Operation Enduring Freedom Research Articles

Retrospective Analysis of Role II Military Hospital Emergency Department Admissions in Operation Enduring Freedom of Afghanistan

Background: The North Atlantic treaty organization (NATO)-led international security and assistance force (ISAF) conducted training, development, and humanitarian activities in addition to security operations during its 13 years in Afghanistan. Objectives: The aim of this study was to present the emergency department experiences of Kabul Ataturk Role II military hospital. Materials and Methods: We performed a retrospective observational study of emergency department admissions at Kabul Ataturk Role II Military hospital during a 12-month period from August 2012 through July 2013. Results: During the 12-month study period, 4348 patients were admitted to our emergency department. Admissions were evaluated as two groups according to trauma exposure of the patients and we detected that the Afghan civilian group had a higher number of admissions with stab wounds and burn injuries compared to the other groups. Moreover, our study results presents higher rates of surgical, orthopedic, and mixed treatments on the Afghan civilian group compared with other groups of patients. Conclusions: Humanitarian care facilities, including medical assistance, are still vital for the Afghan society. Participation of women and/or Muslim caregivers may enhance accessibility, particularly for Afghan women. We believe that the availability of emergency medicine facilities in a hospital setting at a reachable location for Afghan civilians is an effective and profitable choice for medical services. In terms of emergency medicine, the department should be prepared for orthopedic traumas, combat injuries including mine and gunshot wounds, and burn injuries.

Cutting-Edge Forward Burn Nutrition: from the Battlefield to the Burn Center

The US Army Institute of Surgical Research (USAISR) Burn Center is among the first and largest burn centers in the world and is the only US military burn center. This American Burn Association-verified facility is located on the Fort Sam Houston military base, in San Antonio, TX. It has provided comprehensive burn care to both military personnel and civilians in the South Texas area since the end of World War II. The global mission of the USAISR is to optimize combat casualty care, including care for major thermal injuries. This optimization of combat casualty care is executed clinically in the USAISR Burn Center through interdisciplinary teamwork and by advancing the care provided based on leading edge research. This article focuses on clinical lessons learned in the area of burn nutrition over the last decade at this facility during the support of the combat casualties from Operation Iraqi Freedom and Operation Enduring Freedom; it also provides a review of current evidence-based nutritional medicine practices for treating patients with thermal injuries. The extreme nutritional demand and metabolic changes associated with severe burns have been well described. This hypermetabolic, hypercatabolic response can lead to lean body mass and strength loss, resulting in the lack of ability to perform activities of daily living, as well as infection, wound healing failure, and death. Nutrition is an essential tool to avoid these catastrophic results, but monitoring the nutrition status is complicated by the whole body volume overload, resulting from the initial massive fluid resuscitation, which is required to prevent cardiovascular collapse. Techniques such as estimating weight loss from the caloric deficit must be utilized in place of actual weight loss until the interstitial fluid is reclaimed and a dry weight is achieved. Replenishing the extreme caloric expenditure and nitrogen loss is challenging; hence, careful monitoring of the nutrition intake is an essential component of burn treatment. In addition, there are a number of potential adverse effects of nutritional therapy that must also be factored into the complex decision-making regarding the initiation and delivery of nutrition in the critically ill burn population.

Symptoms of Post-Traumatic Stress Disorder and Major Depressive Disorder in Veterans of Operations Enduring Freedom/Iraqi Freedom in Comparison With Those Veterans of Other Conflicts

ABSTRACTLimited research exists on comparing psychiatric symptomatology in veterans of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) and other conflicts. The present study investigated psychiatric symptoms in 238 treatment-seeking veterans. After controlling for demographic differences, participants from OEF/OIF demonstrated a significantly smaller percentage of full diagnosis post-traumatic stress disorder (PTSD), smaller percentage of comorbid depression, and less severe self-reported PTSD intrusions than veterans from other conflicts. The present findings may help to explain previously identified differences in treatment outcome in veterans from OEF/OIF and other conflicts.

