-
Military Medicine Jun 2024The Air Force Dental Service is responsible for ensuring that airmen are dentally ready to support military operations worldwide by delivering top-tier dental care. As...
INTRODUCTION
The Air Force Dental Service is responsible for ensuring that airmen are dentally ready to support military operations worldwide by delivering top-tier dental care. As the military healthcare landscape undergoes significant changes, the Air Force Dental Service has explored innovative approaches to dental care delivery. One consideration involves the potential use of radiographs as the primary tool for assessing service members' dental conditions, specifically focusing on identifying nondeployable conditions and periodontal health.
MATERIALS AND METHODS
Providers who previously participated as examiners in the 2018 Air Force Recruit Oral Health Study were recruited to re-evaluate randomly selected de-identified records, this time making assessments exclusively based on radiographs. Their evaluations included Dental Readiness Classification (DRC) determinations, total caries counts, and Periodontal Screening and Recording (PSR) index scores, providers also rated their confidence in these conclusions using a 5-point Likert scale. The study then computed sensitivity and specificity to assess the diagnostic performance of providers using radiographs only compared to the original study results that use the gold standard of radiographs with a clinical examination.
RESULTS
Providers exceled at ruling out most DRC 3 conditions, with specificities surpassing 70%. Positively identifying those with DRC 3, particularly radiographically identifying periodontal conditions posed challenges with computed sensitivity rates as low as 8%. Discrepancies in PSR scores also accentuated limitations in relying solely on radiographs, where provider's radiographically determined PSR scores that matched less than one third of the time. In general, providers had low to very low confidence in their assessments.
CONCLUSIONS
The study strongly cautions against relying solely on radiographs for determining the dental health of U.S. Air Force personnel. While providers effectively ruled out the absence of certain conditions, the challenge of positively identifying DRC 3 conditions poses significant risks to oral health if such a workflow was utilized. Particularly, the high probability of false negatives would be detrimental to the operational readiness of military personnel. Therefore, results support the continued use of radiographic and clinical examinations for comprehensive dental exams.
PubMed: 38894664
DOI: 10.1093/milmed/usae315 -
The Agreement between Wearable Sensors and Force Plates for the Analysis of Stride Time Variability.Sensors (Basel, Switzerland) May 2024The variability and regularity of stride time may help identify individuals at a greater risk of injury during military load carriage. Wearable sensors could provide a...
The variability and regularity of stride time may help identify individuals at a greater risk of injury during military load carriage. Wearable sensors could provide a cost-effective, portable solution for recording these measures, but establishing their validity is necessary. This study aimed to determine the agreement of several measures of stride time variability across five wearable sensors (Opal APDM, Vicon Blue Trident, Axivity, Plantiga, Xsens DOT) and force plates during military load carriage. Nineteen Australian Army trainee soldiers (age: 24.8 ± 5.3 years, height: 1.77 ± 0.09 m, body mass: 79.5 ± 15.2 kg, service: 1.7 ± 1.7 years) completed three 12-min walking trials on an instrumented treadmill at 5.5 km/h, carrying 23 kg of an external load. Simultaneously, 512 stride time intervals were identified from treadmill-embedded force plates and each sensor where linear (standard deviation and coefficient of variation) and non-linear (detrended fluctuation analysis and sample entropy) measures were obtained. Sensor and force plate agreement was evaluated using Pearson's r and intraclass correlation coefficients. All sensors had at least moderate agreement (ICC > 0.5) and a strong positive correlation (r > 0.5). These results suggest wearable devices could be employed to quantify linear and non-linear measures of stride time variability during military load carriage.
Topics: Humans; Wearable Electronic Devices; Adult; Male; Young Adult; Military Personnel; Walking; Weight-Bearing; Gait; Biomechanical Phenomena; Exercise Test
PubMed: 38894183
DOI: 10.3390/s24113378 -
Open Forum Infectious Diseases Jun 2024Among combat injured, invasive fungal infections (IFIs) result in significant morbidity. Cultures and histopathology are the primary diagnostic methods for IFIs, but...
BACKGROUND
Among combat injured, invasive fungal infections (IFIs) result in significant morbidity. Cultures and histopathology are the primary diagnostic methods for IFIs, but they have limitations. We previously evaluated a panfungal polymerase chain reaction assay, which was 83% sensitive and 99% specific for angioinvasive IFIs. Here, we evaluated 3 less resource-intensive seminested assays targeting clinically relevant fungi in the order Mucorales and genera and .
