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BACKGROUND: Mindfulness-based, in-person programs are effective at reducing stress and enhancing resilience in military and civilian samples, yet few studies have examined or compared training offered via real-time, interactive social media. Such a program would have a wider-reach and could include those unable to attend in-person. There is also interest in resolving ambiguity about the effects of mindfulness training on individual difference variables, such as self-compassion. OBJECTIVE: The purpose of this research was to compare pre/post self-compassion for three interventions; Mindfulness-based Stress Reduction delivered in-person (IP), mindfulness meditation training delivered via a Virtual World (VW), and a wait-list Control Group (CG) among active duty and veteran U.S. military. METHODS: A 2 (pre/post)×3 (group) factorial design was conducted with 250 active duty and veteran U.S. Military service members, with self-compassion measures as dependent variables. RESULTS: Self Compassion improved 10% for the IP group and 14% for the VW group, while the CG group did not improve. Combined treatment groups yielded a 10.3% improvement in self-compassion compared with no change in the CG and with a group×time interaction effect (p < 0.01). Participants with lower initial self-compassion experienced greater benefits than those with higher baseline self-compassion (p < 0.01). CONCLUSION: IP and VW Mindfulness Meditation training were equally effective in increasing self-compassion. Adding effective on-line mindfulness delivery will promote self-compassion among a more extensive audience, likely yielding improved coping, confidence, connectedness, cheerfulness, steadiness, and self-satisfaction, while lessening anxiety, fear-of-failure, and stress among participants. [ABSTRACT FROM AUTHOR]

Virtual worlds (VWs) present a viable, low-cost delivery mechanism for telehealth services. Although preliminary reports support the effectiveness of VWs in terms of health metrics, few studies have examined the perceived benefits and learning potential for military service members and veterans. Trust is integral to any interaction and may be even more important, and problematic to establish, during virtual interactions than in-person (IP) communications. The purpose of this study was to compare active duty and veteran U.S. Military service members' (n = 92) self-reported trust, class satisfaction, and didactic learning after completing either an 8-week training course in mindfulness-based stress reduction (MBSR) delivered IP or an 8-week mindfulness meditation class based on MBSR via the VW of Second Life. Results showed that learning performance was not significantly different between the IP and VW groups (p > 0.05). Although overall trust was high for both groups, participants in the IP group reported greater trust and class satisfaction compared with the VW group (p < 0.05). Trust, satisfaction, and learning were significantly correlated with one another, and trust in the instructor significantly predicted trust-in-classmates, trust-in-self, and class satisfaction for both groups (p < 0.05). In this study, IP group training was superior to VW training in terms of self-reported greater trust in the instructor, classmates, and self, and higher satisfaction with the training. Trust in the instructor is particularly important for group training, whether IP or in a VW. This study reiterates the arduous task of establishing trust in a VW setting and suggests that creating trust between the instructor and participants is high priority as a leading objective for VW communications. Suggestions for building trust are tight collaboration and clear communication, along with supporting and advocating for one another. [ABSTRACT FROM AUTHOR]

BACKGROUND: A standard, reliable, objective measure is needed for identifying individuals with mild to moderate traumatic brain injury (TBI). OBJECTIVE: The purpose of this study was to examine balance using an AMTI OR6-7 force platform (FP), neurocognition and mood using the Automated Neuropsychological Assessment Metric4 (ANAM4), blood flow comparisons using a Brain Acoustic Monitor (BAM), and voice using Voice Analysis software (VA) for screening service members for a mild to moderate TBI. METHODS: Active duty and retired service member volunteers (n = 88, 35 with a diagnosis of mild to moderate TBI and 53 who never had a TBI) completed an informed consent document, and evaluations using the four technologies. RESULTS: Development of a clinical prediction rule yielded two FP variables and one ANAM4 Mood Scale variable (vigor) as helpful in predicting the presence of a TBI. Assuming a 15% pre-test probability, these predictors yield a post-test probability of 75.7% for a positive result with any two or more measures being positive, and a post-test probability of 2.3% for a negative result with zero measures being positive. CONCLUSIONS: This study demonstrated the usefulness of a force platform and a self-reported mood scale for predicting presence of mild to moderate TBI. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic brain injury (TBI) is considered a signature injury from the fighting in Iraq and Afghanistan. Since the year 2000, over 370,000 U.S. active duty service members have been diagnosed with TBI. Although prior research has shown that even mild forms of TBI are associated with impaired cognitive performance, it is not clear which facets of cognition (computation, memory, reasoning, etc.) are impacted by injury.Method: In the present study, we compared active duty military volunteers (n = 88) with and without TBI on six measures of cognition using the Automated Neuropsychological Assessment Metric software.Results: Healthy volunteers exhibited significantly faster response times on the matching-to-sample, mathematical processing, and second round of simple reaction time tasks and had higher throughput scores on the mathematical processing and the second round of the simple reaction time tasks (P < 0.05).Conclusion: In this population, cognitive impairments associated with TBI influenced performance requiring working memory and basic neural processing (speed/efficiency). [ABSTRACT FROM AUTHOR]

