Military Readiness Research Articles

Entering the Temple of Mars: Why There Is Not Substitute for the Spiritual in War

Recent scholarship validates the importance of spirituality and spiritual fitness. This article operationalizes the 2023 article “Holistic Health as a Twenty-First-Century Military Strategy: Stoic Philosophy and Spiritual Fitness for Optimizing Warfighter Readiness,” which argues that the U.S. Department of Navy should actively advocate spiritual fitness at the unit level as a means of improving military personnel’s overall health and readiness. Accordingly, this article aims to provide a scholarly response to the concept of spiritual fitness that has been discussed in various official U.S. Marine Corps documents, including Spiritual Fitness, All Marine Corps Activities (ALMAR) 033/16 (2016); Resiliency and Spiritual Fitness, ALMAR 027/20 (2020); Spiritual Fitness, ALMAR 020/24 (2024); Spiritual Fitness Leader’s Guide, Marine Corps Reference Publication 6-10.1 (2023); and Religious Ministry in the United States Marine Corps, Marine Corps Tactical Publication 3-30D (2023). This article offers a comprehensive understanding of the subject and its relevance to the Marine Corps. It does so by tracing the significance of spirituality in these documents back through Marine Corps history to Lieutenant General John A. Lejeune’s famous statement, “There is no substitute for the spiritual in war.” As such, the article systematically reviews the importance of spirituality through the statements of famed Marine Corps commandants, other revered Marine Corps leaders, as well as celebrated military leaders, noted military strategists, and philosophers. In so doing, it emphasizes the necessity of operationalizing spiritual fitness at the unit level to improve military personnel’s overall health and readiness. To this end, recent scholarship validates the importance of spirituality and spiritual fitness, supporting what many military commanders have always believed about the need for spiritual fitness. As such, the article highlights how command leadership can effectively build character and achieve this result by operationalizing spiritual fitness at the unit level in order to “enter the temple of Mars,” if called on to do so. The article concludes by acknowledging that clinical evidence and practical military wisdom validate the crucial importance of spiritual fitness in character development, military readiness, and battlefield victory.

Micronutrient Status During Military Training and Associations With Musculoskeletal Health, Injury, and Readiness Outcomes.

Micronutrient status, specifically vitamin D and iron, represent modifiable factors for optimizing military readiness. The primary purpose of this investigation was to determine associations between micronutrient deficiency (i.e.,iron status and 25-hydroxy-vitamin D [25(OH)D]) and operationally relevant outcomes (i.e.,skeletal health, musculoskeletal injury) at baseline and post-10weeks of arduous military training. A total of 227 (177 men, 50 women) Marine Officer Candidates School (OCS) candidates who completed OCS training with complete data sets were included in this analysis. Vitamin D and iron status indicators were collected at two timepoints, pre (baseline) and post OCS. Musculoskeletal outcomes at the mid- and proximal tibial diaphysis were assessed via peripheral quantitative computed tomography. Micronutrient status declined following OCS training in men and women and was associated with musculoskeletal outcomes including greater bone strength (strength strain index) at the mid-diaphysis site in those with optimal status (M = 38.26mm3, SE = 15.59) versus those without (M = -8.03mm3, SE = 17.27). In women (p = .037), endosteal circumference was greater in the deficient group (M = 53.26mm, SE = 1.19) compared with the optimal group (M = 49.47mm, SE = 1.31) at the proximal diaphysis. In men, greater baseline hepcidin concentrations were associated with an increased likelihood of suffering musculoskeletal injury during training. Vitamin D and iron status declined over the course of training, suggesting impaired micronutrient status. Differences in musculoskeletal outcomes by micronutrient group suggests optimal vitamin D and ferritin concentrations may exert beneficial effects on bone fatigability and fracture reduction during military training.

