Military medicine
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Many differences between U.S. military beneficiaries and the U.S. general population, including differences in health care access, are known factors affecting invasive breast cancer outcomes. Thus, comparing the two populations for any outcome differences and their contributing factors may provide insights to breast cancer prognosis. ⋯ CBCP-WR patients demonstrated significantly better DSS over matched SEER patients. Although a portion of the outcome disparity, i.e., 36% of the 5.3% DSS rate difference, could be explained by differences in tumor characteristics, the cause(s) behind the majority of the disparity has yet to be identified. Identification and further analysis of contributing factors to survival differences have the potential to improve clinical practice and outcomes for invasive breast cancer patients.
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The U.S. Army Reserve Officers' Training Corps (ROTC) is the largest commissioning source among all branches. Physical Readiness Training (PRT) is fundamental to ROTC cadet training. However, although studies have evaluated the effectiveness of PRT in cadets with prior PRT experience, no study has examined the early phase adaptations in those cadets with no prior PRT experience. ⋯ Nine months of PRT improved APFT scores of freshmen cadets while minor effects were noted in laboratory-based performance. Given the lack of improvements in strength and power, it would be advisable to provide supplemental strength and power training. Being a large commissioning resource for the Army with greater access to equipment and resources, the time spent in ROTC may be a unique opportunity to improve and educate young commissioning officers on the benefits of proper strength and power training for the use in future commands while units are considerably smaller and equipment is more accessible on university grounds.
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Recent studies have demonstrated health problems among veterans of the wars in Afghanistan and Iraq (Operation Enduring Freedom and Operation Iraqi Freedom). Veterans from these conflicts have a higher prevalence of mental disorders and physical diseases, though most studies were conducted using administrative data. ⋯ Deployed veterans are at increased risk for some health conditions; however, nondeployed veterans also report a variety of health conditions. Addressing the unique health concerns of both deployed and nondeployed veterans is important and continued observation of all veterans is recommended.
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Review
A Systematic Review of Risk Analysis Tools for Differentiating Unnatural From Natural Epidemics.
In the era of genetic engineering of pathogens, distinguishing unnatural epidemics from natural ones is a challenge. Successful identification of unnatural infectious disease events can assist in rapid response, which relies on a sensitive risk assessment tool used for the early detection of deliberate attacks (i.e., bioterrorism). ⋯ There are few risk assessment tools for differentiating unnatural from natural epidemics. These tools are increasingly necessary and valuable, but improved scoring systems with higher sensitivity, specificity, timeliness, and wider application to biological attacks must be developed.
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Randomized Controlled Trial
Using a Mobile Application in the Treatment of Dysregulated Anger Among Veterans.
Anger is a symptom of post-traumatic stress disorder (PTSD) associated with a range of clinical and functional impairments, and may be especially prevalent among veterans with PTSD. Effective anger management therapies exist but may be undermined by poor engagement or lack of treatment availability. Finding ways to engage veterans in anger management therapy or to improve access can be helpful in improving clinical outcomes. This randomized controlled trial compared anger management treatment (AMT) with AMT augmented by a mobile application (app) system, Remote Exercises for Learning Anger and Excitation Management (RELAX). ⋯ Findings suggest that AMT + RELAX was beneficial in reducing anger symptoms and promoting efficient use of the between-session practice; however, AMT + RELAX did not outperform AMT. This study is an important contribution as it is one of the first randomized controlled trials to study the efficacy of a technology-enhanced, evidence-based psychotherapy for anger management. Findings are limited because of small sample size and modifications to the technology during the trial. However, the results highlight the possible benefits of mobile app-supported treatment, including increasing the accessibility of treatment, lowering therapist workload, reducing costs of treatment, reducing practice time, and enabling new activities and types of treatments. This study presents preliminary evidence that mobile apps can be a valuable addition to treatment for patients with anger difficulties. Future research should evaluate how much therapist involvement is needed to support anger management.