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International Journal of Environmental... Jan 2022Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events... (Review)
Review
A Scoping Review on the Prevalence and Determinants of Post-Traumatic Stress Disorder among Military Personnel and Firefighters: Implications for Public Policy and Practice.
INTRODUCTION
Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events leaving them at risk of developing mental health conditions such as post-traumatic stress disorder (PTSD). Increasing concern is being raised regarding the mental health impacts, specifically PTSD, among military personnel and firefighters.
OBJECTIVE
There is an increased exposure of firefighters and military personnel to traumatic events and the attendant risk of developing post-traumatic stress disorder. It is crucial to ascertain the level of PTSD amongst this cohort and determinants to formulate policies and practices that mitigate the risk and protect public safety personnel. This scoping review sought to determine the prevalence of PTSD among this cohort globally and to explore determinants of this mental health condition.
METHODS
A literature search in databases including MEDLINE, CINAHL, PubMed, PsycINFO, and EMBASE was conducted electronically from May 2021 to 31 July 2021. Two reviewers independently assessed full-text articles according to the predefined inclusion criteria and screening process undertaken to identify studies for the review. Articles were screened with a third reviewer, resolving conflicts where necessary and further assessing them for eligibility. During article selection, the PRISMA checklist was adopted, and with the Covidence software, a total of 32 articles were selected for the final examination. For the eligible studies, data extraction was conducted, information was collated and summarized, and the findings were reported. Original qualitative and quantitative data on the prevalence and predictors of PTSD among veterans, military, and firefighters were reported.
RESULTS
The prevalence of PTSD was 57% for firefighters and 37.8% for military personnel. Demographic factors, job factors, social support, injuries, physical and psychological factors, and individual traits were the main predictors of PTSD in this cohort.
CONCLUSION
This information is vital for developing and implementing prevention and intervention strategies for PTSD in military personnel and firefighters. Recognizing and addressing factors that predict PTSD will help to improve mental wellbeing and increase productivity. More peer-reviewed studies are needed on the prevalence of PTSD amongst these cohorts.
Topics: Firefighters; Humans; Military Personnel; Prevalence; Public Policy; Stress Disorders, Post-Traumatic
PubMed: 35162587
DOI: 10.3390/ijerph19031565 -
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 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 -
Occupational Medicine (Oxford, England) Jun 2018Combat operations in Southwest Asia have exposed millions of military personnel to risk of mental disorders and physical injuries, including traumatic brain injury...
BACKGROUND
Combat operations in Southwest Asia have exposed millions of military personnel to risk of mental disorders and physical injuries, including traumatic brain injury (TBI). The contribution of specific disorders to disability is, however, uncertain.
AIMS
To estimate the contributions of mental and physical health conditions to disability in military personnel.
METHODS
The sample consisted of military personnel who participated in the cross-sectional 2013 Canadian Forces Mental Health Survey. Disability was measured using the World Health Organization Disability Assessment. The International Classification of Functioning, Disability, and Health was used to classify participants with moderate/severe disability. Chronic mental disorders and physical conditions were measured by self-reported health professional diagnoses, and their contribution to disability was assessed using logistic regression and resulting population attributable fractions.
RESULTS
Data were collected from 6696 military members. The prevalence of moderate/severe disability was 10%. Mental disorders accounted for 27% (95% confidence interval [CI] 23-31%) and physical conditions 62% (95% CI 56-67%) of the burden of disability. Chronic musculoskeletal problems 33% (95% CI 26-39%), back problems 29% (95% CI 23-35%), mood disorders 16% (95% CI 11-19%) and post-traumatic stress disorder (PTSD) 9% (95% CI 5-12%) were the leading contributors to disability. After-effects of TBI accounted for only 3% (95% CI 1-4%) of disability. Mental and physical health interacted broadly, such that those with mental disorders experienced disproportionate disability in the presence of physical conditions.
CONCLUSIONS
Chronic musculoskeletal conditions, back problems, mood disorders and PTSD are primary areas of focus in prevention and control of disability in military personnel.