The 1991 Gulf War and the role of the Allied Air Force in destroying Iraq

When the Iraqi army invaded Kuwait, it quickly followed by a strong international reaction, each one of the United States and its allies in the West and the Gulf countries expressed their opposition and disapproval to this act of Iraq. Not only the aforementioned countries but also some of those countries that considered themselves friends of Iraq like the former Soviet Union condemned this aggressive act of Iraq. Hence, to prevent Iraq from taking further actions to attack some other Gulf countries, the United States began to send troops to Saudi Arabia. Along with the military preparations, Iraq was repeatedly warned to withdraw its forces from Kuwait, but it ignored these demands and did not withdraw from it. Consequently, an international military operation involving 34 countries could expel Iraqi forces from Kuwait from December 17 th to February 24 th 1991. Again, the Kuwaiti ruling family could return to power. In this study, we want to elucidate that although the air force strikes played a role in defeating the Iraqi army, but it was not the main factor in defeating it. In addition, it is true that during the six weeks of the International Allies’ air strikes, they dropped dozens of tons of bombs and missiles on the Iraqi army, and the Iraqi army was not capable of fighting the Allies ground forces. We have also briefly discussed the Gulf War and the reasons that led the Iraqi army to invade Kuwait, then we have discussed the role of the Allied countries’ air forces in this war, whether the air force played a major role in the Gulf War or not. Finally, the effects of the Gulf War on the Iraqi government have been explicated.

Comparing Military and Civilian Dentists' Treatment Planning Decisions: A Pilot Study.

Clinical decision-making varies among dentists. However, the literature is limited and narrow in scope regarding the variation between public and private sector dentists. Because both types of dentists' decisions can directly influence military dental readiness, it is important to understand the potential differences in diagnosis, treatment planning, and the delivery of care. The purpose of this pilot study was to compare treatment planning recommendations between civilian and military providers. Patient-level data from the 2018 Recruit Surveillance, a stratified, cross-sectional study of 1,208 randomly selected U.S. Air Force recruits, were used to evaluate treatment planning outcomes for the 2 provider groups (2 civilians; seven military providers). Treatment planning outcomes included type of noninvasive, operative, and oral surgery treatment recommended, temporomandibular disorder referrals, and orthodontic referrals. Patient demographic variables included age, gender, education, race/ethnicity, and military component ("status"). Data were examined both at the tooth level and patient level for statistical significance. Multivariate analyses were performed with statistically significant variables included in each final model for patient-level data. Data were analyzed with logistic regression and Poisson regression (alpha = 0.05). Bivariate logistic regression analyses were performed for tooth-level data. Significant differences were found between military and civilian dentists' treatment planning decisions (P < .05) for both patient-level and tooth-level data. Adjusted for significant bivariate predictors of patient demographics at the patient level, civilian dentists were more likely to refer patients for orthodontic treatment, prescribe remineralization for sound tooth surfaces, incipient caries, and carious teeth, and prescribe direct restorations for teeth with 3 to 5 carious surfaces instead of single crowns compared to military dentists. Additionally, civilian dentists were less likely to prescribe sealants for sound tooth surfaces or carious teeth. No statistically significant difference in treatment planning outcomes was observed between civilian and military dentists for sealants for incipient caries, single crowns, or extraction of third molars. At the tooth level, civilian dentists were more likely to prescribe remineralization for sound tooth surfaces, remineralization instead of sealants for carious surfaces, and extraction of third molars. No statistically significant differences were noted between civilian and military providers for recommending sealant or remineralization for teeth with incipient caries or prescribing a single crown versus placing a direct restoration on posterior teeth with 3 to 5 carious surfaces. Significant differences in treatment planning outcomes between civilian and military providers exist. Civilian providers are more likely to refer patients for orthodontic treatment and prescribe remineralization, direct restorations instead of single crowns, and third molar extractions, while military providers are more likely to prescribe sealants for sound tooth surfaces or carious teeth. Therefore, comparisons of treatment planning outcomes between civilian and military providers warrant further research.

Motivating servicemen with health problems to engage in physical training physical training

The importance of physical training today is undoubtedly relevant in solving the problems of military personnel's readiness to fulfill the assigned tasks of military and professional activities. It is known that one of the leading factors affecting the health of servicemen with disabilities is compliance with the regime of physical activity, which in turn is facilitated and played an important role by physical training and sports. The systematic formation of the need for physical training and sports depends primarily on the individual, his or her preferences, beliefs and interests, i.e. motivation. Therefore, one of the priority areas of activity of specialists involved in the rehabilitation and adaptation of servicemen with disabilities is the formation of motivation in physical training and sports in the conditions that have developed in our country after the invasion of the Russian aggressor. The article is devoted to highlighting and analyzing the problematic issues that require special attention in terms of helping to integrate servicemen who have health problems or have been severely injured during hostilities into the social environment and further motivate them to participate and engage in physical education activities.

