Military medicine
-
Individuals with obesity have higher rates of mental health disorders, both singly and in combination, than individuals of normal weight. Mental health disorders may negatively impact weight loss treatment outcomes; however, little is known about the mental health burden of individuals using weight loss programs. The current study identifies common mental health diagnostic profiles among participants of MOVE!-the Veterans Health Administration's behavioral weight loss program. ⋯ Efforts to improve patients' engagement in the MOVE! program may need to address barriers to care associated with mental health disorders or incorporate care for both obesity and mental health diagnoses in MOVE! A holistic approach may be particularly important for younger patients who have a higher comorbidity burden and longer care horizons. Future work may address if patient types found in the current study extend to non-VHA obesity treatment seekers.
-
A systems perspective was used to describe U.S. Department of Defense (DoD) Global Health Engagement (GHE). This description was based on DoD instructions and higher-level documents related to DoD GHE. A complex system of systems such as health care can benefit from using modeling approaches to help understand the interactions among major components. Models (conceptual, computer-based programs, realistic simulations, or training exercises) can be used to help stakeholders prioritize options and to identify important components and gaps for making performance improvements. Based on the cited documents, we identified major DoD GHE components to create a conceptual model. ⋯ Examining the composition of DoD GHE and creating a defined model can help identify interacting features of this complex system. All of the identified components have been associated with gaps, such as the need for monitoring and measuring tools, and standards. The current state of this system is dynamic and is evolving when confronting gaps. DoD GHE represents an intersection of global health and security in supporting U.S. national security objectives by establishing access and influence with partner nations and among health care-related government and non-government organizations, and as a result, improves the readiness, health, and safety of our military personnel.
-
There is a growing trend of multidrug-resistant organisms (MDRO). The goal of this study was to characterize MDRO at a single center from ophthalmic cultures to better understand how treatments were tailored and to assess effect on visual acuity. ⋯ This study demonstrated a high frequency of corneal MDRO infections and specifically MRSA and Pseudomonas spp. isolates. Antibiotic treatments frequently required adjustment. Further prospective study of visual outcomes from ophthalmic MDRO cultures is needed.
-
No-shows are detrimental to both patients' health and health care systems. Literature documents no-show rates ranging from 10% in primary care clinics to over 60% in mental health clinics. Our model predicts the probability that a mental health clinic outpatient appointment will not be completed and identifies actionable variables associated with lowering the probability of no-show. ⋯ The National Initiative to Reduce Missed Opportunities-2 confirmed findings that previous patient attendance is one of the key predictors of a future attendance and provides an additional layer of complexity for analyzing the effect of a patient's past behavior on future attendance. The National Initiative to Reduce Missed Opportunities-2 establishes that appointment attendance is related to medication adherence, particularly for medications used for treatment of mood disorders or to block the effects of opioids. However, there is no way to confirm whether a patient is actually taking medications as prescribed. Thus, a low medication possession ratio is an informative, albeit not a perfect, measure. It is our intention to further explore how diagnosis and medications can be better captured and used in predictive modeling of no-shows. Our findings on the effects of different factors on no-show rates can be used to predict individual no-show probabilities, and to identify patients who are high risk for missing appointments. The ability to predict a patient's risk of missing an appointment would allow for both advanced interventions to decrease no-shows and for more efficient scheduling.
-
Because of the physical fitness requirements of Military Occupational Specialties (MOSs) within the US Army, fitness testing batteries have been developed. The Occupational Physical Assessment Test (OPAT) has been used for determining occupation assignment and is meant to assess upper and lower body muscular power, muscular strength, and aerobic capacity. The Army Physical Fitness Test (APFT) is a general fitness assessment meant to test upper and lower body muscular endurance and aerobic capacity. Comparisons of the two testing batteries as well as evaluation of potential sex differences are missing from current literature. Therefore, the purpose of this study was to investigate the sex differences in APFT and OPAT performances, as well as the relationship between the APFT and OPAT individual test events. ⋯ Sex differences and varied relationships among individual events on two common military fitness test batteries were observed. Lower performances on APFT and OPAT by women may suggest the need to evaluate potential training methods to assist women in reaching their desired MOS. Further, individual OPAT events displayed weaker relationships compared with the relationships among individual APFT event, suggesting a greater degree of redundancy among the events on the APFT. Therefore, the combination of APFT and OPAT may offer a greater opportunity to measure physical fitness capabilities as related to various military job performance tasks.