BACKGROUND: Music and meditation have affirmative effects on the parasympathetic nervous system. OBJECTIVE: To investigate individual preferences for background sounds during meditation, using a series of paired, forced-choice comparisons. METHOD: Interventions included music with a distinct melody (one sample) and without a distinct melody (MWDM) (three samples), nature sounds with embedded alpha brainwave pulses (one sample), alpha brainwave pulses alone (one sample), and silence. Participants rated how much they liked hearing a sample during meditation and whether they felt they could meditate deeply while listening to it. Heart rhythm coherence scores were recorded using HeartMath emWavePro software and hardware. Participants were ranked as novice or adept meditators (NM vs AM) based on coherence scores. Rankings were based on preference selections, rating scales, and coherence scores. RESULTS: Rankings were highest for silence and MWDM. AMs preferred silence, followed by MWDM. NMs preferred listening to MWDM during meditation. DISCUSSION: Those with greater experience preferred meditating in silence. A preference was also seen for a composition style that incorporated altering arrhythmic and rhythmic patterns, and alternating asynchronous and synchronous patterns. CONCLUSION: These results indicate a compelling case for further research investigating meditation, music, and the potential interactive effect of the two on mind, body, and personal performance. [ABSTRACT FROM AUTHOR]

Mindfulness meditation training has been shown to reduce stress and improve short-term memory for military personnel. However, no studies have investigated the effects of in-person and virtual world (VW) mindfulness training on Post-Traumatic Stress Disorder (PTSD) or Attention Deficit Hyperactivity Disorder (ADHD) symptoms. In this study, U.S. military active duty service members and veterans were pseudo-randomized into two mindfulness training groups: in-person (IP) and online via a VW, and a wait-list control group. Volunteers answered a demographic questionnaire, and completed the PTSD Checklist-Military Version (PCL-M) and ADHD Current Symptoms Scale before and after training. The results showed practical and clinically relevant reductions in PTSD symptoms, particular for the IP group, but did not show statistical relevance with hypothesis testing. Results also showed post-training reductions in ADHD symptoms for both IP and VW groups, but no change for the control group. To investigate the effects of initial ADHD symptoms, IP and VW groups were combined into a single Mindfulness Training group. Those with high-initial ADHD symptoms attending training showed improvements, but the control group did not. These results expand research on the mindfulness training, and suggest that IP mindfulness training, rather than VW training, may be of greater benefit for those with PTSD symptoms, while either delivery system appears adequate for reducing attentional symptoms. [ABSTRACT FROM AUTHOR]

OBJECTIVE: During interviews with Health Care Specialist military cadre, instructors voiced concern that symptoms associated with attention deficit and hyperactivity disorder (SoADHD) and oppositional defiant disorder (SoODD) were interfering with soldiers' ability to complete training. The purpose of this research was to examine the relationship between SoADHD and SoODD with soldiers' grade point average (GPA), Army Physical Fitness Test (APFT) scores, and musculoskeletal injuries during Health Care Specialist (HCS) Advanced Individual Training (AIT). METHOD: Participants included 122 soldiers attending HCS training. Participants completed a demographic survey and Barkley and Murphy's ADHD and ODD self-report symptom surveys. Their ADHD and ODD self-report scores were correlated with course performance metrics at the conclusion of their 16 weeks of training. RESULTS: Pearson Correlation Coefficients revealed a significant negative relationship between ratings on the Oppositional Defiant Disorder scale with soldiers' GPA (p < 0.05), however the relationship was weak - accounting for 4% of the variance. No significant findings were noted between SoADHD and GPA, nor were significant relationships found between SoADHD or SoODD with APFT scores or musculoskeletal injuries. CONCLUSION: Symptoms associated with ADHD and ODD had little impact on the academic and physical performance of soldiers attending HCS training. Implications and future research are explored, in this article. [ABSTRACT FROM AUTHOR]