Intensive, Real-Time Data Collection of Psychological and Physiological Stress During a 96-Hour Field Training Exercise at a Senior Military College: Feasibility and Acceptability Cohort Study.

Poor physical fitness, stress, and fatigue are factors impacting military readiness, national security, and economic burden for the United States Department of Defense. Improved accuracy of wearable biosensors and remote field biologic sample collection strategies could make critical contributions to understanding how physical readiness and occupational stressors result in on-the-job and environment-related injury, sleep impairments, diagnosis of mental health disorders, and reductions in performance in war-fighters. This study aimed to evaluate the feasibility and acceptability of intensive biomarker and biometric data collection to understand physiological and psychological stress in Army Reserved Officer Training Corps cadets before, during, and after a 96-hour field training exercise (FTX). A prospective pilot study evaluated the feasibility and acceptability of multimodal field data collection using passive drool saliva sampling, sweat sensors, accelerometry, actigraphy, and photoplethysmography. In addition, physical fitness (Army Combat Fitness Test), self-reported injury, and psychological resilience (Brief Resilience Scale) were measured. A total of 22 cadets were included. Two were lost to follow-up due to injury during FTX, for a retention rate of 91%. Assessments of performance and psychological resilience were completed for all remaining participants, resulting in 100% testing adherence. All participants provided saliva samples before the FTX, with 98% adherence at the second time point and 91% at the third. For sweat, data collection was not possible. Average daily wear time for photoplethysmography devices was good to excellent, meeting a 70% threshold with data collected for ≥80% of person-days at all time points. Of the participants who completed the FTX and 12 completed a post-FTX acceptability survey for a response rate of 60%. Overall, participant acceptance was high (≥80%) for all metrics and devices. This study demonstrates that wearable biosensors and remote field biologic sample collection strategies during a military FTX have the potential to be used in higher stakes tactical environments in the future for some, but not all, of the strategies. Overall, real-time biometric and biomarker sampling is feasible and acceptable during field-based training and provides insights and strategies for future interventions on military cadet and active-duty readiness, environmental stress, and recovery.

Associations Between Sleep Disorders and Treatment Response in Service Members With Post-traumatic Stress Symptoms: A Secondary Outcome Analysis

ABSTRACT Introduction Compared with the civilian population, a higher rate of reported sleep apnea exists among military service members resulting in inadequate sleep. Those who experience chronic sleep deprivation may suffer from debilitating problems that may compromise military mission readiness and unit safety. The purpose of the study on which this secondary outcome analysis was based was to evaluate the effect of manual standardized stress acupuncture as an adjunct therapy to an abbreviated form of cognitive behavioral therapy for insomnia for sleep disturbances in post-deployment service members. The aim of this secondary outcome analysis was 2-fold: (1) to assess the relationship between sleep disorder symptoms and post-traumatic stress symptoms (PSS) and (2) to determine if the presence of sleep disorder symptoms influenced the effects of acupuncture and cognitive behavioral therapy as compared to cognitive behavior therapy only on PSS) in post-deployment military service members. Materials and Methods The study was a 2-arm, single-center, randomized controlled trial approved by the Naval Medical Center San Diego and the Vanderbilt University Institutional Review Board. It was conducted at the U.S. Naval Hospital in Okinawa, Japan. Participants were active duty service members from all military branches who were stationed in Okinawa. Two measures were used to analyze the data: the Global Sleep Assessment Questionnaire (GSAQ) and the Post-traumatic Stress Disorder Checklist. A Pearson correlation coefficient was calculated to determine the relationship between sleep disorder symptoms (i.e., 11 pre-intervention GSAQ symptoms) and PSS treatment outcomes (i.e., PCL and PTSD clusters). Results Results indicated associations between the GSAQ components and PCL total and PTSD cluster scores. Findings showed that the presence of sleep disorder symptoms influenced PSS treatment response in post-deployment military service members. Conclusions Results from this secondary outcome analysis showed associations between GSAQ components (i.e., excessive daytime sleepiness, working conditions causing inadequate sleep, involuntary movements in sleep, and sadness or anxiousness) and PCL total and PTSD cluster scores (i.e., avoidance, negative cognition and mood, avoidance, and hyperarousal). Furthermore, sleep disorder symptoms such as having stressful working conditions (e.g., shift work), probable obstructive sleep apnea, insomnia, anxiety, and depression influenced PSS treatment responses. This study provided information on the major contribution of sleep disorder symptoms in the treatment of PSS through self-report. Future researchers should consider the use of physiologic measures to further understand the mechanisms of how sleep disorder symptoms affect treatment responses in service members with PSS. Implications for this study may assist clinicians in determining effective PSS treatments for those with OSA and insomnia.

