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Studies

On this page you can find various studies developed by Military Health System. Please scroll down or use the search box to find specific studies.

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Follow-up analysis of the incidence of acute respiratory infections among enlisted service members during their first year of military service before and after the 2011 resumption of adenovirus vaccination of basic trainees.

Study

Abstract

This analysis estimated the incidence rates of acute respiratory infections (ARIs) during the first year of military service for service members in 16 cohorts (designated 1999 through 2014) based on the years in which they began their service. That first year of service was divided into two separate follow-up periods: the first 3 months of service (corresponding to the period of initial entry training) and the next 9 months of service (months 4-12). The surveillance period covered service members whose first years of service were before and after the 2011 resumption of the administration of adenovirus vaccines, types 4 and 7, to enlisted trainees at the beginning of their initial training periods. In general, the findings were that incidence rates of ARIs were relatively high for the cohorts who did not receive the vaccines, and that the rates were dramatically lower in the cohorts (2012-2014) who did receive the vaccines. These observations pertained to both the first 3 months of service and the next 9 months of service. Possible interpretations of these findings and the limitations of the study methods are discussed.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Armed Forces Health Surveillance Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: December 01, 2015
  • Citation: O'Donnell FL, Taubman SB. Follow-up analysis of the incidence of acute respiratory infections among enlisted service members before and after the 2011 resumption of adenovirus vaccination of basic trainees. MSMR. 2015 Dec;22(12):2-7.

Investigation of Self-Reported Musculoskeletal Injuries on Post-Deployment Health Assessment Forms for Aeromedical Evacuation Personnel.

Study

Abstract

Musculoskeletal injuries (MSIs) are a concern for the military community because of medical expenses, possible disability, and separation from the military. This study investigated the prevalence of MSIs in deployed aeromedical evacuation (AE) populations reported on Post-Deployment Health Assessment (PDHA) forms. A secondary aim was to examine the relationship between the occurrence of self-reported MSIs on PDHAs and a subsequent medical diagnosis. Flight nurses (Air Force Specialty Code [AFSC] 46F) and AE technicians (AETs) (AFSC 4N0 with a flight duty badge) who completed a PDHA during 2008-2010 were investigated. Data from the test population were compared with a control group of deployed ground-based counterparts. During this time period, 1,366 and 1,959 PDHAs were completed by the AE nursing and AET groups, respectively. At least 1 MSI was reported by 18% of AE nurse and 19% of AET compared with 23% of non-AE nurse and 25% of non-AET PDHAs. Of these individuals with reported MSIs, 35% and 44% of AE nurse and AET PDHAs, respectively, had a diagnosis matching their MSIs. Identifying the prevalence of MSIs in the unique AE environment can lead to the development of preventative and ergonomic solutions, minimizing the risk of MSIs and improving mission success.

  • Publication Status: Published
  • Sponsoring Organization: Air Force
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Air Force
  • Release Date/Publication: December 01, 2015
  • Citation: Fouts BL, Serres JL, Dukes SF, Maupin GM, Wade ME, Pohlman DM. Investigation of Self-Reported Musculoskeletal Injuries on Post-Deployment Health Assessment Forms for Aeromedical Evacuation Personnel. Mil Med. 2015 Dec;180(12):1256-61

Sexually transmitted infections and sexual behavior of deploying shipboard US military personnel: a cross-sectional analysis.

Study

Abstract

OBJECTIVES: Sexually transmitted infection (STI) prevalence and risk behavior may differ at different phases of deployment. We examined STI prevalence and sexual behavior in the predeployment time period (12 months prior) among recently deployed shipboard US Navy and Marine Corps military personnel. METHODS: Data were collected from 1938 male and 515 female service members through an anonymous, self-completed survey assessing sexual behaviours and STI acquisition characteristics in the past 12 months. Cross-sectional sex-stratified descriptive statistics are reported. RESULTS: Overall, 67% (n=1262/1896) reported last sex with a military beneficiary (spouse, n=931, non-spouse service member, n=331). Among those with a sexual partner outside their primary partnership, 24% (n=90/373) reported using a condom the last time they had sex and 30% (n=72/243) reported their outside partner was a service member. In total, 90% (n=210/233) reported acquiring their most recent STI in the USA (88%, n=126/143 among those reporting ≥1 deployments and an STI ≥1 year ago) and a significantly higher proportion (p<0.01) of women than men acquired the STI from their regular partner (54% vs 21%) and/or a service member (50% vs 26%). CONCLUSIONS: Findings suggest a complex sexual network among service members and military beneficiaries. Findings may extend to other mobile civilian and military populations. Data suggest most STI transmission within the shipboard community may occur in local versus foreign ports but analyses from later time points in deployment are needed. These data may inform more effective STI prevention interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
  • Release Date/Publication: December 01, 2015
  • Citation: Harbertson J, Scott PT, Moore J, Wolf M, Morris J, Thrasher S et.al., Sexually transmitted infections and sexual behaviour of deploying shipboard US military personnel: a cross-sectional analysis. Sex Transm Infect. 2015 Dec;91(8):581-8.