Topics: Adolescent; Adult; Afghan Campaign 2001-; Canada; Combat Disorders; Female; Humans; Male; Mental Disorders; Middle Aged; Military Personnel; Prevalence; Surveys and Questionnaires; Wounds and Injuries
PubMed: 29788489
DOI: 10.1093/occmed/kqy066 -
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 -
Military Medicine Nov 2019Skin and soft-tissue infections (SSTIs) are an important cause of infectious disease morbidity among military populations. Due to the high direct and indirect costs...
INTRODUCTION
Skin and soft-tissue infections (SSTIs) are an important cause of infectious disease morbidity among military populations. Due to the high direct and indirect costs associated with SSTIs, particularly with methicillin-resistant Staphylococcus aureus (MRSA) infections, there remains a critical need for the development and evaluation of SSTI prevention strategies among high-risk military personnel. Herein, we review efforts of the Infectious Disease Clinical Research Program (IDCRP) related to the prevention of SSTIs in the military.
METHODS
The IDCRP of the Uniformed Services University has conducted clinical research protocols on SSTI epidemiology and prevention among military personnel since 2009. Observational studies have examined the epidemiology of Staphylococcus aureus colonization and SSTI in training and deployment settings. Two randomized controlled trials of personal hygiene strategies for SSTI prevention at Marine Corps Base Quantico (Virginia) and Fort Benning (Georgia) were performed. Lastly, two vaccine trials have been conducted by the IDCRP, including a Phase 2 S. aureus vaccine trial (currently ongoing) among military trainees.
RESULTS
Military recruits and deployed personnel experience an intense and prolonged exposure to S. aureus, the major causative agent of SSTI. The burden of S. aureus colonization and SSTI is particularly high in military trainees. Hygiene-based trials for S. aureus decolonization among military trainees were not effective in reducing rates of SSTI. In January 2018, the IDCRP initiated a Phase 2 S. aureus vaccine trial among the US Army Infantry training population at Fort Benning.
CONCLUSIONS
In the military, a disproportionate burden of SSTIs is borne by the recruit population. Strategies relying upon routine application of agents for S. aureus decolonization have not been effective in preventing SSTIs. A novel S. aureus vaccine candidate is being currently evaluated in a military training population and may represent a new opportunity to prevent SSTIs for the military.
Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Humans; Methicillin-Resistant Staphylococcus aureus; Military Personnel; Mupirocin; Preventive Medicine; Soft Tissue Infections; Staphylococcus aureus; Teaching
PubMed: 31778193
DOI: 10.1093/milmed/usz105 -
Epidemiologic Reviews 2015Since 2001, the US military has increasingly relied on National Guard and reserve component forces to meet operational demands. Differences in preparation and military... (Meta-Analysis)
Meta-Analysis Review
Since 2001, the US military has increasingly relied on National Guard and reserve component forces to meet operational demands. Differences in preparation and military engagement experiences between active component and reserve component forces have long suggested that the psychiatric consequences of military engagement differ by component. We conducted a systematic review of prevalence and new onset of psychiatric disorders among reserve component forces and a meta-analysis of prevalence estimates comparing reserve component and active component forces, and we documented stage-sequential drivers of psychiatric burden among reserve component forces. We identified 27 reports from 19 unique samples published between 1985 and 2012: 9 studies reporting on the reserve component alone and 10 reporting on both the reserve component and the active component. The pooled prevalence for alcohol use disorders of 14.5% (95% confidence interval: 12.7, 15.2) among the reserve component was higher than that of 11.7% (95% confidence interval: 10.9, 12.6) among the active component, while there were no component differences for depression or post-traumatic stress disorder. We observed substantial heterogeneity in prevalence estimates reported by the reserve component. Published studies suggest that stage-sequential risk factors throughout the deployment cycle predicted alcohol use disorders, post-traumatic stress disorder and, to a lesser degree, depression. Improved and more standardized documentation of the mental health burden, as well as study of explanatory factors within a life-course framework, is necessary to inform mitigating strategies and to reduce psychiatric burden among reserve component forces.