A Description of the Dental Health and Treatment of Ukraine Military at U.S. Army Clinics in Germany.

Since the start of the Russo-Ukrainian war, most reports have focused on trauma and combat conditions. Trauma care is essential; however, disease and nonbattle injuries (DNBIs) also burden armies and reduce combat effectiveness. Dental emergencies (DEs) account for a substantial portion of DNBI, but there is limited information on Ukrainian military dental readiness. In September 2023, investigators were informed that Ukrainian military personnel were treated for DEs at 2 dental clinics in Germany. The investigators requested deidentified data from the Corporate Dental System (CDS), which is a repository for dental treatment records utilized by the U.S. Army. The data request captured DE treatment performed for Ukrainian military personnel in Germany from January 1, 2023, to September 20, 2023. The CDS report on DE encounters included the following: Gender, age, procedure codes, and provider narratives. This study was approved by the U.S. Army Institute of Surgical Research Institutional Review Board as research not involving human subjects and provided Log Number H-24-030nh. The CDS report captured 408 Ukrainian military DE encounters. A total of 360 Ukrainian military personnel were treated for DE during the 9-month reporting period in 2023. Oral surgery was the most common DE treatment category and accounted for 55.8% (N = 201) of DE procedures. Restorative dentistry procedures accounted for 18.1% of DE procedures. Of the 27 multiple category treatments, 25 had oral surgery procedures as one of the treatments. Restorative dentistry procedures were performed in 19 of the multiple category cases. The DEs in the Ukrainian military cohort suggest that chronic, untreated dental disease has progressed without routine care for years. The assertion that caries has progressed to a nonrestorable condition is supported by the distribution that 63% of all DE visits included oral surgery treatment. Based on the distribution of dental treatment, US dental officers must be proficient in oral surgery and prosthodontic care.

Испанские оборонительные мероприятия на Канарских островах в контексте британских планов овладения Макаронезией в 1940–1942 годах

This article is devoted to the efforts of Francoist Spain to ensure the defense of the Canary Archipelago in 1940–1942. The obviousness of British plans to conquer Macaronesia forced the Spaniards to take measures to preserve sovereignty over the islands. The goal was achieved in conditions of resource scarcity and the threat of a naval blockade. In this situation, the leadership of the defense resorted to emergency measures. A partial mobilization of people and resources was carried out on the archipelago. The metropolis found reserves of weapons and military equipment, which made it possible to equip thecreated group. Thescarcity of the material base limited thecapabilities of thecontingent, but its presence made it possible to prevent the primary plans of a potential enemy. The article concludes that the Spanish military preparations, along with the political and operational situation, prevented the planned British expansion against the Iberian archipelagos.

Defining performance and competency requirements for army responders to domestic flood response operations