Blurred front lines: triage and initial management of blast injuries.

Study

Abstract

Recent armed conflicts and the expanded reach of international terror groups has resulted in an increased incidence of blast-related injuries in both military and civilian populations. Mass-casualty incidents may require both on-scene and in-hospital triage to maximize survival rates and conserve limited resources. Initial evaluation should focus on the identification and control of potentially life-threatening conditions, especially life-threatening hemorrhage. Early operative priorities for musculoskeletal injuries focus on the principles of damage-control orthopaedics, with early and aggressive debridement of soft-tissue wounds, vascular shunting or grafting to restore limb perfusion, and long-bone fracture stabilization via external fixation. Special considerations such as patient transport, infection control and prevention, and amputation management are also discussed. All orthopedic surgeons, regardless of practice setting, should be familiar with the basic principles of evaluation, resuscitation, and initial management of explosive blast injuries.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: September 01, 2015
  • Citation: Balazs GC, Blais MB, Bluman EM, Andersen RC, Potter BK. Blurred front lines: triage and initial management of blast injuries. Curr Rev Musculoskelet Med. 2015 Sep;8(3):304-11.

Safety, Tolerability, and Compliance with Long-Term Antimalarial Chemoprophylaxis in American Soldiers in Afghanistan.

Study

Abstract

Long-term antimalarial chemoprophylaxis is currently used by deployed U.S. military personnel. Previous small, short-term efficacy studies have shown variable rates of side effects among patients taking various forms of chemoprophylaxis, though reliable safety and tolerability data on long-term use are limited. We conducted a survey of troops returning to Fort Drum, NY following a 12-month deployment to Operation Enduring Freedom, Afghanistan from 2006 to 2007. Of the 2,351 respondents, 95% reported taking at least one form of prophylaxis during their deployment, and 90% were deployed for > 10 months. Compliance with daily doxycycline was poor (60%) compared with 80% with weekly mefloquine (MQ). Adverse events (AEs) were reported by approximately 30% with both MQ and doxycycline, with 10% discontinuing doxycycline compared with 4% of MQ users. Only 6% and 31% of soldiers reported use of bed nets and skin repellents, respectively. Compliance with long-term malaria prophylaxis was poor, and there were substantial tolerability issues based on these anonymous survey results, though fewer with MQ than doxycycline. Given few long-term antimalarial chemoprophylaxis options, there is an unmet medical need for new antimalarials safe for long-term use.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: September 01, 2015
  • Citation: Saunders DL, et. al.,

Comparison of overweight and obese military-dependent and civilian adolescent girls with loss-of-control eating.

Study

Abstract

OBJECTIVE: Limited data suggest that the children of U.S. service members may be at increased risk for disordered-eating. To date, no study has directly compared adolescent military-dependents to their civilian peers along measures of eating pathology and associated correlates. We, therefore, compared overweight and obese adolescent female military-dependents to their civilian counterparts along measures of eating-related pathology and psychosocial functioning. METHOD: Adolescent females with a BMI between the 85th and 97th percentiles and who reported loss-of-control eating completed interview and questionnaire assessments of eating-related and general psychopathology. RESULTS: Twenty-three military-dependents and 105 civilians participated. Controlling for age, race, and BMI-z, military-dependents reported significantly more binge episodes per month (p < 0.01), as well as greater eating-concern, shape-concern, and weight-concern (p's < 0.01) than civilians. Military-dependents also reported more severe depression (p < 0.05). DISCUSSION: Adolescent female military-dependents may be particularly vulnerable to disordered-eating compared with civilian peers. This potential vulnerability should be considered when assessing military-dependents.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: September 01, 2015
  • Citation: Schvey NA, et al., Comparison of overweight and obese military-dependent and civilian adolescent girls with loss-of-control eating. Int J Eat Disord. 2015 Sep;48(6):790-4.