METHODS
Formalin-fixed paraffin-embedded tissue specimens from a multicenter trauma IFI cohort (2009-2014) were used. Cases were US military personnel injured in Afghanistan with histopathologic IFI evidence. Controls were patients with similar injury patterns and no laboratory IFI evidence (negative culture and histopathology). Seminested assays specific to Mucorales (V4/V5 regions of 18S rDNA), (mitochondrial tRNA), and (internal transcribed spacer [ITS]/28A regions of DNA) were compared with a panfungal assay amplifying the internal transcribed spacer 2 region of rDNA and to histopathology.
RESULTS
Specimens from 92 injury sites (62 subjects) were compared with control specimens from 117 injuries (101 subjects). We observed substantial agreement between the seminested and panfungal assays overall, especially for the order Mucorales. Moderate agreement was observed at the genus level for and . When compared with histopathology, sensitivity and specificity of seminested assays were 67.4% and 96.6%, respectively (sensitivity increased to 91.7% when restricted to sites with angioinvasion).
CONCLUSIONS
Prior studies of seminested molecular diagnostics have focused on culture-negative samples from immunocompromised patients. Our findings underscore the utility of the seminested approach in diagnosing soft-tissue IFIs using formalin-fixed paraffin-embedded tissue samples, especially with angioinvasion.
PubMed: 38887475
DOI: 10.1093/ofid/ofae078 -
European Journal of Sport Science Jun 2024Bouts of military load carriage are rarely completed in isolation; however, limited research has investigated the physiological responses to repeated load carriage...
Bouts of military load carriage are rarely completed in isolation; however, limited research has investigated the physiological responses to repeated load carriage tasks. Twelve civilian men (age, 28 ± 8 years; stature, 185.6 ± 5.8 cm; body mass 84.3 ± 11.1 kg and maximal oxygen uptake, 51.5 ± 6.4 mL·kg min) attended the laboratory on two occasions to undertake a familiarisation and an experimental session. Following their familiarisation session, participants completed three bouts of a fast load carriage protocol (FLCP; ∼65 min), carrying 25 kg, interspersed with a 65-min recovery period. Physiological strain (oxygen uptake [V̇O] and heart rate [HR]) was assessed during the FLCP bouts, and physical performance assessments (weighted counter-movement jump [wCMJ], maximal isometric voluntary contraction of the quadriceps [MIVC] and seated medicine ball throw [SMBT]) was measured pre and post each FLCP bout. A main effect for bout and measurement time was evident for V̇O and HR (both p < 0.001 and Ѡ = 0.103-0.816). There was no likely change in SMBT distance (p = 0.201 and Ѡ = 0.004), but MIVC peak force reduced by approximately 25% across measurement points (p < 0.001 and Ѡ = 0.133). A mean percentage change of approximately -12% from initial values was also evident for peak wCMJ height (p = 0.001 and Ѡ = 0.028). Collectively, these data demonstrate that repeated FLCP bouts result in an elevated physiological strain for each successive bout, along with a substantial reduction in lower body power (wCMJ and MIVC). Therefore, future research should investigate possible mitigation strategies to maintain role-related capability.
PubMed: 38886977
DOI: 10.1002/ejsc.12154 -
BMC Emergency Medicine Jun 2024Evidence shows that patients who visit the surgical and trauma emergency units may be discharged with untreated or increased pain levels. This study explored nurses'...
BACKGROUND
Evidence shows that patients who visit the surgical and trauma emergency units may be discharged with untreated or increased pain levels. This study explored nurses' pain assessment and management approaches at a trauma-surgical emergency unit in Ghana.
METHODS
Seventeen nurses who work in the trauma department participated in this qualitative exploratory descriptive study. In-depth individual interviews were conducted, and the thematic analysis was utilized to identify emerging themes and subthemes.
RESULTS
Three main themes were identified: patient pain indicators, pain management, and institutional factors influencing pain management. The study revealed that nurses rely on verbal expressions, non-verbal cues, physiological changes, and the severity of pain communicated. The findings highlighted staff shortage, inadequate resources, and lack of standardized guidelines as factors affecting pain and management.
CONCLUSIONS
Although the study offers critical new perspectives on nurses' experiences regarding pain related issues at the trauma-surgical emergency units, its small sample size limited its generalizability.
Topics: Humans; Ghana; Qualitative Research; Male; Female; Adult; Pain Management; Pain Measurement; Accidents, Traffic; Hospitals, Military; Interviews as Topic; Middle Aged; Nursing Staff, Hospital; Attitude of Health Personnel
PubMed: 38886656
DOI: 10.1186/s12873-024-01016-8 -
CMAJ : Canadian Medical Association... Jun 2024
Topics: Humans; Chronic Pain; Veterans; Canada; Military Personnel; Male
PubMed: 38885976
DOI: 10.1503/cmaj.240219 -
Psychological Trauma : Theory,... Sep 2023The current study evaluates the psychometric properties of the Protective and Compensatory Experiences Survey (PACES; Morris et al., 2018) within a military population....