Purpose The a priori identification and development of army personnel competencies are necessary to enable effective and efficient responses to rapidly changing climate conditions. Accordingly, this study aims to identify the performance requirements of a military flood responder and the competencies (knowledge, skills and abilities) required to perform it. Design/methodology/approach Using an abductive approach, the authors conducted both secondary and primary research to generate a validated framework of performance criteria and competencies for army personnel responding to floods. This literature review integrated both the peer-reviewed academic literature and public sector grey literature. Using the critical incident technique, the authors then conducted semi-structured interviews with 15 members of the Canadian Armed Forces (CAF) who had previously been tasked with flood response operations. Participants were asked about the tasks required while conducting flood response operations. Interview transcripts were then content analysed to identify themes regarding those tasks, and the competencies needed to perform those tasks were then extracted and contrasted with the literature review findings. Inter-rater reliability for the analysis was established via iterative discussion between the two co-authors. Findings The primary data reinforced and expanded the list of performance expectations that the authors deductively identified from the integrated literature review, adding granularity to each. It also identified competencies (including both hard and soft skills) and highlighted previously neglected contextual antecedents of military flood response effectiveness. Research limitations/implications though knowledge saturation was achieved from the 15 interviews conducted, further research with larger samples could more deeply ground the evidence discovered in this study. Nevertheless, the competencies identified in this paper could serve as a starting guide to staffing and/or training interventions targeted at improving these competencies for personnel responding to flood scenarios. Practical implications The theoretical findings also have immediate practical relevance to training for flood response operations. In particular, the subtle challenges in competency crossover from military operations to flood response operations may facilitate not only more efficient, targeted training (that could improve the effectiveness of army personnel involved in humanitarian roles), but could be applied to the selection of army personnel as well. This study may also help provincial/municipal operators and emergency planners by better communicating the strengths and limitations of army personnel in addressing civilian military cooperation for humanitarian operations. Thus, the findings of this research study represent an important first step in prompting attention to the strategic human resource planning studies required to make all responders more efficient and effective in their respective division of labour within the humanitarian domain. Social implications Peering a little beyond these research findings, human-induced climate change is expected to continue increasing the frequency of such events (IPCC, 2021), and a timely, national force is likely to be increasingly required for Canadians impacted by major disasters stemming from natural hazards when local resources become overwhelmed. Yet, there is some concern from the CAF that increasing responsiveness to disaster operations will affect their military readiness (Leuprecht and Kasurak, 2020). One can indeed envision a paradox whereby the CAF is both a “force of last resort” while increasingly becoming a “first choice for domestic disaster and emergency assistance”. The practical implications from this research also suggest that military personnel, while fully capable of successfully conducting flood response operations, may become overburdened and less able to adopt yet greater capacity and training for other additional humanitarian work. Nevertheless, the competencies highlighted by participants can help inform the next flood response operation in Canada. Originality/value Most literature in the field of emergency response focuses on cooperation between civilian and military resources and other strategic-level themes. The findings address critical granularity missing at the operational and tactical levels of humanitarian assistance and disaster relief research. The authors also draw implications beyond the military context, including for local/regional governmental players (operators and emergency planners) as well as for volunteers in flood response roles.

What is the dietary intake and nutritional status of defence members: a systematic literature review.

Optimal diet and nutrition is vital for military readiness, performance and recovery. Previous research on military diets has primarily focused on the nutritional composition of field/combat rations and dietary intake during deployment. There is accumulating research exploring the usual free-living dietary intake and nutritional status of defence members in garrison (i.e. military bases on which personnel are stationed). However, no comprehensive review has been conducted to assess the overall dietary quality of defence members internationally. Therefore, this review assessed the diets of military populations against national nutritional guidelines and Military Dietary Reference Intakes (MDRI). A systematic literature review of original research was conducted. CINAHL, Medline (EBSCO), Scopus (Elsevier), PubMed and AMED databases were searched up to the 20/02/2023. A total of thirty-six studies met the inclusion criteria. The overall quality of included studies was high, with a low risk of bias. The diet quality scores indicate poor to fair diet quality among defence members. Defence members display low intakes of fruits, vegetables, wholegrains, seafood, plant protein and nuts and high intakes of added sugars, trans fat and processed meat. Results also indicated suboptimal intake of fibre, essential fatty acids, vitamin A, vitamin E, folate, Mg, Zn and iodine. This may lead to reduced performance, increased risk of chronic diseases and mental health disorders. More research is needed to assess the long-term consequences of poor diet quality in defence members. These results require the attention of policymakers to ensure that military education and food environment is supportive of healthy eating.

A Review of Force Health Protection Aspects of Lyme Disease in the U.S. Military.

