Military medicine
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As the COVID-19 pandemic continues across the globe, the advent of novel vaccines has created a possible path to prepandemic life for many. Still, many individuals, including those in the U. S. military, remain hesitant about getting vaccinated. ⋯ While many have praised this declaration, others have raised concerns regarding the suppression of individual service member autonomy. This commentary explains the different ethical principles relevant to individual autonomy and how they are understood in a military context and then explores the ethical arguments both for and against mandating vaccination for all U. S. service members.
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Norwegian military forces participated in the military campaign Operation Enduring Freedom in Afghanistan starting in 2001. Military personnel often show a "healthy soldier effect" in terms of lowered all-cause mortality when compared to the general population. However, military service in conflict areas is associated with an increased risk of death from external causes such as transport accidents and suicide after discharge. We aimed to investigate cause-specific mortality in a cohort of 9,192 Norwegian (7.5% women) veterans deployed to Afghanistan between 2001 and 2019. ⋯ In accordance with the "healthy soldier effect," military service in Afghanistan was generally associated with a lower than expected risk of death both during deployment and after discharge. The risk of death from transport accidents was higher than expected after discharge, while the observed incidence of suicide did not differ from the expected rate in the general population.
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DoD Global Health Engagement (GHE) planners can follow a number of models to effectively plan and execute successful GHE activities. One recommendation that could provide a significant return on investment for the DoD GHE enterprise is to utilize a "Crawl, Walk, Run" training model to build or enhance a specific medical capability for a Partner Nation (PN). Through the African Peacekeeping Rapid Response Partnership (APRRP) program, U.S. military medical subject matter experts serving as instructors for a Field Sanitation Course (FSC) delivered to the Senegalese Armed Forces (SAF), gained first-hand experience of the positive outcomes that resulted from incorporating this training model into the DoD GHE process. ⋯ The "Crawl, Walk, Run" training model demonstrates an excellent teaching method that develops PN instructors so they can train more personnel in the long-term, thus building both capacity and capability. This gives the PN the opportunity to sustainably institutionalize a course, allowing them to continue training it in perpetuity. Implementing this training model flexibly to adapt to the differing needs of each PN and each line of effort would increase the success of DoD GHE activities when training PNs. It would also ensure the PN has the capability to sustainably institutionalize a course and can independently train future cohorts through internal iterations of the course.