Menopause is a naturally occurring “equal opportunity” event that every woman who lives beyond the age of approximately 52 years will experience. During the next 20 years, approximately 3.5 million African American women, 2 million Latinas, and 1 million Asian American women will enter the menopause. How a woman approaches the menopausal transition depends on a number of factors, from educational level to socioeconomic status; health-related factors, including stress; and marital status. Increasingly, the roles of race and ethnicity, as they relate to menopausal symptoms, are being explored. Understanding similarities and differences among women of color in perceptions, attitudes, and expectations surrounding the menopause can help provide culturally appropriate care and promote lifestyles that may decrease symptoms and increase quality of life. For example, minority women are usually the gatekeepers for healthcare for themselves and their families and have a highly developed social support network, often including extended family, a church community, and involvement in sororal or social organizations. In the future, research on menopausal symptoms among women of different racial/ethnic groups should focus on exploring in greater detail the effect of dietary factors and body mass index, additional evaluation of pituitary sensitivity, and use of complementary and alternative medicines in symptom management, with a better understanding of the risks and benefits of such therapies. [Copyright &y& Elsevier]

Introduces a series of articles on the work in the U.S. army. Surveillance and risk factors associated with work in the army; Description of intervention programs employed in the army; Exploration to improve performance of soldiers.

Note from the editor: This column was originally published in 2013. Currently, Dr. Hildreth serves as president and CEO of Meharry Medical College, leading the technological, academic, and clinical transformation of the nation's largest private historically Black academic health sciences center. Because of his standing as a world-class infectious disease expert, Hildreth emerged as an important national figure in the response to the COVID-19 pandemic. In September 2020, he was appointed to the FDA Vaccines and Related Biological Products Advisory Committee that reviewed COVID-19 vaccine candidates for approval, and in February 2021, Dr. Hildreth was named to President Joseph Biden's Health Equity Task Force.

The lack of diversity in surgical career pathways impacts the cultural competence of the learning and working environment, the variety of leadership styles found within surgical leadership, and the ability of an organization to achieve equity in the workplace due to ongoing mistrust and untouched bias. Leading mitigating factors include developing pathways for greater numbers of diverse people at the high school and college level and implicit bias training. Though educators have had some success with these factors in the initial stages of diversifying early pathways, these factors are not yet correlated to entry into a surgical career. Future solutions to the lack of diversity in surgery will be predicated on surgeons collectively valuing justice, equity, diversity, and inclusion.

Accountable Care Organizations (ACOs) seek sustainable innovation through the testing of new care delivery methods that promote shared goals among value-based health care collaborators. The Morehouse Choice Accountable Care Organization and Education System (MCACO-ES), or (M-ACO) is a physician led integrated delivery model participating in the Medicare Shared Savings Program (MSSP) offered through the Centers for Medicare and Medicaid Services (CMS) Innovation Center. The MSSP establishes incentivized, performance-based payment models for qualifying health care organizations serving traditional Medicare beneficiaries that promote collaborative efficiency models designed to mitigate fragmented and insufficient access to health care, reduce unnecessary cost, and improve clinical outcomes. The M-ACO integration model is administered through participant organizations that include a multi-site community based academic practice, independent physician practices, and federally qualified health center systems (FQHCs). This manuscript aims to present a descriptive and exploratory assessment of health care programs and related innovation methods that validate M-ACO as a reliable simulator to implement, evaluate, and refine M-ACO's integration model to render value-based performance outcomes over time. A part of the research approach also includes early outcomes and lessons learned advancing the framework for ongoing testing of M-ACO's integration model across independently owned, rural, and urban health care locations that predominantly serve low-income, traditional Medicare beneficiaries, (including those who also qualify for Medicaid benefits (also referred to as "dual eligibles"). M-ACO seeks to determine how integration potentially impacts targeted performance results. As a simulator to test value-based innovation and related clinical and business practices, M-ACO uses enterprise-level data and advanced analytics to measure certain areas, including: 1) health program insight and effectiveness; 2) optimal implementation process and workflows that align primary care with specialists to expand access to care; 3) chronic care management/coordination deployment as an effective extender service to physicians and patients risk stratified based on defined clinical and social determinant criteria; 4) adoption of technology tools for patient outreach and engagement, including a mobile application for remote biometric monitoring and telemedicine; and 5) use of structured communication platforms that enable practitioner engagement and ongoing training regarding the shift from volume to value-based care delivery.

Unhealthy sleep can interfere with U.S. military service members affective and cognitive functioning, and increase accident and injury risks. This study examined the relationship between U.S. active duty and veterans' (n = 233) self-reported sleep (Pittsburgh Sleep Quality Index), anxiety (Zung Self-Rating Anxiety Scale), and cognitive performance (Automated Neuropsychological Assessment Metric). Statistical analyses included Pearson product moment correlations and multivariate analysis of variance, with Tukey-b post-hoc tests, with a p < 0.05 significance level. Higher education, abstinence from sleep aids, longer time in active duty service, and being on active duty were correlated with better sleep and lower anxiety. Greater sleep disturbance, poor sleep quality, and sleepiness-related daytime dysfunction were associated with greater anxiety and slower response times, and lower response accuracy. Statistically controlling for anxiety diminished the magnitude and significance of the correlations between sleep and cognitive performance, suggesting that reducing anxiety will improve sleep and diminish cognitive performance effects. These findings suggest the need for addressing both sleep and anxiety for those with diagnosed sleep disorders, as well as using a procedural systems approach to decrease anxiety during missions that demand outstanding cognitive performance., (Published by Oxford University Press on behalf of Association of Military Surgeons of the United States 2019.)