Lyme disease (LD) is an underrated threat to the military that negatively impacts mission readiness. Lyme disease has traditionally been thought to only be a risk in an operational context, where training or deployments are frequently conducted in heavily wooded environments. However, this view diminishes risks posed by many off-duty outdoor recreational activities. Furthermore, although the Army introduced a permethrin factory-treated Army Combat Uniform in 2012, permethrin retention and subsequent protection have been shown to decrease significantly after 3 months of wear. Thus, although LD is a known health risk that threatens unit readiness, beyond using treated uniforms there has been little progress at the unit level to address this threat. Focusing on a narrative review of LD and its impact on U.S. military force health protection, sources included DoD websites and policies, government press releases and information papers from sources like the CDC and FDA, and scholarly peer-reviewed journals with full-text access from the online databases EBSCOhost, MEDLINE, SCOUT, and Google Scholar. Searches included the following key words: LD and military, Army, etiology, epidemiology, incidence, treatments, post-treatment LD, and chronic LD. Articles were selected for review based on the relevance of their abstracts and titles. Although the incidence of LD appears to be increasing among service members, it is difficult to attribute this increase to military-related duties. Also, despite ongoing LD research specifically conducted and funded by the DoD, there are limited data on the mitigating effects of force education and permethrin-treated uniforms on the LD threat. Therefore, it is reasonable to conclude that LD negatively impacts military readiness and monetary costs diverted from other priorities. Lyme disease poses a genuine threat to the health and careers of service members and is an often-overlooked disruptor to military operations. Simple, feasible prevention strategies that are tailored to high-risk geographic regions can be emphasized by military units to reduce the incidence of on-duty and off-duty cases. Additionally, there remains a critical need for new preventative and diagnostic measures for LD.

War on the pandemic: European armed forces and the impact of COVID-19 deployments on military readiness

ABSTRACT Examining the impact of the coronavirus pandemic on armed forces development, this article compares and contrasts the employment of six European armed forces in their efforts to provide emergency assistance to their respective governments between the first wave of COVID-19 infections from February 2020 and the fifth wave during the winter of 2021-2022. We present a comparative analysis and classification of the tasks undertaken by French, Austrian, Italian, British, German, and Swiss soldiers in health, logistics, and security. We find that a pandemic did not figure prominently in codified security policy and military doctrine before 2020. Additionally, we illustrate that the armed forces were used as a flexible go-to resource while containing COVID-19. Their employment meant a decrease in operational readiness leading to a withdrawal of soldiers in ongoing operations as well as the cancellation of exercises.

Why are we doing this Staff? Justification and implications of aerobic fitness testing in the military.

Physical fitness is a key tenet of military organisations worldwide. Specifically, many consider aerobic fitness (AF) an essential physical attribute for ensuring optimal military performance and readiness. However, the intricate relationship between AF and various facets of military job performance necessitates comprehensive review to ascertain the appropriateness and effectiveness of its assessment. This narrative review aims to describe the relationship between AF and factors influencing individual military performance and readiness, and explores the implications of the enforcement of in-service, generic AF test standards in military populations. Databases (PubMed and Google Scholar) were searched for all relevant published peer-reviewed literature as at August 2023. Inconsistent associations were found between AF and outcomes influencing individual military performance (physical capabilities, cognitive capabilities, presenteeism and productivity, resilience, and technical/tactical capabilities) and readiness (mental health and wellbeing and physical health). Consequently, the level of AF needed for acceptable or optimal military performance remains uncertain. AF is a cornerstone of health and performance, yet linking generic AF test standards to job performance is complex, with multiple factors interacting to influence outcomes. From existing literatures, there does not appear to be a specific level of AF at, and/or above, which acceptable military performance is achieved. As such, the enforcement of and emphasis on in-service, pass/fail, generic AF test standards in military populations is questionable and requires thoughtful re-evaluation. Role/task-specific AF should be assessed through evidence-based PES and the use of generic AF tests limited to the monitoring and benchmarking of health-related fitness.

India’s Framework for Cyber Security since 2014 and its Significance for Armed Forces

The character of warfare changes with the change in its nature. In the last two decades, cyberattacks have expanded in their dimensions with the advent of digital networking in the military sector. Cyber security occupies a significant position in the Indian armed forces because of the increasing threat of cyberattacks from hostile neighbouring countries, particularly China and Pakistan. Cyber threat undermines military preparedness and warfighting capabilities by infiltrating critical weapon systems, vital infrastructure, crucial communication networks, and Intelligence, Surveillance, and reconnaissance (ISR) systems. India is now concentrating on framing its cyber security policy to mitigate the cyber threat and enhance the cyber capabilities of its armed forces. With its cyber security policy, India aspires to make digital armed forces. The present research article will focus on the efforts the Indian government has taken since 2014 to neutralize cyberattacks and the policies it has framed to ensure cyber security. The article will also analyze the significance of the government efforts on the armed forces in the direction of defensive cyber policy.

Sudden Hearing Loss in the Active Duty Population: An Epidemiological Study.

