Military medicine
-
Staphylococcus aureus (SA) is a major human bacterial pathogen increasingly refractory to antibiotics. Given the dearth of novel antibiotics in the developmental pipeline, we require concerted efforts at optimizing novel antimicrobial approaches. One promising option is the utilization of bacteriophage (phage) therapy, which has been resurrected as a viable clinical therapeutic. Specifically, an expanded library of phages targeting SA is desired. We surmised that SA-targeting phages would be readily accessible as a major component of the cutaneous microbiome. Specifically, we sought to discern if easily accessible (convenient) and discrete anatomic locations, including the nares, axilla, fingernails, toenails, and web spaces, could provide intact phages via a noninvasive, expedient procedure involving swabbing. ⋯ Skin swabbing at multiple anatomic sites from 100 adults yielded insufficient biomass for phage recovery. The negative results provide helpful information for future phage isolation attempts. The lessons learned on why this study failed to isolate phages can be easily utilized by others. With a desire to increase our SA-targeting phage library in pursuit of future clinical trials, and acknowledging the paucity of these phages accessible via traditional recovery from environmental sources, we will next acquire large volumes of wound effluent from confirmed infected wounds with SA to optimize the biomass for phage recovery.
-
The Office of Naval Research sponsored the Blast Load Assessment Sense and Test program to develop a rapid, in-field solution that could be used by team leaders, commanders, and medical personnel to make science-based stand-down decisions for service members exposed to blast overpressure. Toward this goal, the authors propose an ensemble approach based on machine learning (ML) methods to derive a threshold surface for potential neurological deficits that encompasses the intensity of the blast events, the number of exposures, and the period over which the exposures occurred. Because of collection challenges presented by human subjects, the authors utilized data representing a comprehensive set of measures, including structural, behavioral, and cellular changes, from preclinical large animal studies on minipig models. This article describes the development process used to procure the resulting methodology from these studies. ⋯ The ensemble approach facilitated the identification of a pattern of changes across multiple variables to predict the occurrence of changes in brain function. Many changes observed after blast exposure were subtle, making them difficult to measure in human subjects. ML methodologies applied to minipig data demonstrated the value of these techniques in analyzing complex datasets to complement human studies. Importantly, the threshold surface supports the development of science-based blast exposure guidelines.
-
Back pain is a major reason for sick leaves and disability pension in primary health care. The prevalence of back pain among adolescents and young adults is believed to be increasing, and back pain during military service predicts unspecified back pain during later life. The aim of this study was to investigate the prevalence and risk factors of back pain among conscripts in compulsory Finnish military service during the period 1987-2005. ⋯ The prevalence of back pain among male Finnish military service conscripts has not changed in the last 25 years. Twenty percent of conscripts suffer from back-related problems during their military service. The majority of the visits to health centers occurred in the first service months. The risk factors for back pain include smoking, low education level, and musculoskeletal disorders in general. Educating the young people about harms of tobacco and supporting education is a way to influence the back pain prevalence. Strength of this study is a good generalized population sample of young Finnish adult males because of the fact that the Finnish military service is compulsory for all men. All medical records of all visits to the Garrison Health Care Centre were available, and all the conscripts filled the same pre-service questionnaire, minimizing the possibility of selection bias. The sample size was also large. Weakness of this study is that the service time changed during the study period and in the latest conscript group born in 1989, data collection and the data available for this cohort was limited, because nearly half of the conscripts had not yet started their service. The Finnish military service is compulsory only for men and because of the low number of female conscripts, they were excluded from this study. Diagnoses were also missing from 70% of the back-related visits, and these visits were recorded as back pain-related visits according to the reason for seeking care.
-
Active duty service women (ADSW) constitute 16% of the force. The prevalence of alopecia, a dermatologic condition characterized by hair loss, is understudied in regard to hairstyle regulations across the U.S. military services. Alopecia has several causes; one of which is due to tension on the scalp secondary to tight hairstyles. In the U.S., alopecia has a lifetime prevalence of 1.7-2.1%; no previous studies which evaluated this condition in service women were found. ⋯ The prevalence of alopecia in ADSW is slightly higher than that in civilian populations and is most likely underreported. It is more commonly diagnosed in Black women than would be expected based on ratios of this population in military service. Policy changes to ensure that traction alopecia is a qualifying medical condition for Veterans Affairs disability compensation, mechanisms are in place for more specific coding in the electronic medical record, and treatment options to be covered by TRICARE are recommended. All U.S. military services should consider updating and evaluating regulations to improve the health and quality of life of ADSW.
-
Editorial Comment Letter
A Comment on "COVID-19 Vaccine Hesitancy and Physician-led Intervention".