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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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Deployment-related psychiatric and behavioral conditions and their association with functional disability in OEF/OIF/OND veterans.

Study

Abstract

Understanding the factors that influence veterans' functional outcome after deployment is critical to provide appropriately targeted care. Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) have been related to disability, but other psychiatric and behavioral conditions are not as well examined. We investigated the impact of deployment-related psychiatric and behavioral conditions on disability among 255 OEF/OIF/OND service members and veterans. Structured clinical interviews assessed TBI and the psychiatric conditions of depression, PTSD, anxiety, and substance use. Self-report questionnaires assessed disability and the behavioral conditions of sleep disturbance and pain. Over 90% of participants had a psychiatric and/or behavioral condition, with approximately half presenting with ≥ 3 conditions. Exploratory factor analysis revealed 4 clinically relevant psychiatric and behavioral factors which accounted for 76.9% of the variance: (a) depression, PTSD, and military mTBI (deployment trauma factor); (b) pain and sleep (somatic factor); (c) anxiety disorders, other than PTSD (anxiety factor); and (d) substance abuse or dependence (substance use factor). Individuals with the conditions comprising the deployment trauma factor were more likely to be substantially disabled than individuals with depression and PTSD, but no military mTBI, OR = 3.52; 95% CI [1.09, 11.37]. Depression, PTSD, and a history of military mTBI may comprise an especially harmful combination associated with high risk for substantial disability.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Defense and Veterans Brain Injury Center
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: February 01, 2015
  • Citation: Lippa SM, Fonda JR, Fortier CB, Amick MA, Kenna A, Milberg WP, McGlinchey RE. Deployment-related psychiatric and behavioral conditions and their association with functional disability in OEF/OIF/OND veterans. J Trauma Stress. 2015 Feb;28(1):25-33.

Mental Health and Substance Use Factors Associated With Unwanted Sexual Contact Among U.S. Active Duty Service Women.

Study

Abstract

Many U.S. military women are exposed to unwanted sexual contact during military service, which can have important implications for mental health. Using data from the 2008 Department of Defense Survey of Health Related Behaviors, we employed multiple logistic regression methods to examine whether unwanted sexual contact was associated with stress, screening positive for mental disorders, or substance use, among active duty service women. The sample included 7,415 female military personnel, of whom 13.4% reported unwanted sexual contact (including any touching of genitals) since entering the military. After adjusting for potentially confounding variables, factors independently associated with unwanted sexual contact included military-related stress (adjusted odds ratio [AOR] = 2.44), family/personal life-related stress (AOR = 1.78), and gender-related stress (AOR = 1.98) in the past 12 months. In addition, screening positive for depression, anxiety, posttraumatic stress disorder, or psychological distress, and suicidal ideation or attempt were associated with unwanted sexual contact (AOR = 1.57-2.11). For drug/alcohol use, only misuse of tranquilizers/muscle relaxers (past 12 months) was associated with report of unwanted sexual contact (AOR = 1.35). Given the prevalence of unwanted sexual contact and corresponding adverse health outcomes in this sample of active duty women, strategies to create military structural/cultural changes and reduce gender-related stress and sexism are needed.

  • Publication Status: Published
  • Sponsoring Organization: Undetermined
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Government, academic, or industry source other than Federal Government
  • Release Date/Publication: May 01, 2015
  • Citation: Stahlman S, Javanbakht M, Cochran S, Hamilton AB, Shoptaw S, Gorbach PM. Mental Health and Substance Use Factors Associated With Unwanted Sexual Contact Among U.S. Active Duty Service Women. J Trauma Stress. 2015 Jun;28(3):167-73.

Profile analyses of the Personality Assessment Inventory following military-related traumatic brain injury.