Breast milk (human milk) is the recommended standard for nutrition for infants. There are strategies to increase breastfeeding for people of color due in part to health disparities experienced in underrepresented populations.

One method to discover possible reasons why individuals fail academic training is to ask them. However, self-report information can be difficult to trust, especially if students are perceived as having something to lose if they are honest. The purpose of this study was to identify potential reasons students fail (or do well) in their training as reported by 4 groups: those who failed the program (F) (n=28) and a peer (F-P) (n=28); and those who passed with a grade of B or above (P) (n=101) and one of their peers (P-P) (n=32). Statistical analysis included chi-square test statistics and t tests with a P < .05. Only findings considered "external" to students are included here, including class structure and schedule, instructors and teaching, support systems, and sleep. Few differences were found between peer reports and self reports by students who passed or students who failed their program. On the positive side, both P and F students indicated they could get individual attention even with large classes, having good support systems, and bonding well with their unit. On the negative side, P and F students reported difficulty staying focused during long class hours, and F students felt teaching methods made it difficult to succeed and struggled with the fast pace of the course (P < .05). More than half of all students reported sleeping between 5 and 6 hours per night, but those who failed more often reported sleeping only 3 to 4 hours per night (P < .05). These findings highlight areas of organizational strength, as well as areas of difficulty for students, which will permit administrators to set goals and perhaps tailor their programs to reduce attrition.

Substantial changes in not only access to care, cost, and quality of care, but also health professions education are needed to ensure effective national healthcare reform. Since the actionable determinants of health such as personal beliefs and behaviors, socioeconomic factors, and the environment disproportionately affect the poor (and often racial/ethnic minorities), many have suggested that focusing efforts on this population will both directly and indirectly improve the overall health of the nation. Key to the success of such strategies are the ongoing efforts by historically black medical schools (HBMSs) as well as other minority serving medical and health professional schools, who produce a disproportionate percentage of the high-quality and diverse health professionals that are dedicated to maintaining the health of an increasingly diverse nation. Despite their public mission, HBMSs receive limited public support threatening their ability to not only meet the increasing minority health workforce needs but to even sustain their existing contributions. Substantial changes in health education policy and funding are needed to ensure HBMSs as well as other minority-serving medical and health professional schools can continue to produce the diverse, high-quality health professional workforce necessary to maintain the health of an increasingly diverse nation. We explore several model initiatives including focused partnerships with legislative and business leaders that are urgently needed to ensure the ability of HBMSs to maintain their legacy of providing compassionate, quality care to the communities in greatest need.

The purpose of this project was to evaluate the effectiveness of an initial screening and referral process in reducing the impact of musculosketetal injuries among soldiers attending Health Care Specialist training. Musculoskeletal injury among Army Health Care Specialist students have been reported to be approximately 24% for men and 24-30% for women. The highest student visit rate to the troop medical clinic for musculoskeletal injuries, for men and women, occurs during the first week of training. Anecdotal reports indicate that many students arrive for training with existing injuries or symptoms. This project was designed to assess whether formalized early screening, referral, and intervention could 1) identify arriving students who need musculoskeletal injury-related medical attention, 2) reduce the number of students receiving limited duty status during their 10-week training, 3) decrease the total number of limited duty days for students, and 4) decrease the number of students who cannot graduate due to musculoskeletal injury. Students (N=291) from one company were divided into three groups of 97 students. Three methods were used to screen and refer students for medical intervention: 1) traditional (T), 2) by health care providers (HCP), or 3) by Drill Sergeants (DS). Screening by HCP and DSs involved using a new screening tool to identify and consequently refer students with symptoms to a troop medical clinic (TMC) for early evaluation and intervention. Using the screening tool, HCPs identified 92% of students with injuries, while DSs accurately identified 80%. The screening did not reduce the number of students receiving limited duty status, total limited duty days, or the number of students that could not graduate due to musculoskeletal injury ("holdovers") (p>0.05). The screening tool demonstrated good sensitivity and specificity whether conducted by HCPs or DSs. It failed to demonstrate efficacy in reducing the impact of musculoskeletal injuries among Combat Medic soldiers, as measured by limited duty days and holdovers.