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Acta Neurologica Scandinavica Jan 2021The cause of amyotrophic lateral sclerosis (ALS) is unknown, but occupations have been explored as a potential proxy measure of risk. There is a substantial body of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The cause of amyotrophic lateral sclerosis (ALS) is unknown, but occupations have been explored as a potential proxy measure of risk. There is a substantial body of literature connecting military service to ALS. We aimed to summarize and assess the quality of this evidence.
METHODS
Systematic review of the literature, including observational studies which explored one of the following exposures: general military service (army, air force, marines, or navy); or specific exposures associated with military service measured among military personnel. The outcome of interest was ALS incidence, which could include onset, diagnosis, or death from ALS.
RESULTS
A total of 2642 articles were screened. Following exclusion, 19 articles remained for inclusion in the systematic review, including 1 meta-analysis and 18 original observational studies. Most studies were of moderate quality. In general, the relationship between military service was suggestive of an increased risk, particularly among Gulf War and WWII veterans. Exposure to pesticides (including Agent Orange) certain chemicals (exhaust, burning agents), heavy metals, and head trauma appeared to increase the risk of ALS among military personnel.
CONCLUSIONS
There is a possible association between military service and the subsequent development of ALS; however, the evidence was limited. Studies were generally hindered by small sample sizes and inadequate follow-up time. Future studies should endeavor to objectively measure specific exposures, or combinations thereof, associated with military service, as this will be of vital importance in implementing preventative strategies into military organizations.
Topics: Amyotrophic Lateral Sclerosis; Case-Control Studies; Craniocerebral Trauma; Environmental Exposure; Female; Humans; Male; Metals, Heavy; Military Personnel; Pesticides; Risk Factors; Veterans; War-Related Injuries
PubMed: 32905613
DOI: 10.1111/ane.13345 -
Sleep Science (Sao Paulo, Brazil) 2022Military personnel are unique occupational groups who happen to frequently experience sleep insuffciencies. Since sleep disorders are known to be linked to many... (Review)
Review
OBJECTIVES
Military personnel are unique occupational groups who happen to frequently experience sleep insuffciencies. Since sleep disorders are known to be linked to many psychiatric symptoms, sleep disturbance is a salient concern among active duty service members and veterans. Existing evidence indicates that although sleep disturbances co-occur with mental illnesses, there is a tendency to particularly label them as consequences of certain mental health issues.
MATERIAL AND METHODS
This review focuses on the emerging evidence which identifies sleep disturbances as a precursor for mental illnesses. In this regard, the impact of sleep disturbance on the development of mental health outcomes including post-traumatic stress disorder (PTSD), depression, and anxiety has been thoroughly scrutinized. A systematic search was conducted using PubMed, Scopus, and Web of Science academic databases using appropriate keywords.
RESULTS
Reviewed evidence substantiates the predicting role of sleep complaints and disorders to herald PTSD, depression, and anxiety among military staff.
CONCLUSION
Early diagnosis of sleep disturbances and properly addressing them in active-duty service members and veterans should be then sought to prevent the development and progression of consequent mental health- related comorbidities in this study group.
PubMed: 36158717
DOI: 10.5935/1984-0063.20220063 -
Frontiers in Public Health 2023Climate change has effects on multiple aspects of human life, such as access to food and water, expansion of endemic diseases as well as an increase of natural disasters...
BACKGROUND
Climate change has effects on multiple aspects of human life, such as access to food and water, expansion of endemic diseases as well as an increase of natural disasters and related diseases. The objective of this review is to summarize the current knowledge on climate change effects on military occupational health, military healthcare in a deployed setting, and defense medical logistics.
METHODS
Online databases and registers were searched on August 22, 2022 and 348 papers retrieved, published between 2000 and 2022, from which we selected 8 publications that described climate effects on military health. Papers were clustered according to a modified theoretical framework for climate change effects on health, and relevant items from each paper were summarized.
RESULTS
During the last decades a growing body of climate change related publications was identified, which report that climate change has a significant impact on human physiology, mental health, water- and vector borne infectious diseases, as well as air pollution. However, regarding the specific climate effects on military health the level of evidence is low. The effects on defense medical logistics include vulnerabilities in the cold supply chain, in medical devices functioning, in need for air conditioning, and in fresh water supply.