Study

Abstract

Personality Assessment Inventory (PAI) profiles were examined in 160 U.S. service members (SMs) following mild-severe traumatic brain injury (TBI). Participants who sustained a mild TBI had significantly higher PAI scores than those with moderate-severe TBI on eight of the nine clinical scales examined. A two-step cluster analysis identified four PAI profiles, heuristically labeled "High Distress", "Moderate Distress", "Somatic Distress," and "No Distress". Postconcussive and posttraumatic stress symptom severity was highest for the High Distress group, followed by the Somatic and Moderate Distress groups, and the No Distress group. Profile groups differed in age, ethnicity, rank, and TBI severity. Findings indicate that meaningful patterns of behavioral and personality characteristics can be detected in active duty military SMs following TBI, which may prove useful in selecting the most efficacious rehabilitation strategies.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Defense and Veterans Brain Injury Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: May 01, 2015
  • Citation: Kennedy JE, Cooper DB, Reid MW, Tate DF, Lange RT. Profile analyses of the Personality Assessment Inventory following military-related traumatic brain injury. Arch Clin Neuropsychol. 2015 May;30(3):236-47.

Indirect associations of combat exposure with post-deployment physical symptoms in U.S. soldiers: roles of post-traumatic stress disorder, depression and insomnia.

Study

Abstract

OBJECTIVE: To characterize the indirect associations of combat exposure with post-deployment physical symptoms through shared associations with post-traumatic stress disorder (PTSD), depression and insomnia symptoms. METHODS: Surveys were administered to a sample of U.S. soldiers (N = 587) three months after a 15-month deployment to Iraq. A multiple indirect effects model was used to characterize direct and indirect associations between combat exposure and physical symptoms. RESULTS: Despite a zero-order correlation between combat exposure and physical symptoms, the multiple indirect effects analysis did not provide evidence of a direct association between these variables. Evidence for a significant indirect association of combat exposure and physical symptoms was observed through PTSD, depression, and insomnia symptoms. In fact, 92% of the total effect of combat exposure on physical symptoms scores was indirect. These findings were evident even after adjusting for the physical injury and relevant demographics. CONCLUSION: This is the first empirical study to suggest that PTSD, depression and insomnia collectively and independently contribute to the association between combat exposure and post-deployment physical symptoms. Limitations, future research directions, and potential policy implications are discussed.

  • 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: May 01, 2015
  • Citation: Quartana PJ, Wilk JE, Balkin TJ, Hoge CW. Indirect associations of combat exposure with post-deployment physical symptoms in U.S. soldiers: roles of post-traumatic stress disorder, depression and insomnia. J Psychosom Res. 2015 May;78(5):478-83.

Comparison of frequency of inflammatory bowel disease and noninfectious gastroenteritis among statin users versus nonusers.

Study

Abstract

Conflicting data exist regarding the effects of statin therapy on the prevalence of inflammatory bowel diseases. We aimed to examine the association of statin therapy with diagnoses of inflammatory bowel diseases and noninfectious gastroenteritis. This is a retrospective study using data of a military health care system from October 1, 2003, to March 1, 2012. Based on medication fills during fiscal year 2005, patients were divided into: (1) statin users (received at least 90-day supply of statin) and (2) nonusers (never received a statin). A propensity score-matched cohort of statin users and nonusers was created using 80 variables. Primary analysis examined the risks of being diagnosed with inflammatory bowel diseases and noninfectious gastroenteritis between statin users and nonusers in the propensity score-matched cohort. Secondary analyses examined the risk of outcomes in the whole cohort and in patients with no comorbidities according to Charlson Comorbidity Index. Of 43,438 patients meeting study criteria (13,626 statin users and 29,812 nonusers), we propensity score matched 6,342 statin users with 6,342 nonusers. For our primary analysis, 93 statin users and 92 nonusers were diagnosed with inflammatory bowel diseases (odds ratio = 1.01, 95% confidence interval = 0.76 to 1.35), and 632 statin users and 619 nonusers were diagnosed of noninfectious gastroenteritis (odds ratio = 1.02, 95% confidence interval = 0.91 to 1.15). In conclusion, the risks of inflammatory bowel diseases and noninfectious gastroenteritis among statin users and nonusers are similar after adjusting for other potential confounding factors.

  • Publication Status: Published
  • Sponsoring Organization: Undetermined
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: May 01, 2015
  • Citation: Khalil D, Boktor M, Mortensen EM, Frei CR, Mansi I. Comparison of frequency of inflammatory bowel disease and noninfectious gastroenteritis among statin users versus nonusers. Am J Cardiol. 2015 May 15;115(10):1396-401.

Epidemiology of HIV among US Air Force Military Personnel, 1996-2011.

