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On June 30, 1960, the independence of the Belgian Congo, once personal possession for 23 years of the Belgian King Leopold II, was proclaimed as the 'Republic of the Congo'. Emery-Patrice Lumumba (1925-1961) played a capital role in this emancipation which resulted in the consecration of Joseph Kasavubu as first President of the Republic of Congo and himself, Emery Patrice Lumumba, as Prime Minister. Congo has proclaimed its independence, but the new country remains plagued by violence and infighting. Belgian troops and peacekeepers from the United Nations intervene in the territory as a standoff begins between Kasavubu and Lumumba. On September 14, 1960, Colonel Joseph Desire Mobutu led a first coup d'etat which was followed by the arrest and assassination of Lumumba. The following years would be punctuated by rebellions and fighting interspersed with ceasefires in protest against the dictatorship established by the Mobutu regime after its second coup d'etat, five years later, during a new political crisis. After thirty-two years of unchallenged reign, Mobutu was ousted from power by Mzee Laurent Desire Kabila in May 1997 and since then, it has been difficult to speak of the real independence of the country, which became the Democratic Republic of Congo. Keywords: formal independence, real independence, Independence Day, Zaire, Democratic Republic of Congo, colonization, decolonization, political emancipation, sovereignty., Introduction Lorsque le Congo-belge accede a sa souverainete nationale et internationale, la ceremonie officielle a lieu en presence du roi Baudouin, du President Kasavubu et du Premier Ministre Lumumba, ainsi [...]

The military coup in Myanmar on February 1, 2021 unleashed massive popular uprising against military rule, which was met with heavy handed military violence. Less than a month after the coup the first soldiers joined the civil disobedience movement (CDM) along with many civil servants who refused to work under the military. The resistance to the military was soon named the Spring Revolution, with calls for pervasive transformation of Myanmar's political structures and security forces. Military defections gradually developed into a "revolutionary strategy." This article explores how this development evolved and how defectors were transformed into "revolutionary actors" during the ongoing revolutionary situation. The analysis is based on the personal narratives and collective activities of those soldiers who became active in the CDM. Applying a conversion narrative approach, the article traces the processes of defection from individual disaffection with military violence to the formation of CDM soldier groups and the personal transformation of soldiers. Adding to existing literature on military defections during popular uprisings against authoritarian regimes, the article demonstrates that defection holds significance not only for the outcomes of revolutions, but also for the shaping of revolutionary ideas and practices during revolutionary situations. [ABSTRACT FROM AUTHOR]

Background: Physical fitness and a healthy body mass are important predictors of a good performance of military tasks. The purpose of this study was to assess the physical activity level and nutrition, in terms of the frequency of consumption of individual food groups, of Polish Navy soldiers and Maritime Unit of the Border Guard officers. Materials and Methods: This study was conducted on 131 Polish Navy soldiers aged 33.1 ± 6.3 years old and 132 Maritime Unit of the Border Guard officers aged 38.6 ± 5.5 years old. In order to carry out research on physical activity, the International Physical Activity Questionnaire was used. Eating habits were assessed based on a Food Frequency Questionnaire for 61 groups of food products. Results: Over 80% of the soldiers and officers studied indicated high levels of physical activity. Only 8.2% of soldiers and 4.3% of officers indicated a low level of physical activity. Of the 61 food product groups analyzed, significant differences were found in the frequency of consumption of 17 products. These differences concerned almost all groups (except dairy products and eggs). Conclusions: To summarize, soldiers and officers presented high and moderate levels of physical activity. Taking into account the demonstrated frequent consumption of high-energy and high-fat products, such as sausages and red meat, as well as margarine, mayonnaise, and sugar, with the low frequency of fruit and vegetable consumption in both studied groups, it is advisable to conduct training among soldiers and officers in the field of health education. [ABSTRACT FROM AUTHOR]