CONCLUSIONS
Climate change may transform both the theoretical framework and practical implementations in military medicine and military healthcare systems. There are significant knowledge gaps on climate change effects on the health of military personnel in operations of both combat and non-combat nature, alerting the need for prevention and mitigation of climate-related health issues. Further research within the fields of disaster and military medicine is needed to explore this novel field. As climate effects on humans and the medical supply chain may degrade military capability, significant investments in military medical research and development are needed.
Topics: Humans; Climate Change; Military Medicine; Disasters; Military Personnel; Natural Disasters
PubMed: 37213601
DOI: 10.3389/fpubh.2023.1099031 -
BMJ Military Health Sep 2023Military service personnel are required to deploy to austere environments where they are exposed to harsh conditions. Many service personnel continue to wear contact...
INTRODUCTION
Military service personnel are required to deploy to austere environments where they are exposed to harsh conditions. Many service personnel continue to wear contact lenses when deployed as they are an effective alternative to spectacles by affording superior ergonomic functionality, although they are associated with significant complications. We aimed to explore the prevalence and type of contact lens-related complications among deployed service personnel worldwide.
METHODS
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. PubMed, Medline, CINAHL and EMBASE databases were searched for relevant articles published between 1950 and 2023. The keywords 'contact lens' and 'military' or 'army' or 'navy' or 'air force' and 'austere' or 'deployed' or 'adverse' were used.
RESULTS
Five eligible articles were included. Excluded articles reported contact lens wear in the firm base, were not related to military personnel or did not involve the deployed setting. Major complications associated with contact lens wear included microbial keratitis and contact lens-related discomfort. Excluding case reports, the overall incidence of contact lens-related complications ranged from 0.35% to 25.4%. The three case reports included in this systematic review described keratitis, keratitis and contact lens-related discomfort as significant complications. These case reports also detailed time to initial presentation and type of contact lens worn when complications were encountered. Types of deployed conditions service personnel were exposed to included desert, temperate and underwater environments.
CONCLUSIONS
We highlight a scarcity of recent data regarding contact lens-related complications in the deployed setting. While contact lens-wearing service personnel are at risk of infectious keratitis and contact lens-related discomfort, we recommend good-quality data collection on contact lens wearing schedules and complication rates to steer guidance on contact lens wear in service personnel.
PubMed: 37699733
DOI: 10.1136/military-2023-002476 -
Military Psychology : the Official... Mar 2024This systematic review examined the effects of mobile health (mHealth) apps on the physical and mental health outcomes of military personnel. Fourteen studies (10 RCTs,... (Review)
Review
This systematic review examined the effects of mobile health (mHealth) apps on the physical and mental health outcomes of military personnel. Fourteen studies (10 RCTs, 4 non-RCTs) published between 2000 and 2022 were included. While app-based interventions did not significantly improve clinical outcomes like HbA1c and blood pressure, they showed a statistically significant reduction in symptom severity of Posttraumatic Stress Disorder symptoms (PTSD), depression, and insomnia. Patients expressed satisfaction with the apps, though statistical significance was not reported. In addition to alleviating mental health symptoms, mHealth apps appear widely accepted by military personnel. Development and implementation of evidence-based mental health apps by healthcare professionals are recommended.
PubMed: 38551462
DOI: 10.1080/08995605.2024.2336640 -
Injury Nov 2022Virtual (VR), augmented (AR), mixed reality (MR) and haptic interfaces make additional avenues available for surgeon assessment, guidance and training. We evaluated... (Review)
Review
OBJECTIVE
Virtual (VR), augmented (AR), mixed reality (MR) and haptic interfaces make additional avenues available for surgeon assessment, guidance and training. We evaluated applications for open trauma and emergency surgery to address the question: Have new computer-supported interface developments occurred that could improve trauma training for civilian and military surgeons performing open, emergency, non-laparoscopic surgery?
DESIGN
Systematic literature review.
SETTING AND PARTICIPANTS
Faculty, University of Maryland School of Medicine, Baltimore., Maryland; Womack Army Medical Center, Fort Bragg, North Carolina; Temple University, Philadelphia, Pennsylvania; Uniformed Services University of Health Sciences, and Walter Reed National Military Medical Center, Bethesda, Maryland.