Study

Abstract

OBJECTIVE: The objectives of this study were to describe the epidemiology of HIV in the United States Air Force (USAF) from 1996 through 2011 and to assess whether socio-demographic characteristics and service-related mobility, including military deployments, were associated with HIV infection. METHODS: We conducted a retrospective cohort analysis of USAF personnel who were HIV-infected during the study period January 1, 1996 through December 31, 2011 and a matched case-control study. Cases were USAF personnel newly-diagnosed with HIV during the study period. Five randomly-selected HIV-uninfected controls were matched to each case by age, length of service, sex, race, service, component, and HIV test collection date. Socio-demographic and service-related mobility factors and HIV diagnosis were assessed using conditional logistic regression. RESULTS: During the study period, the USAF had 541 newly diagnosed HIV-infected cases. HIV incidence rate (per 100,000 person-years) among 473 active duty members was highest in 2007 (16.78), among black/ African-American USAF members (26.60) and those aged 25 to 29 years (10.84). In unadjusted analysis restricted to personnel on active duty, 10 characteristics were identified and considered for final multivariate analysis. Of these single (adjusted odds ratio [aOR], 8.15, 95% confidence interval [CI] 5.71-11.6) or other marital status (aOR 4.60, 95% CI 2.72-7.75), communications/ intelligence (aOR 2.57, 95% CI 1.84-3.60) or healthcare (aOR 2.07, 95% CI 1.28-3.35) occupations, and having no deployment in the past 2 years before diagnosis (aOR 2.02, 95% CI 1.47-2.78) conferred higher odds of HIV infection in adjusted analysis. CONCLUSION: The highest risk of HIV infection in the USAF was among young unmarried deployment-naïve males, especially those in higher risk occupation groups. In an era when worldwide military operations have increased, these analyses identified potential areas where targeted HIV prevention efforts may be beneficial in reducing HIV incidence in the USAF military population.

  • 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: May 01, 2015
  • Citation: Hakre S, Mydlarz DG, Dawson P, Danaher PJ, Gould PL, Witkop CT, Michael NL, Peel SA, Scott PT, Okulicz JF. Epidemiology of HIV among US Air Force Military Personnel, 1996-2011. PLoS One. 2015 May 11;10(5):

Early acute kidney injury in military casualties.

Study

Abstract

BACKGROUND: While acute kidney injury (AKI) has been well studied in a variety of patient settings, there is a paucity of data in patients injured in the course of the recent wars in Iraq and Afghanistan. We sought to establish the rate of early AKI in this population and to define risk factors for its development. METHODS: We combined the results of two studies performed at combat support hospitals in Afghanistan. Only US service members who required care in the intensive care unit were included for analysis. Data on age, race, sex, Injury Severity Score (ISS), first available lactate, and requirement for massive transfusion were collected. Univariate analyses were performed to identify factors associated with the subsequent development of early AKI. Multivariable Cox regression was used to adjust for potential confounders. RESULTS: The two observational cohorts yielded 134 subjects for analysis. The studies had broadly similar populations but differed in terms of age and need for massive transfusion. The rate of early AKI in the combined cohort was 34.3%, with the majority (80.5%) occurring within the first two hospital days. Patients with AKI had higher unadjusted mortality rates than those without AKI (21.7% vs. 2.3%, p < 0.001). After adjustment, ISS (hazard ratio, 1.02; 95% confidence interval, 1.00-1.03; p = 0.046) and initial lactate (hazard ratio, 1.16; 95% confidence interval, 1.03-1.31; p = 0.015) were independently associated with the development of AKI. CONCLUSION: AKI is common in combat casualties enrolled in two prospective intensive care unit studies, occurring in 34.3%, and is associated with crude mortality. ISS and initial lactate are independently associated with the subsequent development of early AKI.

  • 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: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
  • Release Date/Publication: May 01, 2015
  • Citation: Heegard KD, Stewart IJ, Cap AP, Sosnov JA, Kwan HK, Glass KR, Morrow BD, Latack W, Henderson AT, Saenz KK, Siew ED, Ikizler TA, Chung KK. Early acute kidney injury in military casualties. J Trauma Acute Care Surg. 2015 May;78(5):988-93.