MP59-13 BURNS TO THE PERINEAL REGION INCREASE THE RISK OF DEATH AMONG U.S. SERVICE MEMBERS SUSTAINING COMBAT-RELATED BURNS DURING OPERATION IRAQI FREEDOM AND OPERATION ENDURING FREEDOM

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma1 Apr 2016MP59-13 BURNS TO THE PERINEAL REGION INCREASE THE RISK OF DEATH AMONG U.S. SERVICE MEMBERS SUSTAINING COMBAT-RELATED BURNS DURING OPERATION IRAQI FREEDOM AND OPERATION ENDURING FREEDOM Michael Clemens, Judson Janak, Julie Rizzo, Michelle Buehner, Steven Hudak, John Graybill, and Kevin Chung Michael ClemensMichael Clemens More articles by this author , Judson JanakJudson Janak More articles by this author , Julie RizzoJulie Rizzo More articles by this author , Michelle BuehnerMichelle Buehner More articles by this author , Steven HudakSteven Hudak More articles by this author , John GraybillJohn Graybill More articles by this author , and Kevin ChungKevin Chung More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.832AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Burns to the perineal region (genitals, perineum, and buttocks) present a number of unique challenges and thus have been suggested to increase morbidity and mortality compared to burn patients without perineal regional involvement. Despite the large number of U.S. Service Members (SMs) who have sustained burns involving the perineal region during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), no studies have investigated the potential impact of such burns on mortality. The objective of this study was to evaluate the relationship between combat-related burns to the perineal region and mortality among U.S. SMs during OIF/OEF. METHODS The prospectively maintained burn registry from the only burn center in the Department of Defense (United States Army Institute of Surgical Research) was retrospectively reviewed to identify all SMs with combat-related burns sustained during OIF/OEF from March 2003-October 2013. The two primary risk factors of interest were any perineal regional burn (genital, perineal, OR, buttock burns) and complete perineal regional burn (genital, perineal, AND, buttock burns). To estimate the risk of mortality associated with perineal regional burns, we performed individual Cox proportional hazard models adjusting for severe non-burn-related comorbidities (non-burn ISS ≥ 16), percent total body surface area (%TBSA) burned, and inhalational injury. RESULTS Among the 902 SMs with combat-related burns sustained during the study period, 226 (25.0%) had perineal regional involvement. SMs with perineal regional burns had greater overall injury severity as demonstrated by more severe comorbid injuries (non-burn ISS ≥ 16 in 19.5% vs. 8.9%; p < 0.0001), larger burns (median TBSA=35% vs. 5%, p < 0.0001); and greater frequency of inhalational injury (32.7% vs. 10.8%, p < 0.0001) when compared to SMs with burns not involving the perineal region. Burns involving the genitals, perineum, and buttocks were associated with a 5-fold increased risk of mortality (HR: 5.3; 2.9-9.7). However, this risk did not persist in the final adjusted model (HR=1.8; 0.8-4.0). However, percent TBSA was identified as a potential negative effect modifier. Thus, when adjusting for percent TBSA, complete perineal regional burns were associated with an independent risk of death (HR=5.6; 2.45-12.7) among SMs with burn size of < 60% TBSA. CONCLUSIONS Combat-related burns involving the genitals, perineum, and buttocks increase the risk of mortality among SMs with burn size < 60% TBSA. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e789-e790 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Michael Clemens More articles by this author Judson Janak More articles by this author Julie Rizzo More articles by this author Michelle Buehner More articles by this author Steven Hudak More articles by this author John Graybill More articles by this author Kevin Chung More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Impact of Hazardous Alcohol Use on Behavioral Healthcare Utilization Among National Guard Service Members

ABSTRACTBackground: Prior research suggests that both posttraumatic stress disorder (PTSD) and alcohol abuse affect behavioral healthcare utilization among combat-exposed military populations. However, their interactive effect is not well documented, especially after experiencing psychological trauma. Objective: This study examined the role of hazardous alcohol use (i.e. repeated patterns of drinking which lead to harmful consequences) on behavioral healthcare utilization among service members stratified by past-year combat exposure. Method: This study utilized a sample of National Guard service members who participated in an in-depth survey 2–4 months after returning from Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn deployments (2011–2013) (n = 467). We examine the marginal effect (the change in the probability) of hazardous alcohol use on utilization while controlling for trauma exposure, PTSD and other potential covariates. Results: In the unadjusted logistic model, hazardous alcohol use reduced the probability of behavioral healthcare utilization by 77% among service members who had been exposed to combat within the past year. In the adjusted model, which controlled for socio-demographics (age, gender, and race), health status (PTSD symptoms, depression and physical health), and measures of stigma (perception of services as embarrassing or harmful to one's career or social networks), hazardous alcohol use further reduced the utilization probability by 302%. Conclusion/Importance: Although these findings require replication, they appear to demonstrate that when combat-exposed service members engaged in hazardous alcohol use at postdeployment, they were much less likely to utilize behavioral healthcare to manage their posttraumatic stress symptoms during this period.