METHODS
Structured literature searches identified studies using terms for virtual, augmented, mixed reality and haptics, as well as specific procedures in trauma training courses. Reporting bias was assessed. Study quality was evaluated by the Kirkpatrick's Level of evidence and the Machine Learning to Asses Surgical Expertise (MLASE) score.
RESULTS
Of 422 papers identified, 14 met inclusion criteria, included 282 enrolled subjects, 20% were surgeons, the remainder students, medics and non-surgeon physicians. Study design was poor and sample sizes were low. No data analyses were beyond descriptive and the highest outcome types were procedural success, subjective self-reports, except three studies used validated metrics. Among the 14 studies, Kirkpatrick's level of evidence was level zero in five studies, level 1 in 8 and level 2 in one. Only one study had MLASE Score greater than 9/20. There was a high risk of bias in 6 studies, uncertain bias in 5 studies and low risk of bias in 3 studies.
CONCLUSIONS
There was inadequate evidence that VR,MR,AR or haptic interfaces can facilitate training for open trauma surgery or replace cadavers. Because of limited testing in surgeons, deficient study and technology design, risk of reporting bias, no current well-designed studies of computer-supported technologies have shown benefit for open trauma, emergency surgery nor has their use shown improved patient outcomes. Larger more rigorously designed studies and evaluations by experienced surgeons are required for a greater variety of procedures and skills.
COMPETENCIES
Medical Knowledge, Practice Based Learning and Improvement, Patient Care, Systems-Based Practice.
Topics: Humans; Clinical Competence; Military Personnel; Haptic Interfaces; Virtual Reality; Surgeons; User-Computer Interface
PubMed: 36123192
DOI: 10.1016/j.injury.2022.08.003 -
Journal of the Royal Army Medical Corps Dec 2019Despite all local authorities in England signing up to the Armed Forces Covenant, only a small proportion of Joint Strategic Needs Assessments (JSNAs) include detailed... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Despite all local authorities in England signing up to the Armed Forces Covenant, only a small proportion of Joint Strategic Needs Assessments (JSNAs) include detailed consideration of the health of the local ex-military population. This article supports improvements to JSNAs by systematically reviewing published research for evidence of differences in health between the ex-military population and the general public.
METHODS
Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology for qualitative synthesis of mixed study designs. SCOPUS, PubMed and Google Scholar were searched for published research on health outcomes among UK ex-military populations. All study designs were included.
RESULTS
43 studies met the inclusion criteria. Rates of mental illness and hearing loss are higher among ex-military populations compared with the general public, while rates of cancer among ex-military personnel born after 1960 are lower. Despite high rates of hazardous drinking among serving personnel, rates of alcohol-related harm among ex-military populations are no higher than the general public. There is a subpopulation at increased risk of a range of adverse outcomes. This group is variously identified as younger, male, less educated, more likely to have served in a combat role and/or left service early.
CONCLUSIONS
This review found evidence of areas of increased and reduced disease burden among ex-military populations. More detailed information on the make-up of the local ex-service population would support more meaningful needs assessments. The Ministry of Defence and local authorities and service providers should work together to support early identification and targeted support for those at the highest risk of adverse outcomes.
Topics: Alcoholism; Humans; Mental Disorders; Needs Assessment; Neoplasms; Risk Factors; United Kingdom; Veterans
PubMed: 30530498
DOI: 10.1136/jramc-2018-001101 -
The Journal of Head Trauma... 2020To determine whether persons with traumatic brain injury (TBI) are at greater risk of developing posttraumatic stress disorder (PTSD) than other trauma-exposed... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To determine whether persons with traumatic brain injury (TBI) are at greater risk of developing posttraumatic stress disorder (PTSD) than other trauma-exposed populations without TBI, and whether this risk is even greater in military/veteran settings than in civilian settings.
DESIGN
A systematic review and meta-analysis was conducted in 7 databases. Reference lists from the 33 identified studies and other relevant reviews were also searched.
RESULTS
The pooled PTSD proportion reached 27% (95% confidence interval = 21.8-33.1) in groups with TBI, which was 2.68 times greater than the observed 11% (95% confidence interval = 8.0-15.0) in groups without TBI. PTSD after TBI was more frequently observed in military samples than in civilians (37% vs 16%). Military and civilian samples were respectively 4.18 and 1.26 times more inclined to have a diagnosis of PTSD after TBI than when there was no TBI. The proportion of PTSD after TBI was concurrently attributable to the methods of the included studies (objectives focused on PTSD diagnosis, type of comparison group) and to characteristics specific to the military setting (country, sex, blast injuries).