Hume argues that priests feign knowledge of the strange theological country they supposedly represent and so are hypocrites, conceited because they think themselves better than the multitude whose minds they fill with superstitions and keep in ignorance to encourage their veneration as envoys from God. They thus work against the public interest in having an informed and educated citizenry. The nub of his concern, as he wrote in Dialogues Concerning Natural Religion, was that when we consider theological matters, we have moved beyond "the more solid and natural arguments, derived from the senses and experience," and must be more than "apprehensive, that we have here gone quite beyond the reach of our faculties." [ABSTRACT FROM AUTHOR]

Background Musculoskeletal injuries (MSKIs) represent the most substantial and enduring threat to U.S. military readiness. Previous studies have focused on narrow surveillance periods, single branches of service, and used variable approaches for MSKI identification and classification. Therefore, the goals of this retrospective population study were to report the incidence, prevalence, and types of MSKIs sustained by active duty service members (ADSMs) across four Services in direct care (DC) and private sector care (PC) settings over fiscal years (FYs) 2010–2021, and to quantify and describe associated health care utilization and PC costs over the same period. Methods This study included ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Head/Neck, Upper Extremity (UE), Spine (upper back, middle back, lower back, pelvic), and Lower Extremity (LE) MSKIs in ADSMs, associated health care utilization, and PC costs were derived by querying electronic health records from DC, PC claims, and theater medical data from the Military Health System Data Repository. Patient episodes of care and associated PC costs related to MSKIs in DC and PC settings were classified into mutually exclusive outpatient encounter categories and acute inpatient stays, body regions, and Services. Results Over FY10–21, the most prevalent MSKIs were LE (24–29%) followed by Spine (17–20%), UE (14–16%), and Head/Neck (6–8%). Across FY10–21, soldiers were more likely to sustain LE MSKI than Airmen (risk ratio 1.12–1.30) and Marines demonstrated an increasing risk of LE MSKI prevalence and incidence (relative to Airmen) over the study period. The rise in prevalence of LE, Spine, UE, and Head/Neck MSKIs over FY10–21 was accompanied by increased health care utilization and reliance on PC care, especially same-day surgeries (SDS). PC reliance for SDS increased across body regions from FY10 to its peak in FY20 (Head/Neck: 22.7% to 49.7%, Spine: 37.1% to 57.0%, LE: 38.6% to 51.5%, UE: 40.4% to 53.5%). In FY21, the MHS incurred the highest PC costs for LE MSKIs ($132,242,289), followed by Spine ($98,738,863), UE ($92,118,071), and Head/Neck ($42,718,754). Conclusions To our knowledge, this is the first population study of MSKIs in ADSMs spanning the ICD-10 CM transition (FY15–16) that includes the four Services. Across Services, MSKIs in the U.S. military remain a prevalent and persistent problem. Consistent with prior research, the LE was the most common and costly body region affected by MSKIs. Service members with MSKIs demonstrated an increasing reliance on PC for MSKI care, particularly SDS, over the study period. Expanding future research efforts to include all Services to assess risk factors and patient outcomes for treatments across DC and PC settings is vital to mitigate the threat posed by MSKIs to the readiness of the U.S. Armed Forces. [ABSTRACT FROM AUTHOR]