Development of a mother-child database for drug exposure and adverse event detection in the Military Health System.

Study

Abstract

PURPOSE: The aim of this study was to develop a mother-child linked database consisting of all eligible active duty military personnel, retirees, and their dependents in order to conduct medication-related analyses to improve the safety and quality of care in the Military Health System (MHS). METHODS: Eligible women of reproductive age with at least one pregnancy-related encounter between January 2005 and December 2013 receiving care in the MHS were included in the study population. Building on previously published algorithms, we used pregnancy-related diagnostic and procedure codes, parameterized temporal constraints, and data elements unique to the MHS to identify pregnancies ending in live births, stillbirth, spontaneous abortion, or ectopic pregnancy. Pregnancies ending in live births were matched to presumptive offspring using birth dates and family-based sponsorship identification. Antidepressant and antiepileptic use during pregnancy was evaluated using electronic pharmacy data. RESULTS: Algorithms identified 755,232 women who experienced 1,099,648 complete pregnancies with both pregnancy care encounter and pregnancy outcome. Of the 924,320 live birth pregnancies, 827,753 (90.0%) were matched to offspring. Algorithms also identified 5,663 stillbirths, 11,358 ectopic pregnancies, and 169,665 spontaneous abortions. Among the matched singleton live birth pregnancies, 7.1% of mothers were dispensed an antidepressant at any point during pregnancy, usually a selective serotonin reuptake inhibitor, (75.3%), whereas 1.3% of mothers were dispensed an antiepileptic drug.

  • Publication Status: Published
  • Sponsoring Organization: Army
  • Sponsoring Office: Pharmacovigilance Center
  • Congressionally Mandated: No
  • Funding Source: Army
  • Release Date/Publication: May 01, 2015
  • Citation: Taylor LG, Thelus Jean R, Gordon G, Fram D, Coster T. Development of a mother-child database for drug exposure and adverse event detection in the Military Health System. Pharmacoepidemiol Drug Saf. 2015 May;24(5):510-7.

Seroprevalence and seroincidence of herpes simplex virus (2006-2010), syphilis (2006-2010), and vaccine-preventable human papillomavirus subtypes (2000-2010) among US military personnel.

Study

Abstract

BACKGROUND: Sexually transmitted infections have historically been burdensome in military populations. We describe the seroprevalence and seroincidence of vaccine-preventable human papillomavirus (VP-HPV) subtypes in a sample of 200 servicemen, along with the seroprevalence and seroincidence of herpes simplex virus (HSV-1/2) and syphilis in a sample of 200 men and 200 women. METHODS: Sera from 200 men, along with associated demographic data, were obtained and tested for HPV serotypes at service entry and 10 years later. Similarly, 200 active-duty men and 200 active-duty women were tested for HSV-1/2 at entry to service and 4 years later. RESULTS: The baseline prevalence of VP-HPV subtypes was 14.5%, and cumulative seroincidence of new infection was 34% over a 10-year period (n = 68). Of these, 63% (n = 43) represented HPV-6, HPV-11, or both; 18% of new infections were either HPV-16 or HPV-18, and 19% (n = 13) were a mixture of all 4 strains. At entry to military service, 33.5% of men were seropositive for HSV-1 and 1.5% were positive for HSV-2; seroincidence was 3.4 and 1.1 per 100 person-years, respectively. Among women, 39% were seropositive for HSV-1 and 4.0% for HSV-2; seroincidence was 5.5 and 3.3 per 100 person-years, respectively. There were 2 prevalent and 3 incident cases of syphilis. CONCLUSIONS: Sexually transmitted infections in military populations are highly prevalent, incident, and epidemiologically distinct. Our data show the rates of HPV and HSV-1/2 acquisition that are higher than those seen in the general public, again highlighting the need for continued preventive efforts. Consideration of universal HPV vaccination among men is warranted.

  • 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: May 01, 2015
  • Citation: Masel J, et. al., Seroprevalence and seroincidence of herpes simplex virus (2006-2010), syphilis (2006-2010), and vaccine-preventable human papillomavirus subtypes (2000-2010) among US military personnel. Sex Transm Dis. 2015 May;42(5):253-8

Survival and Racial Differences of Non-Small Cell Lung Cancer in the United States Military.