Hearing loss among military personnel is a well-known challenge, reported as the second most common VA service-connected disability. Although most hearing loss occurs gradually, a subset occurs suddenly and significantly impacts quality of life and military readiness and is considered as a medical emergency. This study aims to evaluate the incidence of sudden hearing loss among different subpopulations within the military system to better identify at-risk groups. This study was a retrospective population-based study reviewing all cases of diagnosed sudden hearing loss between January 1, 2016 and December 31, 2021 within active duty service members in the U.S. DoD. Statistical analysis of multiple subpopulations was performed. There were 2,650 cases of sudden hearing loss diagnosed in active duty service members during the study period, with an average incidence of 32.9 cases per 100,000 people per year, compared with 5 to 27 cases per 100,000 people per year reported in civilian populations. Senior officers demonstrated significantly increased rates of sudden hearing loss with 103.9 cases per 100,000 people per year, likely as a result of increased age, as did Air Force personnel with 45.1 cases per 100,000 people per year. There was no difference in incidence based on military occupational specialty, though service members located overseas were noted to have decreased incidence compared with those stationed within the USA. There was no significant difference during the years before coronavirus-19 pandemic (2016-2019) compared to the years following the start of the pandemic (2020-2021). Sudden hearing loss appears to occur more frequently in military personnel than in the civilian population. The increased incidence in senior officers is likely driven by increased age, though further evaluation into the discrepancies between reported incidence of hearing loss among enlisted service members and officers is warranted. Although military occupational specialty did not demonstrate any significant difference in incidence, for thus far unknown reasons those in the Air Force demonstrated increased rates of sudden hearing loss. Although other potentially at-risk groups were identified, focused efforts to better understand contributing factors to elevated incidence in senior officers and Air Force personnel will help to better mitigate the incidence and effects of sudden hearing loss.

Characterization of Mild Traumatic Brain Injury Cohort With Photophobia From the Defense and Veterans Eye Injury and Vision Registry.

Photophobia is a common visual symptom following mild traumatic brain injury (mTBI), which can adversely affect the military readiness and performance of service members (SMs). We employed the Defense and Veterans Eye Injury and Vision Registry (DVEIVR) to identify and describe a cohort of SMs diagnosed with photophobia post-mTBI. The objective of this study was to characterize comorbid conditions and symptoms in an mTBI cohort with photophobia, to assess their co-occurrence, to describe the persistence of photophobia, and to assess the effectiveness of utilization of currently available International Statistical Classification of Diseases and Related Health Problems (ICD) codes in reporting photophobia in this cohort. The DVEIVR database was searched to identify a cohort of SMs experiencing photophobia after mTBI. Photophobia and other potentially related conditions and symptoms, both coded and descriptive, which were abstracted directly from the medical records of SMs, were found within DVEIVR. The presence of the conditions and symptoms comorbid with photophobia was characterized on both patient and encounter levels. Analysis of co-occurrence of photophobia with these conditions or symptoms was performed on the encounter level using co-occur package in the statistical program R. Persistence of photophobia up to 1 year since the injury was assessed. The utilization of currently available ICD codes for photophobia was analyzed. A total of 639 SMs exhibiting photophobia after mTBI were identified in DVEIVR. Headaches, including migraines, were the most frequently experienced comorbidity affecting 92% of the SMs in the cohort. The second most frequent complaint was dizziness and/or vertigo (53%) followed by nausea (42%), blurry vision (31%), and irritation and discomfort in the eye (17%). In all, 20% of encounters with photophobia had a complaint of headaches, followed by 8.3% of photophobia encounters co-occurring with dizziness and vertigo, 5.7%-with nausea, 4.5%-with blurred vision, and 2.1%-with subjective sensations in the eye. All comorbidities co-occurred with photophobia at probabilities higher than by chance alone. The percentage of mTBI SMs experiencing photophobia declined to 20% at 30 days after the injury, 17% at 3 months, 12% at 6 months, and 7% at 12 months post-injury, respectively. The use of currently available ICD codes for photophobia was very low-only 27.1% of the cohort had at least 1 ICD code recorded in their medical records. The results of this study support the idea that there is a strong relationship between photophobia and headache after an mTBI. Additional research is warranted to better understand this relationship and its causes so that clinical management improves. The results of this study show a precipitous decline in the numbers of cases of photophobia after mTBI over the first 30 days and a longer-term persistence up to a year in a minority of cases, which is consistent with other research in this field. Various ICD codes, which are currently used to code for photophobia, along with other vision conditions, were not widely used to document photophobia symptoms. It is important to adopt a dedicated ICD code for photophobia to improve the surveillance, data collection, and analysis of this condition.