Longitudinal assessment of gender differences in the development of PTSD among US military personnel deployed in support of the operations in Iraq and Afghanistan.

Study

Abstract

Divergent findings from previous research examining gender differences in the development of posttraumatic stress disorder (PTSD) among US military members deployed to the operations in Iraq or Afghanistan (recent operations) prompted this study utilizing a matching approach to examine whether risk for new-onset PTSD and PTSD severity scores differed by gender. US military members from the Millennium Cohort Study deployed in support of the recent operations were followed for approximately 7 years from baseline through 2 follow-up periods between 2001 and 2008. Propensity score matching was used to match 1 male to each female using demographic, military, and behavioral factors including baseline sexual assault. Analyses were stratified by combat experience defined as reporting at least one of five exposures during follow-up. Outcome measures included a positive screen for PTSD and severity scores measured by the PTSD Patient Checklist-Civilian Version. Discrete-time survival analysis quantified the association between gender and incident PTSD. Among 4684 matched subjects (2342 women and men), 6.7% of women and 6.1% of men developed PTSD during follow-up. Results showed no significant gender differences for the likelihood of developing PTSD or for PTSD severity scores among women and men who reported combat experience and among those who did not. This study is the first of its kind to match a large population of male and female service members on important baseline characteristics including sexual assault. Findings suggest that while combat deployed personnel develop PTSD, women do not have a significantly different risk for developing PTSD than men after experiencing combat.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: September 01, 2015
  • Citation: Jacobson IG, et. al., Longitudinal assessment of gender differences in the development of PTSD among US military personnel deployed in support of the operations in Iraq and Afghanistan. J Psychiatr Res. 2015 Sep;68:30-6.

Factors Associated with psychiatric evacuation among Service members deployed to OEF/OIF, January 2003 – September 2010

Study

Abstract

Objective: To determine the association between psychiatric evacuation from Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) and demographic, military, and deployment characteristics of deploying Service members. The increased frequency of psychiatric evacuations since 2004 has been anecdotally attributed to the cumulative effects of multiple deployments, or the increased reliance on Reserve and National Guard units, but quantitative evidence is lacking. Study Design: This observational study used retrospectively-collected deployment and aeromedical evacuation records to calculate psychiatric evacuation rates, characterize the evacuation circumstances, and quantify the rates of re-deployment after evacuation. Descriptive statistics were used to compare characteristics for psychiatric evacuees with those of other deployers. Binary logistic regression analysis was used to assess the likelihood of psychiatric evacuation based on Service, component, personal demographics, year of military accession, theater of first deployment, and number of deployments. Statistical significance was assessed at a 95% confidence level. Population Studied: All Service members evacuated from OEF/OIF from January 2003 through September 2010 with a primary or secondary psychiatric diagnosis (ICD-9 codes 290 – 319), on their evacuation record; and a 20% random sampling of all other deployers who did not psychiatrically evacuate (N = 364,047). Principle Findings: After applying sample weights, a total of 0.3% (n = 5887) deployers experienced one or more psychiatric evacuations. Relative to other deployers, psychiatric evacuees were significantly over-represented by females (14.8% versus 11.4%); age group 17 – 24 years (55.4% versus 44.8); whites (69.9% versus 65.6%); and those with a high school diploma or less (83.8% versus 73.6%); those never married (49.1% versus 47.8%); and those with one or two dependents (37.1% versus 34.7%). Elevated psychiatric evacuation rates were observed inconsistently across both combat and noncombat duty assignments. A total of 3951 (67.1%) of evacuees evacuated upon first deployment and 1553 (26.4%) of evacuees evacuated on second deployment. Among all psychiatric evacuees, 4754 (80.8%) never turned to theater or redeployed after they evacuated. Depression (24.9%), post-traumatic stress disorder (24.9%), and psychotic illness (18.4%) accounted for two-thirds of evacuation diagnoses. Drug and alcohol-related disorders accounted for less than 3% of psychiatric evacuations. After adjusting for personal demographics and deployment characteristics, Army Active Duty members had the highest likelihood of psychiatric evacuation, followed by Army National Guard (AOR = 0.852, 95% CI 0.790, 0.919), Army Reserve (AOR = 0.825, 95% CI 0.740, 0.919), Navy Reserve (AOR = 0.585, 95% CI 0.461, 0.742), and Marine Active Duty (AOR = 0.390, 95% CI 0.353, 0.0.430). Conclusions: This study identified psychiatric evacuation as primarily an Army burden, and an Active Duty burden within the Army. While other studies have linked violent combat-related exposures to adverse, post-deployment mental and behavioral health outcomes, the contribution of multiple deployments or prolonged combat exposure to an outcome of psychiatric evacuation is not apparent in these findings. Further study is warranted to isolate and mitigate the underlying causes of this growing and costly contributor to unit attrition.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Defense Health Agency (formerly TRICARE Management Activity)
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: January 01, 2015
  • Citation: Wilmoth MC, Williams TV, et.al., Factors associated with psychiatric evacuation among service members deployed to operation enduring freedom and operation iraqi freedom, january 2004 to september 2010. Mil Med. 2015 Jan;180(1):53-60.