Topics: Humans; Mental Disorders; Mental Health; Military Personnel; Models, Statistical; Prevalence; Risk Factors; United States; Veterans; Veterans Health
PubMed: 25595172
DOI: 10.1093/epirev/mxu007 -
European Journal of Psychotraumatology 2021: The mental health burden of posttraumatic stress disorder (PTSD) is high in U.S. military samples. Social support is one of the most robust protective factors against... (Meta-Analysis)
Meta-Analysis Review
: The mental health burden of posttraumatic stress disorder (PTSD) is high in U.S. military samples. Social support is one of the most robust protective factors against PTSD and a recent meta-analysis indicates that this relationship is even stronger in military samples compared to civilian samples. Yet no meta-analyses have explored factors impacting this association in veterans and military service members (VSMs). : The current meta-analysis examined demographic, social support, and military characteristics that may moderate the relationship of PTSD severity and social support among U.S. VSMs. : A search identified 37 cross-sectional studies, representing 38 unique samples with a total of 18,766 individuals. : The overall random effects estimate was -.33 (95% CI: -.38, -.27, Z = -10.19, <.001), indicating that lower levels of social support were associated with more severe PTSD symptoms. PTSD measures based on the Diagnostic and Statistical Manual (DSM)-III had a larger effect size than measures based on DSM-IV or DSM-5. The social support source was a significant moderator such that support perceived from non-military sources was associated with a larger effect size than support perceived from military sources. This finding held after accounting for covariates. Deployment-era, timing of social support, and age were also significant moderators, but were no longer significantly associated with effect size after adjusting for covariates. Although previous meta-analyses have shown social negativity to be more impactful than positive forms of social support, there were too few studies conducted to evaluate social negativity in moderator analyses. : Results suggest that social support received from civilians and in the home environment may play a greater protective role than social support received from military sources on long-term PTSD symptom severity. The literature on social support and PTSD in U.S. VSMs would be strengthened by studies examining the association of social negativity and PTSD symptoms.
Topics: Humans; Military Personnel; Self Report; Social Support; Stress Disorders, Post-Traumatic; United States; Veterans
PubMed: 34992740
DOI: 10.1080/20008198.2020.1851078 -
European Journal of Trauma and... Jun 2020An increasing number of international and domestic armed conflicts, including terror attacks on civilians, along with constrained healthcare finance and resource... (Review)
Review
PURPOSE
An increasing number of international and domestic armed conflicts, including terror attacks on civilians, along with constrained healthcare finance and resource limitation, has made a civilian-military collaboration (CMC) crucial. The purpose of this study was to identify facilitators and constrainers in CMC in a national perspective with a specific focus on medical aspects.
METHOD
A literature review of recently published papers about civilian-military collaboration, along with a short survey, was conducted. For the review, major search engines were used.
RESULTS
The results indicated many facilitators, but few important constrainers with a high impact on the outcome. The conducted survey indicated discrepancies between the needs and resources.
CONCLUSION
The current global and domestic security threats and challenges, make CMC critical and inevitable. However, there is a need for careful analysis of its consequences, impact, possibilities, and limitations to differentiate between our expectations and the current reality.
Topics: Armed Conflicts; Cooperative Behavior; Humans; Military Medicine; Military Personnel; Sweden
PubMed: 30542745
DOI: 10.1007/s00068-018-1058-9 -
Journal of Special Operations Medicine... 2011This article will analyze the concept of trauma, and illustrate distinctions between accepted definitions and actual meaning. For populations at high risk for exposure... (Review)
Review
PURPOSE
This article will analyze the concept of trauma, and illustrate distinctions between accepted definitions and actual meaning. For populations at high risk for exposure to traumatic situations, such as Special Operations Forces (SOF) and deployed military personnel, delineating the beliefs and environment-specific comprehension of trauma and its consequences is imperative.
BACKGROUND
Trauma is a common term in health sciences literature and in the social vernacular, but is often misunderstood and lacks specificity. Differences in perception of what trauma is and is not may exist even between civilian and military populations. Therefore, the concept of trauma warrants clarification, to define the terminology and to use it appropriately with full understanding.
DATA SOURCES
EbscoHost, PubMed, CINAHL, MedLine, and Google Scholar. Only English-language results were accepted, and were limited to publications from the dates of 1975-2010.
Topics: Humans; Military Personnel; Terminology as Topic; United States; Wounds and Injuries
PubMed: 21455905
DOI: 10.55460/Z2X8-LCBZ