Study

Abstract

BACKGROUND: Lung cancer is the leading cause of cancer-related death in the United States (US) Military and worldwide, with non-small cell lung cancer (NSCLC) accounting for 87 % of cases. OBJECTIVES: Using a US military cohort who receives equal and open access to healthcare, we sought to examine demographic, clinical features and outcomes with NSCLC. DESIGN AND PARTICIPANTS: We conducted a retrospective cohort analysis of 4,751 patients, aged ≥ 18 years and diagnosed with a first primary NSCLC between 1 January 2003 and 31 December 2013 in the US Department of Defense (DoD) cancer registry. MAIN MEASURES: Differences by patient and disease characteristics were compared using Chi-square and t-test. Kaplan Meier curves and Cox proportional hazards regression assessed overall survival. RESULTS: The mean age at diagnosis was 66 years, 64 % were male, 72 % were Caucasian, 41 % were diagnosed at early stage, 77 % received treatment and 82 % had a history of tobacco use. Mean age at diagnosis was highest among Caucasians (67 years) and lowest among African Americans (AA; 62 years). Asian/Pacific Islanders (PI) were more likely to be female (p < 0.0001), have adenocarcinoma histology (p = 0.0003) and less likely to have a history of tobacco use (p < 0.0001) compared to other racial/ethnic groups. In multivariable survival analysis, older age, male gender, increasing stage, not receiving treatment, and tobacco history were associated with higher mortality risk. Untreated patients exhibited a 39 % higher mortality risk compared to treated patients (HR = 1.39; 95%CI = 1.23-1.57). Compared to Caucasian patients, Asian/PIs demonstrated a 20 % lower risk of death (HR = 0.80; 95%CI = 0.66-0.96). There was no difference in mortality risk between AAs and Hispanics compared to Caucasians. CONCLUSION: The lack of significant outcome disparity between AAs and Caucasians and the earlier stage at diagnosis than usually seen in civilian populations suggest that equal access to healthcare may play a role in early detection and survival.

  • 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: October 01, 2015
  • Citation: Brzezniak C, Satram-Hoang S, Goertz HP, Reyes C, Gunuganti A, Gallagher C, Carter CA. Survival and Racial Differences of Non-Small Cell Lung Cancer in the United States Military. J Gen Intern Med. 2015 Oct;30(10):1406-12

Ethics, Human Use, and the Department of Defense Serum Repository.

Study

Abstract

The Department of Defense Serum Repository (DoDSR) contains a growing archive of sera from service members collected to perform medical surveillance, clinical diagnosis, and epidemiologic studies to identify, prevent, and control diseases associated with military service. The specimens are a mandatory collection under DoD and U.S. regulations and do not include informed consent for uses beyond force health protection. Any use of the specimens for research requires deidentification of the samples and must be approved by Institutional Review Boards. However, as expansion of the DoDSR is contemplated, ethical considerations of sample collection, storage, and use must be carefully reconsidered. Other similar programs for research use of specimens collected for public health purpose are also undergoing similar reviews. It is recommended that at a minimum, service members are informed of the potential storage and use of their specimens and are allowed to opt out of additional use, or a broad informed consent is provided. The DoDSR provides a tremendous resource to the DoD and global health community, and to ensure its continued existence and improvement, the DoD must stay consistent with all principles of research ethics.

  • 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: October 01, 2015
  • Citation: Pavlin JA, Welch RA. Ethics, Human Use, and the Department of Defense Serum Repository. Mil Med. 2015 Oct;180(10 Suppl):49-56.

Typhoid fever cases in the U.S. military.

Study

Abstract

BACKGROUND: Salmonella enterica, serovar Typhi (S. Typhi), a causative agent of enteric fever (typhoid fever), predominately affects populations in developing regions with poor access to clean food and water. In addition, travelers to these regions are at risk of exposure. METHODS: We report the epidemiological characteristics of S. Typhi cases among active duty United States military personnel from 1998 to 2011 using data obtained from the Defense Medical Surveillance System. Cases were identified based on International Classification for Disease Ninth Edition - Clinical Modification codes. RESULTS: We identified a total of 205 cases S. Typhi for an incidence of 1.09 per 100,000 person-years. Cases were on average 31.7 years old, predominately married (n = 129, 62.9 %), Caucasian (n = 142, 69.3 %), male (n = 176, 85.9 %), and had a high school education (n = 101, 49.3 %). Of the identified cases, 122 had received a Typhoid vaccination within 4 years of diagnosis. CONCLUSION: This study provides an overview of enteric fever in the United States military. The incidence was similar to the general U.S. population except for increased incidence from 1998 to 2000, perhaps attributable to operational deployments in that period. Given that vaccination is an effective primary prevention measure against typhoid fever, active monitoring of pre-deployment vaccine history is warranted.

