Military medicine
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Excessive gambling can cause substantial biopsychosocial problems (e.g., difficulties with finances, relationships, mental, and physical health). For military Service Members, it can also result in security clearance denial or revocation, failure to achieve promotions, and premature career termination. Recent congressional mandates have obligated the U.S. Department of Defense to screen for problematic gambling, the predictive values of which are a function of (i) problem prevalence and (ii) tool sensitivity and specificity. This meta-review (i.e., systematic review of systematic reviews) on the screening properties of gambling assessment tools and the effectiveness of treatments for gambling disorder is to inform military services on responding to Service Members' gambling problems. ⋯ The combination of low prevalence of GD and subclinical gambling problems in the general population, coupled with modest sensitivity and specificity, makes screening unfeasible in the general SM population. However, dual-phase screening in higher-prevalence subpopulations (i.e., SMs already identified with substance-abuse or mental-health problems) would be viable. Regarding treatment, several interventions-already used in military healthcare-with extensive empirical track records have been successfully used to treat adults with GD.
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There are established protocols for staged return to physical activity in sport and military settings following concussion. Currently, there is no evidence-based staged return to shooting protocol in use by the U.S. military despite the unique challenges and stresses shooting places on the vestibular-ocular and cognitive systems often disrupted by a concussion. The primary purpose of this scoping review was to summarize available evidence and current practices on return to shooting post-concussion, with the goal of optimizing an evidence-based return to shooting protocol for military service members. Our secondary aim was to identify individuals who may benefit from a return to shooting progression. ⋯ Based on our results, there is insufficient evidence to inform current practices on return to shooting post-concussion. In the absence of a published return to shooting protocol, we offer recommendations for identifying individuals who may benefit from a return to shooting progression and a revised version of a U.S. Army Special Operations Command Return to Range Progression. This protocol follows a conceptual framework for progression for variables such as environment, weapon type/caliber, and shooter position/movement. Further research is needed on identifying individuals who may benefit from a return to shooting protocol and safely and effectively progressing these individuals through a return to shooting protocol post-concussion.
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There are established protocols for staged return to physical activity in sport and military settings following concussion. Currently, there is no evidence-based staged return to shooting protocol in use by the U.S. military despite the unique challenges and stresses shooting places on the vestibular-ocular and cognitive systems often disrupted by a concussion. The primary purpose of this scoping review was to summarize available evidence and current practices on return to shooting post-concussion, with the goal of optimizing an evidence-based return to shooting protocol for military service members. Our secondary aim was to identify individuals who may benefit from a return to shooting progression. ⋯ Based on our results, there is insufficient evidence to inform current practices on return to shooting post-concussion. In the absence of a published return to shooting protocol, we offer recommendations for identifying individuals who may benefit from a return to shooting progression and a revised version of a U.S. Army Special Operations Command Return to Range Progression. This protocol follows a conceptual framework for progression for variables such as environment, weapon type/caliber, and shooter position/movement. Further research is needed on identifying individuals who may benefit from a return to shooting protocol and safely and effectively progressing these individuals through a return to shooting protocol post-concussion.
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Access to mental health care has been a priority area for the U.S. Department of Veterans Affairs (DVA) for decades. Access for veterans with PTSD is essential because untreated PTSD is associated with numerous adverse outcomes. Although interventions have been developed to improve access to DVA mental health care, the impact of these interventions on access for veterans with untreated PTSD has not been examined comprehensively, limiting guidance on appropriate implementation. ⋯ Access interventions for veterans with PTSD demonstrated varied success across interventions and outcomes. The national initiatives-particularly primary care mental health integration -were successful across several outcomes; telemental health demonstrated promise in improving access; and the success of direct outreach varied across interventions. Confidence in these findings is tempered by potential bias among studies. Limited literature on how these interventions impact relevant preattendance barriers, along with incomplete data on how many perform nationally, suggests that additional work is needed to ensure that these interventions increase access for veterans with PTSD nationwide.
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During the COVID-19 pandemic, a significant number of individuals experienced persistent symptoms, collectively termed post-COVID-19 condition (PCC) by the World Health Organization. While civilian prevalence has been extensively studied, little is known about PCC in military personnel. This article highlights the need for increased awareness, documentation, and research on PCC within the military context, utilizing the Defense Health Agency database. ⋯ To comprehensively address PCC in military personnel, it is imperative to foster both awareness and documentation. Creating a centralized Defense Health Agency-DoD repository for active duty service members with PCC diagnoses offers a valuable opportunity to conduct trend analysis, identify missed cases, and better understand the individual and military readiness implications of this condition. Additionally, to address the educational needs of clinicians, it is essential to develop continuing medical education and continuing nursing education programs focusing on PCC signs, symptoms, and their impact on readiness. Furthermore, randomized controlled trials and longitudinal experimental clinical trials are essential for monitoring service members over time, providing valuable insights into the course of PCC and potential interventions. These research endeavors collectively contribute to improving the health, readiness, and care of military personnel affected by PCC.