Military medicine
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After mild traumatic brain injury, service members may experience difficulty with executive functions, which could interfere with return to duty and life roles. Because performance-based multitasking assessments are sensitive to executive dysfunction, a team of military and civilian rehabilitation researchers developed the Charge of Quarters Duty Test (CQDT) to help inform duty readiness after concussion; it is a multitasking test based on a military task scenario that challenges executive functions, such as foresight and planning, set shifting, and prospective memory. Although previous study indicates that CQDT has reliability and known-groups validity, like other multitasking tests, it should not be readministered after rehabilitative care because of learning effects. The purpose of this study was to develop an alternate form of the CQDT and evaluate its equivalence to the CQDT. ⋯ The MODT appears to be an equivalent form of the CQDT that mitigates learning effects that often accompany performance of multitasking assessments. Having developed and validated the equivalence of the CDQT's alternate form, military rehabilitation clinicians have an expanded set of clinical tools by which to identify possible executive dysfunction and evaluate service members' response to rehabilitative care via pre- and post-rehabilitation testing after mild traumatic brain injury.
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Piloting an aircraft is a complex multitasking activity that involves managing information in a nonautomatic way and generates a high workload (psychological, cognitive, and physical) for the pilot. The excess of these demands can result in decreased performance and may impair flight safety. Heart rate variability (HRV) has been used in recent studies as a method to investigate operator's workload in complex environments. This measure can assess the stress and recovery ability of the autonomic nervous system. However, a better understanding of flight influence on the pilot's autonomic modulation is necessary. Therefore, this scoping review aims to systematically map the studies related to changes in the autonomic modulation in military pilots during flight, in order to characterize their workload at different times and flight profiles. ⋯ This scoping review provided insight into the influence of flight on autonomic modulation in military pilots. Some key themes were highlighted: Increased sympathetic activity during flight, sensibility of different domains of HRV to flight demands, and autonomic changes during recovery time. Future research efforts may allow us to enhance the understanding of pilot's workload limits and to elucidate the optimal postflight recovery time.
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Congenital syphilis (CS) case rates have increased significantly in the United States over the past 20 years, accelerating during the COVID-19 pandemic. Increasing rates may relate to access to care but have not been evaluated in a fully-insured population, such as the Military Health System. ⋯ Congenital syphilis care rates were substantially lower in this insured group than national rates but increased significantly during the COVID-19 pandemic. Higher care rates were seen in children of military members of lower rank. Regional trends differed from national data. These findings suggest that, even in a fully-insured population, income and regional differences impact CS, and the COVID-19 pandemic may have exacerbated differences in care delivery.
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The medical entry standards for the United States Central Command (USCENTCOM) restrict individuals with various medical conditions from entering the deployed environment. The impact of this program is unknown. ⋯ The medical entry standards, as written and adjudicated in 2023, resulted in a relatively reduced evacuation rate for individuals with otherwise prohibited medical conditions compared to the general deployed population.
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The demands of future large-scale combat operations may require medics and corpsmen to increasingly perform expectant casualty care (ECC). However, no detailed guidelines currently exist for providing ECC within military medicine. To guide the development of education and training guidelines and advance team training of both medics and non-medics, an in-depth understanding is first needed regarding caregivers' experiences providing ECC in recent conflicts as well as perceived training gaps. Therefore, this study explored the experiences of medics and physicians providing ECC and investigated their perceptions of training needs in this area for future conflicts characterized by large-scale combat operations and prolonged casualty care operational settings. ⋯ Our results provide direction for development of ECC clinical guidance and collective team training recommendations. Following these guidelines may increase life-saving capabilities on the far-forward battlefield and equip medical directors and medics to provide ethical and compassionate care to those who cannot be saved in the setting of limited resources and evacuation opportunities.