Introduction Musculoskeletal injuries (MSKIs) are highly prevalent and costly conditions among active duty service members (ADSMs), and female service members sustain these injuries at a higher rate than men. However, lack of women-specific research regarding MSKIs in the U.S. military has limited Department of Defense (DoD) leadership from assessing and addressing the burden of these conditions. The purposes of this study were to report the incidence, prevalence, and types of MSKIs sustained by female ADSMs across the four services in direct care (DC) and private sector care (PC) settings from fiscal years (FYs) 2016 through 2021 and to quantify and describe the health care utilization and private sector costs associated with MSKIs in women over the same period. Materials and Methods This retrospective, longitudinal population study included ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Head/Neck, Upper Extremity (UE), Spine, and Lower Extremity (LE) MSKIs in female ADSMs, associated health care utilization, and private sector costs were derived by querying electronic health records from military treatment facilities, PC claims, and theater medical data from the Military Health System Data Repository from October 1, 2015 to September 30, 2021 (FY16–21). Health care utilization associated with MSKIs among female ADSMs for each body region in DC and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC MSKI-associated costs in service women were captured for each year and categorized by service, body region, and setting. Results In FY21, 10.8% (n  = 27,976) of female ADSMs sustained Head/Neck MSKI, 16.3% (n  = 42,294) UE MSKI, 23.6% (n  = 61,048) Spine MSKI, and 33.3% (n  = 86,235) LE MSKI. Across the study period, female ADSMs had a 25%–29% higher risk of any MSKI (risk ratio (RR) 1.25–1.29) relative to men. Female soldiers had the highest annual prevalence of MSKIs (62.1%–66.4%), while female Marines had the highest risk of MSKI relative to men (RR 1.40–1.47) for all four major body regions. From FY16 to FY21, the body region with the highest risk of MSKI relative to men was Head/Neck (RR 1.61–1.63), while the region with the lowest relative risk was UE (RR 1.05–1.10). LE MSKIs represented the most common and costly type of injury in female ADSMs, with 406,997 outpatient DC and 87,374 PC encounters in FY21. Total PC costs of LE MSKI for female ADSMs were $30,643,535 in FY21 alone. Conclusions This is the first population-level assessment of MSKI prevalence, incidence rates, health care utilization, and PC costs over a 6-year period for service women in the military health system (MHS). Female ADSMs sustain MSKIs at a higher rate than their male counterparts. Given the critical role of service women in the military, MHS leaders, researchers, and public health officials should continue to explore the underlying causes of these disparities in MSKI rates between the sexes, by expanding research efforts to all services and military settings. [ABSTRACT FROM AUTHOR]

Introduction This study aimed to examine the prevalence of cold injuries and review the cold injury monitoring system in the South Korean military. Materials and Methods This study conducted a retrospective and cross-sectional analysis using data from the Defense Medical Statistic Information System (DMSIS) on cold injuries among military personnel from 2018 to 2023. It incorporated findings from the Korean Armed Forces Medical Command's cold injury surveillance system and analyzed cases from the Armed Forces Capital Hospital, covering all branches of the military by status and rank. Results An analysis of cold injury in the South Korean military over the past 5 years revealed varying numbers of cases treated, from 799 in 2018-2019 to 467 in 2022-2023. According to the surveillance system in 2023-2024, the Army experienced the majority of these cases, with 94.5% of the total. The incidence per 1,000 personnel was the highest in the Army at 0.98 compared to the Air Force and Navy/Marine Corps. Rank-based analysis indicated the most affected were private first-class soldiers. Frostbite was the most frequent condition, alongside chilblains, hypothermia, and immersion injuries, with no marked difference in the type of illness across branches. Conclusions The study underscores the need for focused prevention and treatment, particularly in the Army. By analyzing data from a newly implemented surveillance system, it revealed a higher incidence of frostbite and chilblains among lower ranks. The findings highlight the importance of targeted educational measures and enhanced response strategies to protect personnel against cold injuries. [ABSTRACT FROM AUTHOR]