Primary Blast Exposure Increases Hippocampal Vulnerability to Subsequent Exposure: Reducing Long-Term Potentiation.

Up to 80% of injuries sustained by U.S. soldiers in Operation Enduring Freedom and Operation Iraqi Freedom were the result of blast exposure from improvised explosive devices. Some soldiers experience multiple blasts while on duty, and it has been suggested that symptoms of repetitive blast are similar to those that follow multiple non-blast concussions, such as sport-related concussion. Despite the interest in the effects of repetitive blast exposure, it remains unknown whether an initial blast renders the brain more vulnerable to subsequent exposure, resulting in a synergistic injury response. To investigate the effect of multiple primary blasts on the brain, organotypic hippocampal slice cultures were exposed to single or repetitive (two or three total) primary blasts of varying intensities. Long-term potentiation was significantly reduced following two Level 2 (92.7 kPa, 1.4 msec, 38.5 kPa·msec) blasts delivered 24 h apart without altering basal evoked response. This deficit persisted when the interval between injuries was increased to 72 h but not when the interval was extended to 144 h. The repeated blast exposure with a 24 h interval increased microglia staining and activation significantly but did not significantly increase cell death or damage axons, dendrites, or principal cell layers. Lack of overt structural damage and change in basal stimulated neuron response suggest that injury from repetitive primary blast exposure may specifically affect long-term potentiation. Our studies suggest repetitive primary blasts can exacerbate injury dependent on the injury severity and interval between exposures.

A decade of pelvic vascular injuries during the Global War on Terror

Pelvic vascular injuries (PVIs) rarely occur in isolation and are often associated with significant morbidity. The purpose of this study was to examine the incidence, trends, and early outcomes of PVIs sustained in combat. The Department of Defense Trauma Registry was queried to identify all patients treated with PVIs during the first 10years of Operation Enduring Freedom. Patient demographics, mechanism of injury, type of vascular injury, in-theater complications, and early clinical outcomes were examined. From 2003 to 2012, 143 patients (99% male) sustained a PVI in Afghanistan. During this period, there was a persistent increase in the percentage of patient visits (0.4% in 2003 to 2.0% in 2012). The mean Injury Severity Score (ISS) was 24. Sixty-six percent of patient injuries were secondary to explosions. Improvised explosive devices (IEDs) encountered by dismounted personnel accounted for 47% of all injuries and were associated with a significantly higher ISS (28) compared with all other mechanisms of injury (P< .01). There were 85 (43%) arterial and 112 (57%) venous PVIs. The most frequent arterial injury was the common iliac artery. Injury to the femoral vein was associated with a higher median transfusion requirement. One patient died in combat theater. Injuries from IEDs had higher rates of coagulopathy, acidosis, and hypothermia compared with other mechanisms of injury (P= .03). Forty-two patients (29%) sustained early infectious complications. Injuries from explosions were also associated with a significantly higher rate of infectious complications compared with other mechanisms of injury (P< .01). PVIs have occurred with increasing frequency during Operation Enduring Freedom. Despite a persistently low mortality, complication and infection rates remain high, particularly when injuries are secondary to explosions. IEDs are associated with higher ISS and complication rates. Future studies must continue to focus on the prevention and treatment of PVIs sustained in combat, particularly those caused by explosions.

Postdeployment Respiratory Health Care Encounters Following Deployment to Kabul, Afghanistan: A Retrospective Cohort Study.

