A Retrospective, Epidemiological Review of Type 2 Diabetes Mellitus in a Military Population

OBJECTIVE: Examine incidence rates of Type 2 Diabetes Mellitus (T2DM) in a military population over a tenyear period and whether demographic characteristics differ within the same population. METHODS: Diagnostic data and demographic variables from 23,821 active duty service members between 2006 and 2015 were analyzed from the Defense Medical Epidemiological Database. RESULTS: The incidence rates of new onset cases ranged from .22 (per 1,000 service members) in 2015 to a high of 1.46 (per 1,000 service members) in 2006 for T2DM without complications and .00 (per 1,000 service members) in 2007 to a high of .29 (per 1,000 service members) in 2015 for T2DM with complications. The one-sample chi-square test showed the observed, and expected frequencies differed significantly for all demographic variables tested. CONCLUSIONS: Although there was a significant increase in the diagnosis of T2DM with complications in 2015, the overall downtrend is similar to that of the general US population. Older age and higher rank were more likely to be associated with the diagnosis of T2DM with and without complications, again suggestive of similar trends with the general US population. Continued efforts towards early diagnosis and treatment of these service members are needed to address this problem regarding military readiness

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Examining student well-being: Development and initial validation of the perceived vulnerability and hardiness scale

Objectives: The primary aim was to assess the factor structure and establish measurement invariance across sex for the Perceived Vulnerability and Hardiness Scale. Participants: Sample 1 (N = 377) and Sample 2 (N = 401) were volunteers from six large southern universities. Methods: Iterative and collaborative survey-based focus groups were used to create the final version of the PVHS. Results: A two-factor model was identified through exploratory and confirmatory factor analyses. The psychological hardiness subscale was found to positively correlate with hardiness and resilience, and negatively correlate with psychosocial functioning, depression, and anxiety. The vulnerability subscale was found to positively, strongly correlate with the anxiety, psychological vulnerability, and psychosocial functioning, and negatively correlate with the hardiness and resilience. Men and women interpreted the PVHS in an equivalent manner Conclusions: This brief measure provides researchers, counselors, and administrations a method for general assessment, intervention effectiveness, and evaluation of campus climates

Development and psychometric validation of the Dispositional Recovery and Dysfunction Inventory: a tool to assess for positive and negative cognitions following trauma exposure

Background: Recovery from trauma can be naturally occurring or facilitated through psychotherapy. Few brief measures exist to provide clinicians with dispositional, empirical assessments of patient’s sentiments during psychotherapy. Aims: This manuscript presents the Dispositional Recovery and Dysfunction Inventory (DRDI), a measure created to assist clinicians in evaluating patient’s treatment progress during psychotherapy, as well as evaluate its factor structure, reliability estimates, measurement invariance, and correlates. Method: The DRDI was created based on feedback from experts with experience treating posttraumatic stress disorder (PTSD) and was structurally validated in two distinct populations. Exploratory factor analysis was conducted in sample 1 consisting of (n=401) university students. Confirmatory factor analysis, measure validity and structure validation were then conducted in sample 2 (n=249) composed of 49% individuals with clinically significant PTSD symptoms. Results: Exploratory and confirmatory factor analysis revealed that the DRDI was best represented by a two-factor correlated traits model representing sentiments related to dispositional recovery and dysfunctional cognitions. The recovery subscale exhibited relationships with convergent measures including authenticity and psychological hardiness (r values of .30 to .60). The dysfunctional beliefs subscale exhibited relationships with convergent measures: PTSD, depression, suicidality and stress (r values of .55 to 80). Measurement invariance across gender and PTSD status was observed. Conclusion: Initial findings indicate that the DRDI has the potential to be a useful tool to assess individuals’ beliefs about their propensity to recover from and thrive through adversity

A Retrospective, Epidemiological Review of Type 2 Diabetes Mellitus in a Military Population