Exploring the protective experiences of those who "protect and serve": A psychometric evaluation of Protective and Compensatory Experiences Survey within a military sample.
OBJECTIVE
The current study evaluates the psychometric properties of the Protective and Compensatory Experiences Survey (PACES; Morris et al., 2018) within a military population. The study's aims are to evaluate if the PACES is a reliable measure to use with military samples and to examine the validity of the PACES measure when exploring protective experiences in relation to adverse childhood experiences (ACEs) and adult traumatic stress (ATS) in an active duty military sample.
METHOD
Active duty Service members were recruited to complete an online survey that included measures pertaining to ACEs, PACES, and ATS.
RESULTS
The reliability and validity of PACES indicate that Service members who are involved in protective and compensatory experiences as youth are less likely to have experiences of stress both as children and as adults.
CONCLUSIONS
Given the need for mission readiness of Service members and their higher likelihood to experience ACEs than civilians, the role of protective and compensatory factors is vital to their livelihood and career. PACES psychometrics offer a reliable and valid measure to use when exploring the risk and resilience experiences of Service members across the lifespan. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Topics: Humans; Psychometrics; Military Personnel; Adult; Male; Female; Reproducibility of Results; Adverse Childhood Experiences; Resilience, Psychological; Young Adult; Surveys and Questionnaires; Middle Aged; Adolescent
PubMed: 38885426
DOI: 10.1037/tra0001497 -
Contemporary Nurse Jun 2024Moral injury occurs when one witnesses or perpetrates an act that transgresses strongly held moral beliefs and expectations. First documented among active military and...
BACKGROUND
Moral injury occurs when one witnesses or perpetrates an act that transgresses strongly held moral beliefs and expectations. First documented among active military and veterans, moral injury is increasingly studied in healthcare personnel impacted by the coronavirus pandemic. Measurement of moral injury among this population, particularly nurses, is still in its infancy.
OBJECTIVE
To develop the Moral Injury Symptom Scale - Clinician-Short Form and validate it among United States based acute care nurses. .
METHODS
The Moral Injury Symptom Scale - Military Version was modified for a healthcare audience. 174 acute care nurses responded to a survey package including the scale and related instruments. Reliability and validity, including convergent and discriminant validities, were assessed, and a cutoff score was calculated using the area under the receiver operating characteristic curve.
RESULTS
Reliability (Cronbach α = .75) and validity were established and a cutoff score of 41, based on functional impairment caused by moral injury, demonstrated 86.4% sensitivity and 69.6% specificity. Nurses who screened positive for moral injury experienced higher depression, anxiety, work exhaustion, interpersonal disengagement, emotional exhaustion, and depersonalization. .
CONCLUSIONS
The Moral Injury Symptom Scale - Clinician Version - Short Form is a valid and reliable instrument with strong psychometric properties that can assess moral injury in acute care nurses, a population at risk due to the challenges of providing care during the pandemic. Appropriate measurement and establishing prevalence should prompt support and intervention from healthcare organizations. .
PubMed: 38885130
DOI: 10.1080/10376178.2024.2366915 -
Infection and Drug Resistance 2024
A Response to the Article "Seroprevalence of Hepatitis B and C Viruses and Their Associated Factors Among Military Personnel at Military Camps in Central Gondar, Ethiopia: A Cross-Sectional Study" [Letter].
PubMed: 38882655
DOI: 10.2147/IDR.S480588 -
Clinical and Experimental Dental... Jun 2024The objective of this study was to investigate the relationship of the depression level with temporomandibular disorders (TMDs) in young conscripts as a population with...
OBJECTIVES
The objective of this study was to investigate the relationship of the depression level with temporomandibular disorders (TMDs) in young conscripts as a population with chronic stresses.
MATERIAL AND METHODS
A total number of 144 male conscripts with chronic stress and different levels of depression were assigned to four groups according to the Beck's Depression Inventory (BDI). The control group consisted of age-matched male conscripts without chronic stress. The diagnosis of TMD was made according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Data were analyzed using Mann-Whitney and chi-square tests.
RESULTS
The participants with severe depression were significantly more susceptible to have TMD (p = .001) followed by the moderate depression, borderline clinical depression, mild mood disturbance, and control groups. The TMD diagnoses were more prevalent within depression groups compared with the control population (p = .01).
CONCLUSIONS
The level of depression is directly associated with the presence of TMD in young men with chronic stress.
Topics: Humans; Male; Temporomandibular Joint Disorders; Depression; Stress, Psychological; Young Adult; Case-Control Studies; Military Personnel; Adolescent; Adult; Chronic Disease
PubMed: 38881227
DOI: 10.1002/cre2.909