Superiority of High-Load vs. Low-Load Resistance Training in Military Cadets.

Øfsteng, SF, Hammarström, D, Knox, S, Jøsok, Ø, Helkala, K, Koll, L, Hanestadhaugen, M, Raastad, T, Rønnestad, BR, and Ellefsen, S. Superiority of high-load vs. low-load resistance training in military cadets. J Strength Cond Res 38(9): 1584-1595, 2024-Muscle strength and power are important determinants of soldiers' performance in modern warfare. Here, we compare the efficacy of 22 weeks of whole-body resistance training with high load (HL, 10 repetitions maximum/RM) and low load (LL, 30RM) for developing maximal muscle strength and power, performance, and muscle mass in moderately trained cadets (20 ± 1 year, f; n = 5, m; n = 22). Outcome measures were assessed at baseline and at week 22, in addition to a mid-intervention assessment at week 10. Twenty-two weeks of HL led to greater increases in muscle strength (upper limb, Δ 10%, 95% CI [2.8, 17.1], p = 0.01; lower limb, Δ 9.9%, CI [1.1, 18.6], p = 0.029), jump height (Δ 5.5%, CI [1.4, 9.6], p = 0.011), and upper limb lean mass (Δ 5.2%, CI [1, 9.4], p = 0.018) compared with LL. HL and LL led to similar changes in agility, muscle endurance performance, lower limb muscle mass, and cross-sectional area in m. vastus lateralis. For all variables, training-associated changes occurred primarily during the initial 10 weeks of the intervention, including the differential responses to HL and LL. In conclusion, although 22 weeks of HL led to greater increases in lower and upper limb muscle strength, power, and upper limb lean mass than LL, the 2 load conditions led to similar improvements in agility performance and lower limb muscle mass. Our results thus indicate that both loading regimes elicit multifaceted physiological improvements important for military readiness.

Strengthening Military Medical Provider Readiness: A Comprehensive Examination of VHA-MHS Partnerships.

Military medical readiness, particularly in surgical specialties, remains a significant concern within the Military Health System (MHS). While initiatives like the U.S. Army Military-Civilian Trauma Team (AMCT3) Program have addressed some readiness gaps, they primarily focus on trauma care, leaving other crucial medical specialties underserved. Leveraging partnerships between the Department of Veterans Affairs (VA) and the Defense Health Agency (DHA) emerges as a strategic approach to address these challenges comprehensively. Further collaboration between the VA and MHS is an opportunity to enhance military medical provider readiness, covering expanded medical specialties and health care personnel. By utilizing resource-sharing agreements (RSAs) and the Joint Incentive Fund (JIF), opportunities for increased collaboration and interoperability between the VA and MHS are explored. Challenges such as maintaining partnerships, addressing billing issues, and navigating local-level politics are identified, with proposed solutions, including establishing a centralized interagency office to monitor and manage specialty care partnerships. A comprehensive approach to enhancing military medical provider readiness through VA-MHS partnerships is crucial. By addressing readiness gaps and optimizing resource utilization, such collaboration would likely improve the overall readiness of the medical force, benefiting both military and veteran patient populations.

Autoimmune Thyroid Disease: An Unusual Cause or Confounder of Vertigo.

Over the last decade, the published literature investigating the association between thyroid function and recurrent or persistent vertigo has become more robust. We present an interesting case of persistent vertigo in a healthy 31-year-old active duty Navy pilot who was restricted from operating single-pilot rotary aircraft because of the severity of her symptoms. During her work-up, she was newly diagnosed with autoimmune thyroid disease and started on thyroid hormone supplementation. Adequately treating her underlying thyroid disease was associated with resolution of dizzy symptoms and she was granted a waiver to return to flying. This case highlights the importance of autoimmune thyroid disease as a less common but important diagnosis to consider in the broad differential for vertigo. This is especially relevant to the military population since dizziness contributes to spatial disorientation for aviators and can be highly debilitating for warfighters. Astutely diagnosing and treating underlying causes of dizziness may allow service members to return to physically demanding and mentally arduous duties, improving overall military readiness.