  • Publication Status: Published
  • Sponsoring Organization: Navy
  • Sponsoring Office: Naval Medical Research Center
  • Congressionally Mandated: No
  • Funding Source: Navy
  • Release Date/Publication: October 01, 2015
  • Citation: Sorrell T, Selig DJ, Riddle MS, Porter CK. Typhoid fever cases in the U.S. military. BMC Infect Dis. 2015 Oct 14;15:424.

Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members.

Study

Abstract

BACKGROUND AND OBJECTIVES:

  • 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: October 01, 2015
  • Citation: Bolanos JA, Yuan CM, Little DJ, Oliver DK, Howard SR, Abbott KC, Olson SW. Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members. Clin J Am Soc Nephrol. 2015 Oct 7;10(10):1732-9.

An Overview of Biorepositories-Past, Present, and Future

Study

Abstract

The collection, storage, and distribution of biological materials for research and improving health have been employed for more than a century. Biorepositories have been used to maintain and reallocate these specimens. Historically, the Department of Defense (DoD) has been maintaining biorepositories and using the materials stored to expand our understanding of diseases and for developing medical countermeasures since the Civil War. Other U.S. Government and nongovernmental organizations are also engaged in curating human and other samples for future studies, as are organizations in other countries. The reasons for collection and the possible uses of specimens maintained within repositories have changed with the advent of novel technologies and the genomics discipline. However, over the years, many of the issues faced by repositories have remained largely the same, although of increased importance more recently because of limited funding and enhanced ethical concerns. These issues include what samples to collect; how to collect, transport, and store the samples; legal and ethical matters relating to sample collection and use; durability of analytes of interest in stored specimens; assessing the quality of stored specimens and providing researchers with statements of specimen quality; costs; maintenance and sustainability of the repository; and, implementing and maintaining laboratory quality programs and possibly accreditation. National and international scientific groups are working to identify and define best practices, but universal standards and practices remain challenges for the future. To begin addressing the above issues, the DoD implemented several initiatives, which are described elsewhere in this Military Medicine Supplement. Additionally, staff members working on the issues saw potential value in identifying other biorepository groups and similar work being done by these groups with the expectation of developing lines of communication and, eventually, even collaboration in establishing universal standards and practices. The repositories identified are briefly discussed in this report.

  • 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: October 01, 2015
  • Citation: Siwek M. An Overview of Biorepositories-Past, Present, and Future. Mil Med. 2015 Oct;180(10 Suppl):57-66.

Completeness and timeliness of reporting of notifiable medical conditions, active component, U.S. Armed Forces, 2008-2014.

Study

Abstract

The complete and timely reporting of notifiable medical conditions occurring among U.S. military service members is important for the control of communicable and preventable diseases and injuries. The Defense Medical Surveillance System (DMSS) was used to identify all hospital and ambulatory care encounters among service members occurring during 2008-2014. Incident encounters with diagnoses of Department of Defense notifiable medical conditions were matched to reportable medical events entered through the Disease Reporting System Internet. Over this time period, the Services reported 47.6% of notifiable hospitalized cases and 57.2% of notifiable ambulatory care cases. Timeliness of reporting improved over the time period with 40.0% of notifiable hospitalized cases reported within 1 week in 2008 and 73.6% in 2014. For ambulatory care cases, 62.3% were reported within 1 week in 2008 and 81.3% in 2014.

  • 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: October 01, 2015
  • Citation: Hurt L, Ying S. Completeness and timeliness of reporting of notifiable medical conditions, active component, U.S. Armed Forces, 2008-2014. MSMR. 2015 Nov;22(11):8-21.
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