OBJECTIVE: Examine incidence rates of Type 2 Diabetes Mellitus (T2DM) in a military population over a tenyear period and whether demographic characteristics differ within the same population. METHODS: Diagnostic data and demographic variables from 23,821 active duty service members between 2006 and 2015 were analyzed from the Defense Medical Epidemiological Database. RESULTS: The incidence rates of new onset cases ranged from .22 (per 1,000 service members) in 2015 to a high of 1.46 (per 1,000 service members) in 2006 for T2DM without complications and .00 (per 1,000 service members) in 2007 to a high of .29 (per 1,000 service members) in 2015 for T2DM with complications. The one-sample chi-square test showed the observed, and expected frequencies differed significantly for all demographic variables tested. CONCLUSIONS: Although there was a significant increase in the diagnosis of T2DM with complications in 2015, the overall downtrend is similar to that of the general US population. Older age and higher rank were more likely to be associated with the diagnosis of T2DM with and without complications, again suggestive of similar trends with the general US population. Continued efforts towards early diagnosis and treatment of these service members are needed to address this problem regarding military readiness

Alcohol use disorder in active duty service members: Incidence rates over a 19-year period

Background: Alcohol use is a concerning issue for the military given its potential negative impact on human performance. Limited data are available regarding the incidence of alcohol use disorder in the military, which is critical to understand to evaluate force readiness, as well as for preventative initiatives and treatment planning. The aim was to examine the alcohol use disorder incidence rates (overall and across demographics) among active duty service members from 2001 to 2018. Methods: Data on 208,870 active duty service members between 2001 and 2018 from the Defense Medical Epidemiology Database was examined. Incidence rates were analyzed to determine the diagnostic rates of AUD (including both alcohol abuse and dependence), which were then examined by sex, age, service branch, military pay grade, marital status, and race. Results: Incidence rates of AUD in active duty service members (per 1,000 service members) ranged from 6.45 to 10.50 for alcohol abuse and 5.21 to 7.11 for alcohol dependence. Initial diagnoses of new-onset AUD occurred most frequently within 20–24 year-old, white, male, and non-married U.S. Army service members in the enlisted pay grades of E-1 to E-4. Statistically significant differences (p \u3c.001) were found between observed and expected counts across all examined demographic variables. Conclusions: To our knowledge, this is the first study to provide a comprehensive examination of AUD incidence rates in an active-duty military population over an extended 18-year period and during the last decade. Incidence rates were higher than expected for alcohol dependence and lower than expected for alcohol abuse. Given the untoward effects of AUD on overall health and force readiness, active-duty service members may benefit from more advanced preventative interventions to decrease incidence rates of AUD over time. Future research should use these data to develop targeted interventions for the demographics at greatest risk

Behavioral and Occupational Health in Military Firefighters: An Understudied Population

To our knowledge, no studies on health conditions in U.S. military firefighters exist. Data and demographics from the Defense Medical Epidemiology Database were analyzed on several shared medical issues among military personnel and civilian firefighters. Descriptive statistics and Chi-Square goodness of fit tests were conducted to support study aims. Between 2001 and 2015, substantial incidence rate increases (per 10,000) of tinnitus, PTSD, insomnia, and OSA (2005-2015) were observed. Modest to large increases in depressive disorders, adjustment reaction, generalized anxiety disorder, and panic disorder were observed. Decreasing rates were observed for alcohol dependence, hypertension, and tobacco use disorder. While efforts have examined the impact of sustained operations on military members, first responder military subgroups like firefighters are deficient. Cognitive Behavior Therapy interventions are efficacious for preventing and reducing behavioral health problems; therefore, tailoring them specifically for U.S. military firefighters could significantly improve quality of life and long-term health

Post-9/11 service members: Associations between gender, marital status, and psychiatric aeromedical evacuations from combat zones

Psychiatric aeromedical evacuations are one of the leading causes of medical related evacuations of US military personnel from combat. Currently, no studies have examined gender and marital status of individuals who were evacuated from combat for a psychiatric diagnosis. Psychiatric aeromedical evacuation data from 5,957 United States military personnel deployed to Iraq or Afghanistan between 2001 and 2013 were analyzed using chi-square tests of independence, odds ratios (OR), and standardized residuals. Analyses showed that female service members were evacuated at higher rates (178 per 100,000) than males (115 per 100,000). When compared to nonmarried females, married females did not present with increased risk of psychiatric aeromedical evacuation on any diagnosis. Married males, however, were more likely to be evacuated than married females for PTSD (OR = 1.98) and TBI (OR = 1.14). Likewise, married males, compared to nonmarried males, were more likely to be evacuated for PTSD (OR = 1.66) and anxiety (OR = 1.38). Although deployments can be extremely stressful experiences for some military service members, they may be especially so among unmarried females and married males. This study provides a unique contribution to enhancing the understanding of risk factors related to psychiatric aeromedical evacuation for deployed service members