalent among military populations and frequently leads to irreversible spinal cord tissue damage that manifests as sensorimotor and autonomic nervous system dysfunction. Clinical recovery from bSCI has been proven to be multifactorial, as it is heavily dependent on the function of numerous cell populations in the tissue environment, as well as extensive ongoing inflammatory processes. This varied recovery process is thought to be due to irreversible spinal cord damage after 72 hours post-injury. Stem cell therapy for spinal cord injuries has long been investigated due to these cells' proliferative nature, ability to enhance neuro-regeneration, neuroprotection, remyelination of axons, and modulation of the immune and inflammatory responses. Therefore, this study hypothesizes that the impaired function after injury is due to a lack of specific ectoderm and neural stem cell population activity at the injury site. This study aimed to elucidate changes in endogenous stem cell patterns by evaluating immunohistochemical staining densities of various stem cell markers using a preclinical thoracolumbar bSCI model. Analysis was performed 24-, 48-, and 72 hours following blast exposure. Behavior tests to assess sensory and mechanical functions were also performed. The following Cluster of differentiation (CD) markers CD105, CD45, CD133, and Vimentin, Nanog homebox (NANOG), and sex determining region Y HMG-box 2 (SOX2) positive cell populations were significantly elevated with trending increases in Octamer-binding transcription factor 4 (OCT4) in the thoracolumbar region of spinal cord tissue at 72 hours following bSCI (p < 0.05). Behavior analyses showed significant decreases in paw withdrawal thresholds in the hind limbs and changes in locomotion at 48- and 72 hours post-injury (p < 0.05). The significant increase in mesenchymal, pluripotent, and neural stem cell populations within the thoracolumbar region post-injury suggests that migratory patterns of stem cell populations are likely altered in response to bSCI. Behavioral deficits were consistent with those experienced by military personnel, such as increased pain-like behavior, reduced proprioception and coordination, and increased anxiety-like behavior post-bSCI, which underlines the translational capabilities of this model. While further research is vital to understand better the intrinsic and synergistic chemical and mechanical factors driving the migration of stem cells after traumatic injury, increased endogenous stem cell populations at the injury site indicate that stem cell-based treatments in patients suffering from bSCI could prove beneficial.

Comparing Visual Outcomes of KLEx, PRK, and LASIK Procedures in the Military Population.

To assess the 6-month visual and refractive outcomes of keratorefractive lenticule extraction (KLEx) as compared to laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in a military population at a Joint Warfighter Refractive Surgery Center. Joint Warfighter Refractive Surgery Center (JWRSC), Lackland Air Force Base, San Antonio, TX. Retrospective Study. Patients who underwent either KLEx, PRK, or LASIK between 2019-2022 were included. Anonymized data collected included demographics, pre- and post-operative uncorrected and corrected visual acuity, and manifest refraction. Of the 4,466 treated eyes, 737 (16.5%) underwent the KLEx, 2,801 (62.7%) underwent PRK, and 928 (20.8%) underwent LASIK treatment. In terms of efficacy, there was no statistically significant difference at post-operative month (POM)6 between the percentage of eyes reaching an uncorrected distance visual acuity (UDVA) of 20/20 or better between the three procedures. At POM1 (P < 0.001) and POM3 (P < 0.001), there were a greater number of eyes in the KLEx group that achieved the same or 1 line better of distance visual acuity than the PRK group. The efficacy index of KLEx, PRK, and LASIK at POM6 were 1.09, 1.10, and 0.97, respectively. The safety index for KLEx, PRK, and LASIK at POM6 were 0.96, 1.01, and 0.81, respectively. After the initial recovery period, KLEx demonstrates comparable outcomes in terms of efficacy, safety, and accuracy as compared to LASIK and PRK.