Multiple Past Concussions Are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers.

Study

Abstract

The extent to which multiple past concussions are associated with lingering symptoms or mental health problems in military service members is not well understood. The purpose of this study was to examine the association between lifetime concussion history, cognitive functioning, general health, and psychological health in a large sample of fit-for-duty U.S. Army soldiers preparing for deployment. Data on 458 active-duty soldiers were collected and analyzed. A computerized cognitive screening battery (CNS-Vital Signs(®)) was used to assess complex attention (CA), reaction time (RT), processing speed (PS), cognitive flexibility (CF), and memory. Health questionnaires included the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Military Version (PCL-M), Zung Depression and Anxiety Scales (ZDS; ZAS), Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the Alcohol Use and Dependency Identification Test (AUDIT). Soldiers with a history of multiple concussions (i.e., three or more concussions) had significantly greater post-concussive symptom scores compared with those with zero (d=1.83, large effect), one (d=0.64, medium effect), and two (d=0.64, medium effect) prior concussions. Although the group with three or more concussions also reported more traumatic stress symptoms, the results revealed that traumatic stress was a mediator between concussions and post-concussive symptom severity. There were no significant differences on neurocognitive testing between the number of concussions. These results add to the accumulating evidence suggesting that most individuals recover from one or two prior concussions, but there is a greater risk for ongoing symptoms if one exceeds this number of injuries.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: September 01, 2015
  • Citation: Dretsch MN, et. al., Multiple Past Concussions Are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers. J Neurotrauma. 2015 Sep 1;32(17):1301-6.

Combat trauma-associated invasive fungal wound infections: epidemiology and clinical classification

Study

Abstract

The emergence of invasive fungal wound infections (IFIs) in combat casualties led to development of a combat trauma-specific IFI case definition and classification. Prospective data were collected from 1133 US military personnel injured in Afghanistan (June 2009-August 2011). The IFI rates ranged from 0·2% to 11·7% among ward and intensive care unit admissions, respectively (6·8% overall). Seventy-seven IFI cases were classified as proven/probable (n = 54) and possible/unclassifiable (n = 23) and compared in a case-case analysis. There was no difference in clinical characteristics between the proven/probable and possible/unclassifiable cases. Possible IFI cases had shorter time to diagnosis (P = 0·02) and initiation of antifungal therapy (P = 0·05) and fewer operative visits (P = 0·002) compared to proven/probable cases, but clinical outcomes were similar between the groups. Although the trauma-related IFI classification scheme did not provide prognostic information, it is an effective tool for clinical and epidemiological surveillance and research.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
  • Release Date/Publication: January 01, 2015
  • Citation: Weintrob AC, et. al., Combat trauma-associated invasive fungal wound infections: epidemiology and clinical classification. Epidemiol Infect. 2015 Jan;143(1):214-24.

Women in Combat: Framing the Issues of Health and Health Research for America's Servicewomen.

Study

Abstract

BACKGROUND: Although women have served in the U.S. military officially since 1901, the medical needs of women in combat have historically been poorly understood. Recent expansion of the opportunities females may now play in combat roles has created an urgent need for a review of how Department of Defense supports females as they transition into these new roles, as well as current science related to key aspects of the health of female warriors. There is currently no systematic institutional structure in place to regularly and methodically examine gaps in policy, research, and treatment for issues related to women in combat. METHOD: This article serves as a brief overview and introduction to some of the critical topics related to the health of women in combat roles, to include women's health issues research and treatment efforts, physiological differences between sexes, and leadership and unit factors. CONCLUSION: The Department of Defense should continue to explore and address policy, research, and practice related to the complex ongoing needs of military females in combat roles, and ensures sufficient staffing, resources and support from senior military leaders.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: January 01, 2015
  • Citation: Moosey M. Communicating Difficult and Taboo Information: A How-To Guide for Commanders. Mil Med. 2016 Jan;181(1 Suppl):40-3.