Inhalational hazards are numerous in operational environments. A retrospective cohort study was conducted to investigate associations between deployment to Kabul, Afghanistan and subsequent respiratory health among U.S. military personnel. The study population consisted of personnel who deployed to Kabul, select Operation Enduring Freedom locations, personnel stationed in the Republic of Korea, and U.S.-stationed personnel. Incidence rate ratios (IRRs) were estimated for respiratory symptoms, signs, and ill-defined conditions, asthma, and chronic obstructive pulmonary disease. A significantly elevated rate of symptoms, signs, and ill-defined conditions was observed among Kabul-deployed personnel compared to personnel deployed or stationed in Bagram (IRR 1.12; 95% confidence interval [CI], 1.05-1.19), Republic of Korea (IRR 1.20; 95% CI, 1.10-1.31), and the United States (IRR 1.52; 95% CI, 1.43-1.62). A statistically elevated rate of asthma was observed among personnel deployed to Kabul, relative to U.S.-stationed personnel (IRR 1.61; 95% CI, 1.22-2.12). Statistically significant rates were not observed for chronic obstructive pulmonary disease among Kabul-deployed personnel compared to other study groups. These findings suggest that deployment to Kabul is associated with an elevated risk of postdeployment respiratory symptoms and new-onset asthma.

Examination of the dynamic interplay between posttraumatic stress symptoms and alcohol misuse among combat-exposed Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) Veterans

BackgroundAlthough alcohol misuse co-occurs with PTSD symptoms at a strikingly high rate (i.e., nearly 52% of men and 28% of women with PTSD also meet diagnostic criteria for an Alcohol Use Disorder), the functional associations between these symptom types remain unclear. MethodsThe current study sought to clarify the nature of posttraumatic stress-alcohol misuse relations by employing a prospective longitudinal methodology-the latent difference score approach-to examine dynamic change in posttraumatic stress symptoms and alcohol misuse among 478 combat-exposed Veterans completing a longitudinal survey of post-deployment mental and physical health. This study builds on the existing literature, as most prior research has been limited to cross-sectional studies and has not explored prospective relations between specific PTSD symptom clusters and alcohol misuse. ResultsConsistent with the self-medication model, results indicated that PTSD symptoms demonstrate a prospective and proximal association with alcohol misuse during the assessment period; however, alcohol misuse did not appear to be a unique contributor to overall PTSD symptom exacerbation over time. Examination of individual PTSD symptom clusters revealed that more severe symptoms of intrusion and numbing, but not avoidance and hyperarousal, predicted greater alcohol misuse at subsequent time intervals. LimitationsThe constructs examined within this investigation relied on self-report data; diagnostic criteria for PTSD and/or Alcohol Use Disorders were not assessed. Future work may benefit from replicating these findings in clinical populations formally diagnosed with PTSD via clinician-administered structured interviews. ConclusionsFindings underscore the importance of addressing PTSD symptoms in the context of alcohol treatment to facilitate improved drinking outcomes.

Predictors of Inpatient PTSD Treatment Noncompletion Among OEF/OIF/OND Veterans

ABSTRACTVeterans returning from Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) display high rates of noncompletion from post-traumatic stress disorder (PTSD) treatment. The present study included 282 male OEF/OIF/OND veterans and examined predictors of noncompletion from inpatient evidence-based treatment (EBT) for PTSD. Logistic regression analyses identified younger age, higher military rank, less improvement in symptom reduction, less improvement in overall functioning, and greater concurrent drug use at admission as significant and unique predictors of noncompletion. Overall, these findings reveal clinically relevant predictors of noncompletion and provide information that may increase PTSD treatment completion.

5. Applying Data Mining Methods to Blast‐Related Mild Traumatic Brain Injury

Mild traumatic brain injury (mTBI), or concussion, is one of the most common forms of injury sustained throughout Operations Iraqi Freedom and Enduring Freedom. Diagnosis is difficult for many of the symptoms are very common and may not manifest themselves immediately after the injury. Many studies on blast‐related mTBI have been published from research regarding the current war in Iraq and Afghanistan. Continuous work is underway to more accurately determine its causes and symptoms, as mTBI is considered difficult to diagnose. Using the Oak Ridge National Laboratory (ORNL) developed data mining software PIRANHA, an integrative literature analysis was conducted to assist and facilitate possible research on the processes of mTBI. Data were collected from academic databases as well as PIRANHA’s internet search function. The PIRANHA categories feature was employed to visualize the areas of overlapping research regarding manifestations of mTBI relating to the biological processes and behavioral changes. PIRANHA was also used to review current research on mTBI, including animal testing on mice and swine. The integrated results from these data mining analyses revealed areas that could be studied further, as well as a clearer indication of the specific processes of mTBI. These results can contribute to ORNL’s current LDRD, an mTBI‐specific project.

