Military medicine
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Posttraumatic nightmares (PTNs) are common among service members with a history of combat or mission-related trauma and are associated with decreased well-being. Unfortunately, beyond establishing an association between mental health symptoms and PTNs, the existing literature fails to provide a more comprehensive understanding of factors associated with PTNs. The effectiveness of current recommended treatments is frequently debated, with the literature varying in levels of support. Treatment of PTN is complicated, given their association with a number of mental health difficulties including posttraumatic stress disorder (PTSD), anxiety, and depression. The present study sought to better delineate the association of these difficulties with PTNs, in an effort to inform and improve treatments for the nation's service members. ⋯ Findings support the association of PTSS, anxiety, and depression to PTNs, and, importantly, suggest that other factors may be equally or more important in understanding PTNs. Notably, increased odds of PTNs were observed among patients with pain that disrupts their sleep. The cross-sectional nature of the study allows examination of these co-occurring symptoms as they would present in the clinic, potentially informing assessment and treatment strategies; however, it precludes consideration of temporal relationships. Results highlight the importance of considering comorbid symptoms and relevant military characteristics to gain a more complete understanding of PTNs. Future research utilizing longitudinal methods are needed to inform the temporal/causal aspects of these relationships.
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Gout is caused by monosodium urate crystal deposition within joints and periarticular structures. It is characterized by the typical arthritis symptoms such as pain, swelling, and redness usually involving the first metatarsophalangeal joint. ⋯ This case report is the first to describe an immediate acute gout episode after surgical management of a facial abscess involving multiple spaces, associated with severely decayed, nonrestorable lower left molars, in a 58-year-old male patient with a history of gout. It furthermore describes prophylactic measures to prevent the occurrence of gout flares in similar cases.
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The Air Force Dental Service is responsible for ensuring that airmen are dentally ready to support military operations worldwide by delivering top-tier dental care. As the military healthcare landscape undergoes significant changes, the Air Force Dental Service has explored innovative approaches to dental care delivery. One consideration involves the potential use of radiographs as the primary tool for assessing service members' dental conditions, specifically focusing on identifying nondeployable conditions and periodontal health. ⋯ The study strongly cautions against relying solely on radiographs for determining the dental health of U.S. Air Force personnel. While providers effectively ruled out the absence of certain conditions, the challenge of positively identifying DRC 3 conditions poses significant risks to oral health if such a workflow was utilized. Particularly, the high probability of false negatives would be detrimental to the operational readiness of military personnel. Therefore, results support the continued use of radiographic and clinical examinations for comprehensive dental exams.
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As of 2020 Holistic health and fitness (H2F) teams have been embedded into brigades to engage Soldiers in Preventative Mental, Physical, Nutritional, Spiritual, and Sleep Readiness services. This represents a change in Army culture from a focus on testing to one of wellness because of increasing sleep concerns, mental health concerns, and injury rates. Soldier awareness of H2F services, where to find them, how to use them, and command endorsement of H2F professional's services has been limited and not well studied. Most soldiers fall into the Generations Y and Z categories, and this population tends to access information primarily from social media sources. Social media platforms therefore represent potentially effective ways to reach these individuals to increase their awareness of H2F services. ⋯ The use of social media to facilitate soldier awareness and use of H2F mental and sleep readiness services is a viable option for H2F units seeking to enhance their reach in these areas. The project created very little demand on the local therapist's time or to brigade resources and may help increase Soldier accessing of H2F resources online and directly.
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Review
A Review of JAK Inhibitors for Treatment of Alopecia Areata in the Military Health Care System.
Alopecia areata (AA) is a disease that manifests as patchy hair loss on the scalp and other parts of the body; severe disease may result in disfigurement, functional impairment, and significant psychological distress. This condition is understood to be caused by autoimmunity to the hair follicle and subsequent arrest of hair growth. New medications, baricitinib and ritlecitinib, belong to the Janus kinase (JAK) inhibitor family and are among the first FDA-approved treatments for severe AA. In this manuscript, we aim to answer the question: What treatment options exist for AA in the military health care system (MHS)? In doing so, we review the pathogenesis, physical and psychosocial impact of AA, conventional treatment of AA, and the efficacy and safety of baricitinib and ritlecitinib. ⋯ Baricitinib and ritlecitinib are effective treatments for widespread, progressive, and refractory AA. Although JAK inhibitors demonstrate improved effectiveness compared to non-immunomodulator treatments, their use in the MHS for this purpose is limited.