Prevalence and correlates of suicidal behavior among new soldiers in the U.S. Army: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

Study

Abstract

BACKGROUND: The prevalence of suicide among U.S. Army soldiers has risen dramatically in recent years. Prior studies suggest that most soldiers with suicidal behaviors (i.e., ideation, plans, and attempts) had first onsets prior to enlistment. However, those data are based on retrospective self-reports of soldiers later in their Army careers. Unbiased examination of this issue requires investigation of suicidality among new soldiers. METHOD: The New Soldier Study (NSS) of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) used fully structured self-administered measures to estimate preenlistment histories of suicide ideation, plans, and attempts among new soldiers reporting for Basic Combat Training in 2011-2012. Survival models examined sociodemographic correlates of each suicidal outcome. RESULTS: Lifetime prevalence estimates of preenlistment suicide ideation, plans, and attempts were 14.1, 2.3, and 1.9%, respectively. Most reported onsets of suicide plans and attempts (73.3-81.5%) occurred within the first year after onset of ideation. Odds of these lifetime suicidal behaviors among new soldiers were positively, but weakly associated with being female, unmarried, religion other than Protestant or Catholic, and a race/ethnicity other than non-Hispanic White, non-Hispanic Black, or Hispanic. CONCLUSIONS: Lifetime prevalence estimates of suicidal behaviors among new soldiers are consistent with retrospective reports of preenlistment prevalence obtained from soldiers later in their Army careers. Given that prior suicidal behaviors are among the strongest predictors of later suicides, consideration should be given to developing methods of obtaining valid reports of preenlistment suicidality from new soldiers to facilitate targeting of preventive interventions.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: January 01, 2015
  • Citation: Ursano RJ, et al. Prevalence and correlates of suicidal behavior among new soldiers in the U.S. Army: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Depress Anxiety. 2015 Jan;32(1):3-12.

Colon cancer lymph node evaluation among military health system beneficiaries: an analysis by race/ethnicity.

Study

Abstract

BACKGROUND: The number of lymph nodes examined during colon cancer surgery falls below nationally recommended guidelines in the general population, with Blacks and Hispanics less likely to have adequate nodal evaluation in comparison to Whites. The Department of Defense's (DoD) Military Health System (MHS) provides equal access to medical care for its beneficiaries, regardless of racial/ethnic background. This study aimed to investigate whether racial/ethnic treatment differences exist in the MHS, an equal-access medical care system. METHODS: Linked data from the DoD cancer registry and administrative claims databases were used and included 2,155 colon cancer cases. Multivariate logistic regression assessed the association between race/ethnicity and the number of lymph nodes examined (<12 and ≥12) overall and for stratified analyses. RESULTS: No overall racial/ethnic differences in the number of lymph nodes examined was identified. Further stratified analyses yielded similar results, except potential racial/ethnic differences were found among persons with poorly differentiated tumors, where non-Hispanic Blacks tended to be less likely to have ≥12 lymph nodes dissected (odds ratio 0.34; 95 % confidence interval 0.14-0.80; p = 0.01) compared with non-Hispanic Whites. CONCLUSION: Racial/ethnic disparities in the number of lymph nodes evaluated among patients with colon cancer were not apparent in an equal-access healthcare system. However, among poorly differentiated tumors there might be racial/ethnic differences in nodal yield, suggesting the possible effects of factors other than access to healthcare.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: January 01, 2015
  • Citation: Gill AA, Zahm SH, Shriver CD, Stojadinovic A, McGlynn KA, Zhu K. Colon cancer lymph node evaluation among military health system beneficiaries: an analysis by race/ethnicity. Ann Surg Oncol. 2015 Jan;22(1):195-202

Effects of hyperbaric oxygen on symptoms and quality of life among service members with persistent postconcussion symptoms: a randomized clinical trial.

