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Addictive Behaviors Mar 2019A substantial amount of individuals with substance use disorders (SUD) also meet criteria for posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) is an... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
A substantial amount of individuals with substance use disorders (SUD) also meet criteria for posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) is an effective, evidence-based treatment for PTSD, but there is limited data on its use among individuals with current alcohol or drug use disorders. This study evaluated the efficacy of an integrated treatment that incorporates PE (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure or COPE) among veterans.
METHOD
Military veterans (N = 81, 90.1% male) with current SUD and PTSD were randomized to 12 sessions of COPE or Relapse Prevention (RP). Primary outcomes included the Clinician Administered PTSD Scale (CAPS), PTSD Checklist-Military version (PCL-M), and the Timeline Follow-back (TLFB).
RESULTS
On average, participants attended 8 out of 12 sessions and there were no group differences in retention. Intent-to-treat analyses revealed that COPE, in comparison to RP, resulted in significantly greater reductions in CAPS (d = 1.4, p < .001) and PCL-M scores (d = 1.3, p = .01), as well as higher rates of PTSD diagnostic remission (OR = 5.3, p < .01). Both groups evidenced significant and comparable reductions in SUD severity during treatment. At 6-months follow-up, participants in COPE evidenced significantly fewer drinks per drinking day than participants in RP (p = .05).
CONCLUSIONS
This study is the first to report on the use of an integrated, exposure-based treatment for co-occurring SUD and PTSD in a veteran sample. The findings demonstrate that integrated, exposure-based treatments are feasible and effective for military veterans with SUD and PTSD. Implications for clinical practice are discussed.
Topics: Adult; Female; Humans; Implosive Therapy; Male; Military Personnel; Secondary Prevention; Stress Disorders, Post-Traumatic; Substance-Related Disorders; Treatment Outcome
PubMed: 30529244
DOI: 10.1016/j.addbeh.2018.11.032 -
The Western Journal of Emergency... May 2018Operation Enduring Freedom (OEF-A) in Afghanistan and Operation Iraqi Freedom (OIF) represent the first major, sustained wars in which emergency physicians (EPs) fully... (Review)
Review
Operation Enduring Freedom (OEF-A) in Afghanistan and Operation Iraqi Freedom (OIF) represent the first major, sustained wars in which emergency physicians (EPs) fully participated as an integrated part of the military's health system. EPs proved invaluable in the deployments, and they frequently used the full spectrum of trauma and medical care skills. The roles EPs served expanded over the years of the conflicts and demonstrated the unique skill set of emergency medicine (EM) training. EPs supported elite special operations units, served in medical command positions, and developed and staffed flying intensive care units. EPs have brought their combat experience home to civilian practice. This narrative review summarizes the history, contributions, and lessons learned by EPs during OEF-A/OIF and describes changes to daily clinical practice of EM derived from the combat environment.
Topics: Afghan Campaign 2001-; Emergency Medicine; Humans; Iraq War, 2003-2011; Military Personnel; Multiple Trauma; Physicians; Resource Allocation; Warfare
PubMed: 29760853
DOI: 10.5811/westjem.2018.1.36233 -
Chinese Journal of Traumatology =... Jul 2022Military training is intense, difficult and often dangerous, so all kinds of injuries or diseases frequently occur during training. Most of the previous studies and... (Review)
Review
Military training is intense, difficult and often dangerous, so all kinds of injuries or diseases frequently occur during training. Most of the previous studies and reviews on military training-related injuries focused on musculoskeletal system, whereas there are no reviews of abdominal injuries and diseases. Although the incidence of military training-related abdominal injuries and diseases is relatively low, the patients' condition is often critical especially in the presence of abdominal organ injury, leading to multi-organ dysfunction syndrome and even death. This paper elaborates on common types of military training-related abdominal injuries and diseases as well as the prevention and treatment measures, which provides some basis for scientific and reasonable training and improvement of medical security.
Topics: Abdominal Injuries; Humans; Incidence; Military Personnel; Musculoskeletal System; Wounds and Injuries
PubMed: 35331607
DOI: 10.1016/j.cjtee.2022.03.002 -
Military Medicine Dec 2021Genetic counseling for military beneficiaries poses unique challenges and counseling opportunities. In order to fully meet the needs of this population, genetic... (Review)
Review
Genetic counseling for military beneficiaries poses unique challenges and counseling opportunities. In order to fully meet the needs of this population, genetic counseling involves critical ethical and psychosocial considerations. This article reviews some elements of genetic counseling that must be considered when working with beneficiaries in the military health system.