The Association Between Military Sexual Trauma and Use of VA and Non-VA Health Care Services Among Female Veterans With Military Service in Iraq or Afghanistan.

Military sexual trauma (MST) has been linked with increased rates of mental health disorders among veterans. Few studies have addressed how MST is related to use of VA and non-VA health care. The purpose of the current study was to (a) examine the association between MST, combat experiences, and mental health outcomes (i.e., posttraumatic stress disorder [PTSD] and depression) and (b) examine the association of MST and use of VA and non-VA health care services among female veterans who served in Iraq and Afghanistan. Female respondents to a survey assessing Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans' needs and health ( N = 185) completed measures of demographic variables, military history, combat exposure, MST, PTSD, and depression symptoms, and use of VA and non-VA health care. Overall, 70% of the sample experienced one or more combat-related experiences and 15.7% endorsed MST during deployment to Iraq or Afghanistan. MST and combat exposure were both positively associated with PTSD and depression symptoms even after controlling for the effects of demographic and military history variables. MST was associated with increased use of VA mental health services in bivariate results but was not independently related to VA service utilization after accounting for PTSD and depression symptoms. Approximately half of the women who reported MST had not used VA health care. Continued outreach and education initiatives may be needed to ensure veterans understand the resources available to address MST-related mental and physical health problems through the VA.

Casualty Rates of US Military Personnel During the Wars in Iraq and Afghanistan

In Operation Iraqi Freedom, which ended in August 2010, nearly 3500 hostile deaths occurred among US military personnel and 32,000 more were wounded in action (WIA). More than 1800 hostile deaths occurred during Operation Enduring Freedom (in and around Afghanistan) through 2014 and about 20,000 were WIA. A larger proportion of wounded personnel survived in Iraq and Afghanistan than during the Vietnam War, but the increased survival rates were not as high as some studies have asserted. The survival rates were 90.2% in Iraq and 91.6% in Afghanistan, compared with 86.5% in Vietnam. The casualty rates varied between the conflicts in Iraq and Afghanistan and before, during, and after the respective surges. Amputation rates are difficult to measure consistently, but I estimate that 2.6% of all WIA and 9.0% of medically evacuated WIA from the Iraq and Afghanistan theaters combined resulted in the major loss of a limb. Elevated non-hostile death rates (including deaths due to accidents, illnesses, homicides, or suicides) resulted in about 220 more deaths in Iraq and about 200 more deaths in Afghanistan than would have been expected in peacetime among populations of the size deployed to those two conflicts.

Traumatic Brain Injury in United States Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Hispanic Veterans-A Review Using the PRISMA Method.

Traumatic brain injury (TBI) is commonly defined by Menon et al. as an “alteration of the brain function, or other evidence of brain pathology, caused by an external force.” TBI can be caused by penetrating trauma to the head in which the magnitude of the injury is dependent on the magnitude of the forces that are applied to the head. The consequences of TBI can range from minimal to severe disability and even death. The major objectives of this systematic review are to survey the current literature on Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Hispanic veterans with TBI. To complete this analysis, the Preferred Reporting Items for Systematic Reviews and MetaAnalysis (PRISMA) identified 875 articles in common and retrieved a total of 34 articles that met the inclusion criteria, consisted of OEF/OIF Hispanic veterans, reported quantitative data, and were conducted with adult U.S. veterans living in the United States. Since TBI diagnosis was unclear in most articles, only five articles that used the VATBIST instrument were analyzed. The results suggested that there is a lack of research on OEF/OIF Hispanic veterans and Hispanic subgroups. Future studies need to be conducted to consider minority groups while analyzing data involving TBI.

Improvised explosive device-related lower genitourinary trauma in current overseas combat operations.