Study

Abstract

IMPORTANCE: Improvement has been anecdotally observed in patients with persistent postconcussion symptoms (PCS) after mild traumatic brain injury following treatment with hyperbaric oxygen (HBO). The effectiveness of HBO as an adjunctive treatment for PCS is unknown to date. OBJECTIVES: To compare the safety of and to estimate the efficacy for symptomatic outcomes from standard PCS care alone, care supplemented with HBO, or a sham procedure. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, double-blind, sham-controlled clinical trial of 72 military service members with ongoing symptoms at least 4 months after mild traumatic brain injury enrolled at military hospitals in Colorado, North Carolina, California, and Georgia between April 26, 2011, and August 24, 2012. Assessments occurred before randomization, at the midpoint, and within 1 month after completing the interventions. INTERVENTIONS: Routine PCS care was provided in specialized clinics. In addition, participants were randomized 1:1:1 to 40 HBO sessions administered at 1.5 atmospheres absolute (ATA), 40 sham sessions consisting of room air at 1.2 ATA, or no supplemental chamber procedures. MAIN OUTCOMES AND MEASURES: The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) served as the primary outcome measure. A change score of at least 2 points on the RPQ-3 subscale (range, 0-12) was defined as clinically significant. Change scores from baseline were calculated for the RPQ-3 and for the total RPQ. Secondary measures included additional patient-reported outcomes and automated neuropsychometric testing. RESULTS: On average, participants had sustained 3 lifetime mild traumatic brain injuries; the most recent occurred 23 months before enrollment. No differences were observed between groups for improvement of at least 2 points on the RPQ-3 subscale (25% in the no intervention group, 52% in the HBO group, and 33% in the sham group; P = .24). Compared with the no intervention group (mean change score, 0.5; 95% CI, -4.8 to 5.8; P = .91), both groups undergoing supplemental chamber procedures showed improvement in symptoms on the RPQ (mean change score, 5.4; 95% CI, -0.5 to 11.3; P = .008 in the HBO group and 7.0; 95% CI, 1.0-12.9; P = .02 in the sham group). No difference between the HBO group and the sham group was observed (P = .70). Chamber sessions were well tolerated. CONCLUSIONS AND RELEVANCE: Among service members with persistent PCS, HBO showed no benefits over sham compressions. Both intervention groups demonstrated improved outcomes compared with PCS care alone. This finding suggests that the observed improvements were not oxygen mediated but may reflect nonspecific improvements related to placebo effects.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: January 01, 2015
  • Citation: Miller RS et al., Effects of hyperbaric oxygen on symptoms and quality of life among service members with persistent postconcussion symptoms: a randomized clinical trial. JAMA Intern Med. 2015 Jan;175(1):43-52.

Epidemiologic, clinical, and virologic characteristics of human rhinovirus infection among otherwise healthy children and adults: rhinovirus among adults and children.

Study

Abstract

BACKGROUND: Human rhinovirus (HRV) is a major cause of influenza-like illness (ILI) in adults and children. Differences in disease severity by HRV species have been described among hospitalized patients with underlying illness. Less is known about the clinical and virologic characteristics of HRV infection among otherwise healthy populations, particularly adults. OBJECTIVES: To characterize molecular epidemiology of HRV and association between HRV species and clinical presentation and viral shedding. STUDY DESIGN: Observational, prospective, facility-based study of ILI was conducted from February 2010 to April 2012. Collection of nasopharyngeal specimens, patient symptoms, and clinical information occurred on days 0, 3, 7, and 28. Patients recorded symptom severity daily for the first 7 days of illness in a symptom diary. HRV was identified by RT-PCR and genotyped for species determination. Cases who were co-infected with other viral respiratory pathogens were excluded from the analysis. We evaluated the associations between HRV species, clinical severity, and patterns of viral shedding. RESULTS: Eighty-four HRV cases were identified and their isolates genotyped. Of these, 62 (74%) were >18 years. Fifty-four were HRV-A, 11HRV-B, and 19HRV-C. HRV-C infection was more common among children than adults (59% vs. 10%, P<0.001). Among adults, HRV-A was associated with higher severity of upper respiratory symptoms compared to HRV-B (P=0.02), but no such association was found in children. In addition, adults shed HRV-A significantly longer than HRV-C (P trend=0.01). CONCLUSIONS: Among otherwise healthy adults with HRV infection, we observed species-specific differences in respiratory symptom severity and duration of viral shedding.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: January 01, 2015
  • Citation: Chen WJ, et. al., Epidemiologic, clinical, and virologic characteristics of human rhinovirus infection among otherwise healthy children and adults: rhinovirus among adults and children. J Clin Virol. 2015 Mar;64:74-82.
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