CONCLUSIONS
TBI diagnosis and military setting represent greater risks for PTSD. The dual diagnosis of TBI and PTSD requires interdisciplinary collaboration, as physical and psychological traumas are closely intertwined.
Topics: Brain Injuries, Traumatic; Humans; Military Personnel; Stress Disorders, Post-Traumatic; Veterans
PubMed: 31479073
DOI: 10.1097/HTR.0000000000000514 -
European Journal of Psychotraumatology 2022Military members report higher instances of trauma exposure and subsequent posttraumatic stress disorder (PTSD) relative to civilians. Encounters with children in war... (Review)
Review
Military members report higher instances of trauma exposure and subsequent posttraumatic stress disorder (PTSD) relative to civilians. Encounters with children in war and conflict settings may have particularly unsettling consequences. However, the nature of these consequences has yet to be systematically examined. This systematic review sought to identify and document deployment-related encounters with children and associated outcomes reported by military personnel, as well as identify any current training programs, policies, or procedures in place regarding encountering children during deployment. A total of 17 studies with 86 independent samples were included. Analyses were based primarily on qualitative data. Based on the review, 77 military personnel samples documented their experiences encountering children during deployment. Most commonly, child encounters included armed children, porters/human shields, suicide bombers, and ambiguous interactions. Outcomes from encountering children during deployment were diverse, occurring both during the encounter, and described by many as persisting years following the exposure. Consequences of encounters as described by military personnel included: hesitation to complete mission objectives, mental health concerns, moral struggles, social isolation, and sleep disturbances. Of the 86 included reports, only nine provided information regarding training at any stage (pre-, during, or post-deployment) in relation to encountering children. Much of the available information underscored the lack of training, with six reports highlighting the lack of pre-deployment training and five reports describing the lack of policies, including rules of engagement, as they relate to encountering children during deployment. Only two reports described post-deployment procedures made available to military personnel following exposure to children while on deployment. Results from this review will be used to identify available research, develop and support training initiatives, and increase awareness regarding implications of encountering children during deployment. We further provide recommendations regarding research needs, policy implementation, and current training gaps.
Topics: Child; Humans; Military Personnel; Military Deployment; Stress Disorders, Post-Traumatic; Family; Mental Health
PubMed: 36325257
DOI: 10.1080/20008066.2022.2132598 -
Complementary Therapies in Clinical... Feb 2021In recent years, mindfulness-based interventions (MBIs) have experienced exponential growth in terms of development, application, and research. However, few studies have...
BACKGROUND
In recent years, mindfulness-based interventions (MBIs) have experienced exponential growth in terms of development, application, and research. However, few studies have examined implementation and efficacy of these interventions in particular populations, such as military Veterans. Such studies are needed as one cannot assume that the literature on MBIs implemented with the general population or other specific populations apply equally well to Veterans. This population is unique regarding professional competencies, military ethos, high degrees of medical comorbidities and barriers to treatment. The aim of this work was to review and summarize the literature over the previous five years (2014-2020) assessing the use of MBIs among military Veterans to guide clinical care and future research.
METHODS
Systematic literature review.
RESULTS
A total of 88 articles were found. Screening titles and abstracts resulted in 49 articles being excluded. The remaining 39 articles were read in full, and of these, 12 were excluded due to not fully meeting the inclusion criteria. Thus, the present review included a total of 27 articles, 3 of which used qualitative methods and 24 of which used quantitative methods.
CONCLUSIONS
MBIs hold promise as complementary adjunctive interventions for Veterans with PTSD and possibly other psychiatric disorders. Currently there are significant gaps in the literature that must be addressed to move the field forward. The main deficiency is, with a few exceptions, the lack of rigorous RCTs. Another major concern is the lack of generalizability to female and non-white Veterans given that the subject samples across all studies reviewed were 85% male and 76% white. At this time, MBSR, PCBMT and MBCT can be recommended as adjunctive complementary interventions for the reduction of PTSD symptoms. Research recommendations to move the field forward are provided.
Topics: Female; Humans; Male; Mental Disorders; Military Personnel; Mindfulness; Veterans
PubMed: 33276226
DOI: 10.1016/j.ctcp.2020.101274