The use of improvised explosive devices (IEDs) has had a profound effect on battlefield trauma in the 21st century. Historically, wounds to the genitourinary (GU) structures have been less common than extremity and penetrating abdominal trauma in combat operations. GU injury incidence, severity, and associated injuries secondary to the use of this weapon in Operations Iraqi and Enduring Freedom has not been described. Data from the Department of Defense Trauma Registry was reviewed for combat-related GU injuries in Operations Iraqi and Enduring Freedom from 2001 to 2011. All wounded US armed service members are included in this database. Subjects were selected by a query of current procedural terminology and DRG International Classification of Diseases-9th Rev. codes related to traumatic injury of the penis, scrotum, testicles, and urethra. A retrospective chart review was performed for each patient to identify the date of injury, the mechanism of injury, and the associated traumatic wounds. Subjects' follow-up records were reviewed until present time or separation from active duty. A total of 501 soldiers sustained lower GU trauma, with a total of 729 injuries. Of these casualties, 448 (89%) were wounded by IEDs. Dismounted injuries (87%) made up more of the cohort than did vehicular. Specific trauma sites include 149 (20%) penile, 260 (36%) testicular, 284 (39%) scrotal, and 36 (5%) urethral injuries. The 180 limb amputations (36%) and 86 fractures (17%) were the most encountered concomitant skeletal wounds among service members with GU injuries. This is the first review of all lower GU trauma sustained by all US armed service members in current overseas combat operations. Combat-related lower GU trauma is primarily caused by IEDs in the spectrum of complex dismounted blast injuries. The mechanism primarily results in multisystem injury, with isolated GU involvement being uncommon. Continued evaluation of long-term sequelae, including sexual, urinary, and reproductive dysfunction, is needed. Epidemiologic study, level V.

Accuracy and Reliability of Triage at the Point of Injury During Operation Enduring Freedom

Accurate point-of-injury reports and casualty evacuation requests allow for optimal resource utilization. However, the accuracy of these reports has not been previously studied.All trauma patients treated at one of three forward surgical elements (FSE) in Western Afghanistan during May-August 2012 were prospectively included. North American Treaty Organization (NATO) 9-line medical evacuation request and mechanism, injuries, signs, and treatments (MIST) reports were compared to the initial findings on arrival to the FSE.There were 179 casualty evacuation reports and 298 patients. NATO 9-line and/or MIST reports were available for 70% of these. Triage was accurate for 77%, but there was 17% overtriage and 6% undertriage (k = .619). The number of patients was accurate in 95% of reports, the mechanism of injury was accurate for 98%, and the body region involved was accurate for 92% (k = .850, .943, and .870, respectively). There was no difference between the mean vital signs at the point of injury or on arrival at the FSE. When analyzed individually, however, there was no correlation between each casualty's pulse, mean arterial pressure, or respiratory rate between the two time points.There was a high degree of correlation between the triage category of casualty evacuation reports and the patient's actual medical needs. There was also a highly significant association with the number of patients, mechanism of injury, and bodily injuries. However, there was discordance between the vital signs at an individual level, which may represent regression toward the resuscitation threshold.

Pain and psychiatric comorbidities among two groups of Iraq and Afghanistan era Veterans.

This study aimed to (1) identify the prevalence and severity of pain and psychiatric comorbidities among personnel who had been deployed during Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) and (2) assess whether the Department of Veterans Affairs (VA) Polytrauma System of Care and an OIF/OEF/OND registry reflect real differences among patients. Participants (N = 359) were recruited from two VA hospitals. They completed a clinical interview, structured diagnostic interview, and self-report measures. Results indicated pain was the most common complaint, with 87 percent experiencing pain during the prior week and 56 percent reporting moderate or severe pain. Eighty percent of participants met criteria for at least one of seven assessed comorbid problems (moderate or severe pain, postconcussional disorder, posttraumatic stress disorder [PTSD], anxiety disorder, mood disorder, substance use disorder, psychosis), and 59 percent met criteria for two or more problems. PTSD and postconcussional disorder rarely occurred in the absence of pain or other comorbidities (0.3% and 0%, respectively). The Polytrauma group had more comorbid psychiatric conditions (χ(2) = 48.67, p < 0.05) and reported greater severity of symptoms (p < 0.05) than the Registry group. This study confirmed the high prevalence of pain and concurrent mental health problems among personnel returning from military deployment.

"Preliminary data suggest rates of male military sexual trauma may be higher than previously reported": Retraction of Sheppard et al. (2015).