Topics: Counseling; Genetic Counseling; Humans; Military Personnel
PubMed: 34967403
DOI: 10.1093/milmed/usab007 -
Annals of Surgery Nov 2021Numerous surgical advances have resulted from exchanges between military and civilian surgeons. As part of the U.S. National Library of Medicine Michael E. DeBakey... (Review)
Review
Numerous surgical advances have resulted from exchanges between military and civilian surgeons. As part of the U.S. National Library of Medicine Michael E. DeBakey Fellowship in the History of Medicine, we conducted archival research to shed light on the lessons that civilian surgery has learned from the military system and vice-versa. Several historical case studies highlight the need for immersive programs where surgeons from the military and civilian sectors can gain exposure to the techniques, expertise, and institutional knowledge the other domain provides. Our findings demonstrate the benefits and promise of structured programs to promote reciprocal learning between military and civilian surgery.
Topics: Education, Medical; History, 20th Century; History, 21st Century; Humans; Learning; Military Medicine; Military Personnel; Surgeons; Traumatology
PubMed: 31599807
DOI: 10.1097/SLA.0000000000003635 -
Occupational Medicine (Oxford, England) Jul 2022Despite research highlighting the role of alcohol in military life, specifically in relation to mental health and certain combat experiences, there is no synthesised...
BACKGROUND
Despite research highlighting the role of alcohol in military life, specifically in relation to mental health and certain combat experiences, there is no synthesised evidence looking at the relationship between military service and alcohol use.
AIMS
To synthesize and examine evidence exploring the relationship between military service and alcohol use.
METHODS
Six databases were examined across a 10-year period. Papers were included if they involved a military population and focused on alcohol use. From 4046 papers identified, 29 papers were included in the review.
RESULTS
Military characteristics and experience were linked to high levels of alcohol use across military populations. Societal and cultural factors also played a role in alcohol use in military populations. Predatory behaviour of alcohol establishments, pressures to conform, an acceptance of alcohol use, and the role of religious services and military affiliated social networks were all considered. Excessive drinking impacted physical and mental health. Those diagnosed with PTSD and associated symptoms appeared to have greater alcohol use.
CONCLUSIONS
This review identified certain characteristics and experiences of military service that are associated with higher levels of alcohol use. It is important to identify risk factors for alcohol misuse to develop appropriate policy, targeting prevention.
Topics: Alcohol Drinking; Humans; Mental Health; Mental Health Services; Military Personnel; Risk Factors; Stress Disorders, Post-Traumatic
PubMed: 35674143
DOI: 10.1093/occmed/kqac045 -
International Journal of Environmental... Apr 2022The families of public safety personnel (PSP) face demands that are unique to these occupations. Nonstandard work, trauma exposure, and dangerous work environments... (Review)
Review
The families of public safety personnel (PSP) face demands that are unique to these occupations. Nonstandard work, trauma exposure, and dangerous work environments affect both workers and the families who support them. This narrative review aims to identify the stressors that PSP families experience and the support and resources needed to enhance family resilience. Due to a lack of research on PSP families, this review is a necessary first step to summarizing and interpreting a diverse body of research. The studies included addressed structural and emotional work-family conflict with reference to PSP sectors. A framework from the military family resiliency literature interprets the findings. Factors influencing family functioning and the availability and accessibility of resources provide clues about the type of skills and supports that PSP families rely on. Meaning-making, collaboration, a sense of coherence, and communication were identified as themes associated with intrafamilial processes. Extrafamilial themes included public perceptions, a lack of recognition for the roles families fulfill, and the need for information and education. The results suggest that the vulnerability of PSP families is variable and extrafamilial resources in the form of formal and informal supports are necessary to enhance family resiliency.
Topics: Communication; Family; Family Health; Humans; Military Personnel; Occupations; Resilience, Psychological
PubMed: 35564618
DOI: 10.3390/ijerph19095224 -
Chiropractic & Manual Therapies 2019Musculoskeletal injuries are one of the most prevalent battle and non-battle related injuries in the active duty military. In some countries, chiropractic services are... (Review)
Review
BACKGROUND
Musculoskeletal injuries are one of the most prevalent battle and non-battle related injuries in the active duty military. In some countries, chiropractic services are accessed to manage such injuries within and outside military healthcare systems; however, there is no recent description of such access nor outcomes. This scoping review aimed to synthesize published literature exploring the nature, models, and outcomes of chiropractic services provided to active duty military globally.
METHOD
We employed scoping review methodology. Systematic searches of relevant databases, including military collections and hand searches were conducted from inception to October 22, 2018. We included peer-reviewed English literature with qualitative and quantitative designs, describing chiropractic practice and services delivered to active duty military worldwide. Paired reviewers independently reviewed all citations and articles using a two-phase screening process. Data from relevant articles were extracted into evidence tables and sorted by study type. Results were descriptively analyzed.
