Military medicine
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Early diagnosis and treatment of chronic obstructive pulmonary disease (COPD) can slow disease progression. The Department of Veterans Affairs (VA)/Department of Defense Clinical Practice Guidelines (CPG), established to improve patient outcomes, recommend the use of spirometry in the COPD diagnostic process. The aims of this study were to assess VA health care providers' performance related to CPG-recommended spirometry administration in the evaluation of newly diagnosed COPD among veterans, determine the patient characteristics that may influence the adherence rate, and compare VA concordance rates to those of other health plans. ⋯ VA provider adherence to CPG-concordant spirometry would decrease the prevalence of false-positive COPD cases and lead to more targeted disease treatment. Future research should focus on such cases by assessing the association between COPD diagnosis and bronchodilator responsiveness.
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Unhealthy drinking is relatively common among women U.S. military Veterans. Primary care is often the setting where patients first come into contact with the health care system, and providers in this setting play a critical role in connecting unhealthy drinkers to appropriate care. Little is known about primary care providers' perspectives on factors that affect whether women Veterans presenting to primary care with unhealthy drinking connect to alcohol-related care. Understanding factors that affect whether patients connect to alcohol-related care may improve providers' ability to support women Veterans with unhealthy drinking get needed care. ⋯ Although primary care providers are gatekeepers to specialty treatment services, ongoing education, and colocated mental health staff could help reduce barriers to these services, ultimately improving health outcomes for women Veterans and others with unhealthy drinking.
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The procedure of wrapping a heat casualty in ice-water soaked bed sheets to reduce core temperature has received little investigation, despite the practice and recommendation for its use in some military settings. Thus, the purpose of this study was to investigate the cooling efficacy of ice-sheet cooling (ISC) following exertional hyperthermia. ⋯ ISC does not provide effective reduction in Tre following exertional hyperthermia compared to no treatment. However, perceptual benefits may warrant the use of ISC in settings where rapid reductions in core temperature are not a concern (i.e., recovery from exercise). Thus, clinicians should continue to utilize validated techniques (i.e., cold-water immersion) for the treatment of exertional heat illnesses.
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There is a scarcity of research establishing a relationship between mental illness and the U.S. military service members who participate in the field of military humanitarian assistance/disaster relief (HA/DR). One of the few studies in this area showed that participation in military HA/DR was not associated with depressive symptoms, however, the study was limited by sample size. This study examined (1) the relationship between participation in military HA/DR and mental health symptoms and military stress and (2) the relationship between HA/DR and mental health treatment and therapy. ⋯ Results showed that participation in HA/DR was associated with significant reductions in PTSD symptoms, depressive symptoms, and the use of antidepressants by service members. Further research needs to understand the mechanism of these associations for better planning and implementation of HA/DR and delivery of care to service members who participate in these missions.