Reports the retraction of "Preliminary data suggest rates of male military sexual trauma may be higher than previously reported" by Sean C. Sheppard, Edward J. Hickling, Mitch Earleywine, Tim Hoyt, Amanda R. Russo, Matthew R. Donati and Kevin E. Kip (Psychological Services, 2015[Nov], Vol 12[4], 344-347). The following article from the November 2015 issue is being retracted. The retraction is at the request of the authors. The data analysis was flawed due to the method used to test for statistical significance which was not consistent with modern methods. This compromised the study findings. Thus, the conclusions about statistical significance drawn in the paper were not consistent with the data. The statistical testing error that occurred was unintentional and acknowledged by the authors when pointed out by external scholars. All authors of the article joined in the request for the retraction. (The following abstract of the original article appeared in record 2015-49326-002.) Stigma associated with disclosing military sexual trauma (MST) makes estimating an accurate base rate difficult. Anonymous assessment may help alleviate stigma. Although anonymous research has found higher rates of male MST, no study has evaluated whether providing anonymity sufficiently mitigates the impact of stigma on accurate reporting. This study used the unmatched count technique (UCT), a form of randomized response techniques, to gain information about the accuracy of base rate estimates of male MST derived via anonymous assessment of Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) combat veterans. A cross-sectional convenience sample of 180 OEF/OIF male combat veterans, recruited via online websites for military populations, provided data about history of MST via traditional anonymous self-report and the UCT. The UCT revealed a rate of male MST more than 15 times higher than the rate derived via traditional anonymous assessment (1.1% vs. 17.2%). These data suggest that anonymity does not adequately mitigate the impact of stigma on disclosure of male MST. Results, though preliminary, suggest that published rates of male MST may substantially underestimate the true rate of this problem. The UCT has significant potential to improve base rate estimation of sensitive behaviors in the military.

Association of parental status and diagnosis of posttraumatic stress disorder among veterans of Operations Iraqi and Enduring Freedom.

Research indicates that concerns about disruption of family relationships during military service may be associated with greater posttraumatic stress symptomatology. The current study sought to extend previous findings by examining the relative odds of a posttraumatic stress disorder (PTSD) diagnosis among Operations Enduring and Iraqi Freedom (OEF/OIF) veterans with dependent children versus veterans without dependent children. Administrative databases were queried to identify 36,334 OEF/OIF veterans with dependent children seeking care in the Veterans Health Administration (VA) during fiscal years 2006-2009. These veterans were matched 1:1 on age, gender, and demobilization date to veterans without dependent children (N = 72,668). In unconditional analyses, OEF/OIF veterans with dependent children versus those without were significantly more likely to incur a PTSD diagnosis (44% vs. 28%). After controlling for demographic variables, mental health utilization, and other serious mental illness, OEF/OIF veterans with dependent children were about 40% more likely to carry a diagnosis of PTSD. The association was stronger for men than for women. It may be of value for clinicians to consider parental status when assessing and treating veterans with PTSD. In-depth study of OEF/OIF veterans is needed to determine whether disruption of family relationships leads to increased psychological stress or parents are more likely than nonparents to seek VA mental health services for PTSD symptoms.

INFIX/EXFIX: Massive Open Pelvic Injuries and Review of the Literature.

Introduction. Open pelvic fractures make up 2–5% of all pelvic ring injuries. Their mortality has been reported to be as high as 50%. During Operation Enduring Freedom protocols for massive open pelvic injuries lead to the survival of injuries once thought to be fatal. The INFIX is a subcutaneous anterior fixator for pelvic stabilization which is stronger than external fixation. The purpose of this paper is to describe the use of INFIX and modern algorithms for massive open pelvic injuries. Methods. An IRB approved retrospective review describes 4 cases in civilian practice with massive open pelvic injuries. We also review the modern literature on open pelvic injures. Discussion. Key components in the care of massive open pelvic injuries include hemorrhage control by clamping of the aorta or REBOA when necessary and fecal/urinary diversion. The INFIX can be used internally, as a partial INFIX partial EXFIX, or as an EXFIX. Its low profile allows for easy application of wound vacs and wound care and when subcutaneous avoids pin tract infections. Conclusion. Massive open pelvic injuries are a difficult problem. Following modern protocols can help prevent mortality.