RESULTS
We screened 497 articles and 20 met inclusion criteria. Chiropractic services were commonly provided on-base only in the US. Services were accessed by physician referral and commonly after initiation or non-response to other care. Use of scope of practice was determined by the system/facility, varying from intervention specific to comprehensive services. Back pain with and without radiculopathy accounted for most complaints. Treatment outcomes were reported primarily by case reports. However, two recent randomized trials reported improved pain, disability, and satisfaction when adding chiropractic care to usual medical care compared to usual medical care alone in management of low back pain. Specific reaction time measures in special operation forces military did not improve after chiropractic care compared to wait-list control.
CONCLUSIONS
Our scoping review found the majority of published articles described chiropractic services in the active duty military in the US setting. Recent RCTs suggest a benefit of including chiropractic care to usual medical care in managing back pain in active duty military. Yet despite reported benefits in Australia, Canada, and the US, there is a need for further qualitative, descriptive, and clinical trial data worldwide to inform the role of chiropractic services in active duty military.
Topics: Chiropractic; Humans; Manipulation, Chiropractic; Military Personnel; Musculoskeletal Pain
PubMed: 31338157
DOI: 10.1186/s12998-019-0259-6 -
European Journal of Psychotraumatology 2022During a deployment, soldiers must make seemingly impossible decisions, including having to engage with child soldiers. Such moral conflicts may continue to affect... (Review)
Review
During a deployment, soldiers must make seemingly impossible decisions, including having to engage with child soldiers. Such moral conflicts may continue to affect service members and veterans in the aftermath of a deployment, sometimes leading to severe moral distress, anguish, and personal crises. Service providers have increasingly argued that as a diagnosis, Post-Traumatic Stress Disorder (PTSD) cannot account for these deeply personal and painful moral conflicts. In light of this, the concept of moral injury has been introduced to better capture the profound forms of guilt and shame that may be experienced by service members and veterans. This paper addresses encounters with children and child soldiers during military deployments, as well as the risk for moral injury during and following these encounters, and their implications. This exploratory paper brings together existing literature on the topic to introduce, illustrate, and offer potential and promising interventions. Given the potential moral conflicts that may ensue, military personnel who encounter child soldiers during a military deployment may be at risk for moral injury during and following these encounters. The introduction of the concept of moral injury provides a way for these largely unnamed personal and painful moral conflicts and violations to be recognized, addressed, and with appropriate care, remedied. Although there is limited research into their effectiveness at treating moral injury, individual and group-based interventions have been identified as potentially beneficial. As encounters with children during deployments are likely to continue, systematic research, training, healing interventions and prevention strategies are vital to support and protect children in conflict settings, as well as to ensure the mental health and well-being of service members and veterans. Profound moral conflicts may affect service members and veterans in the aftermath of a military deployment, sometimes leading to severe moral distress, anguish, and personal crises. The concept of moral injury has been introduced to better capture the profound forms of guilt and shame that may be experienced by service members and veterans.Encountering children and child soldiers during a military deployment, may present unique challenges, stress, and moral crises leading to potentially moral injurious events. In particular, which result from an individual perpetrating or engaging in acts that contravene his or her deeply held moral beliefs and expectations such as harming children, and , which results from witnessing or falling victim to the perceived moral transgressions of others, may lead to lasting psychological, biological, spiritual, behavioural and social impairments.Interventions applied in both an individual-based context such as , and a group-based context such as and have been identified as potentially beneficial to addressing moral injury. However, more research is required to ascertain appropriate and effective intervention and healing strategies.
Topics: Acceptance and Commitment Therapy; Child; Female; Humans; Male; Military Deployment; Military Personnel; Stress Disorders, Post-Traumatic; Veterans
PubMed: 35979504
DOI: 10.1080/20008066.2022.2104007 -
Military Medical Research Nov 2020Military drill injury is a significant part of military medical research. The increase of training intensity and changes in training methods lead to differences in... (Review)
Review
Military drill injury is a significant part of military medical research. The increase of training intensity and changes in training methods lead to differences in injury types. The ideal therapeutic modality should allow rapid healing at a reasonable cost and minimize impact on patients' life. Platelet -rich plasma (PRP), a platelet concentrate, is rich in a variety of growth factors and widely used clinically as a minimally invasive treatment. It plays an important role in injury repair and rehabilitation. In this article, we review the therapeutic role of PRP in military drill injury and its possible underlying mechanisms, with a focus on plantar fasciitis, stress fractures and other common injuries, in order to provide basic support for military reserve.
Topics: Humans; Military Personnel; Platelet-Rich Plasma; Wound Healing; Wounds and Injuries
PubMed: 33220706
DOI: 10.1186/s40779-020-00285-1