Introduction The fit of military clothing and equipment is essential for the health and safety of military operators. Given the aim of increasing the proportion of women and the known biological and morphological differences between male and female soldiers, an understanding of fit across different items of kit is needed. The aim of this study was to quantify subjective fit ratings of 8 items of military clothing and equipment, including combat shirt, combat pants, rucksack, small pack, tactical vest, fragmentation vest, helmet, and ballistic eyewear as a function of relative stature and occupational group among male and female Canadian Armed Forces members. Materials and Methods An online survey was distributed to male and female Canadian Armed Forces members, where fit was reported by participants according to a 7-point Likert acceptability scale. Participants were binned into 1 of 6 (3 males, 3 females) standing stature categories based on percentiles in a male and female distribution that included (1) under 35th percentile stature, (2) 35th to 80th percentile stature, and (3) over 80th percentile stature. Additionally, participants were separated according to occupational group: Group A: Infantry, Combat Engineer, Artillery, Armored; group B: Signals, Medical Technician, Intelligence, Signals Intelligence/Cyber Ops; group C: Supply Technician, Weapons Technician, Vehicle Technician, Electronic-Optronic Technician, Ammunition Technician; other: Not in other groups, examples include: Financial Services Administrator, Cook. This study was approved by the Defence Research and Development Canada Human Research Ethics Committee under protocol 2019-048, Amendment 2. Results There were significant effects attributable to stature category and occupational group on the fit of equipment. Specifically, fit acceptability of the rucksack helmet, small pack, and tactical vest was significantly affected by occupational group. Differences between stature categories were detected in all items with the exception of the small pack. Conclusions Military equipment fit has previously been shown to have implications for protection, performance, and mobility. The results of the investigation demonstrate different patterns of fit acceptability in male and female soldiers across items of clothing and equipment and may require different solutions. [ABSTRACT FROM AUTHOR]

Introduction This study aimed to examine the relationships between dissociative and somatic symptoms and how they might contribute to PTSD severity among ex-soldiers who sought help from the IDF Combat Stress Reaction Unit (CSRU). Materials and Methods This cross-sectional study included 1,305 former compulsory, career, and reserve soldiers, who filled out self-report questionnaires on admission for evaluation at the CSRU. The study's dependent variables included two posttraumatic stress disorder measures (CAPS and PCL-5). The independent variables were the Dissociative Experience Scale and Brief Symptom Inventory. Background and service-related variables were also examined. Results Spearman correlation revealed that the higher the level of somatization is, the higher the level of PTSD via PCL and CAPS. A significant positive association was found between somatization and dissociation (r  = 0.544; P  < 0.001). The higher the somatization level, the more severe the dissociation. A multivariate logistic regression analysis to predict severe PTSD revealed that the longer the time elapsed from the traumatic event (OR = 1.019, P  = 0.015), the higher the risk for severe PTSD. The most prominent variables were dissociation (OR = 6.420, P  < 0.001) and somatization (OR = 4.792, P  < 0.001). The entire model reached 40.8% of the shared variance in the regression. Conclusions While there is direct reference to dissociation in the clinical assessment by PCL or CAPS, there is no such reference to somatization. Highly functioning combatants sometimes express their distress somatically. Our findings suggest regarding severe somatic symptoms as diagnostic criteria for PTSD. [ABSTRACT FROM AUTHOR]

Introduction The population of the Republic of Korea often experiences heat-related illnesses during summer that are exacerbated by significant variations. With rising temperatures attributed to global warming and other environmental changes within the military, combined with the military medical services' mission to uphold combat capabilities and promote health, it has become crucial to accurately understand the status of heat-related illnesses and integrate more comprehensive and systematic preventive measures. This study aimed to analyze data on heat-related illnesses between 2018 and 2022 to assess and reflect on the said diseases in the South Korean Military. Materials and Methods We performed a secondary analysis using data provided by the Defense Medical Statistic Information System. This single-institution retrospective, cross-sectional study was approved by the Institutional Review Board of the Armed Forces Medical Command (approval number: AFMC-2023-11-001). Results Over the past 5 years, the annual number of soldiers treated for heat-related illnesses, whether as outpatients or inpatients, at division medical facilities and military hospitals ranged from 846 to 1,250 cases per year. The proportion of severe cases fluctuates annually between 1.1% and 1.8%. Notably, 94 to 96% of all heat-related illnesses were recorded between May and September, with peak rates in July and August. Conclusion The army reported the highest number of heat-related illnesses among military branches, with soldiers comprising the majority of cases. This highlights the urgent need for enhanced heat illness prevention measures within army ranks. Notably, the incidence of these illnesses peaked during July and August, underlining the critical periods for intensified preventive efforts. [ABSTRACT FROM AUTHOR]

Introduction Medial opening wedge high tibial osteotomy (MOWHTO) is a surgical option for medial femorotibial osteoarthritis, which preserves articular cartilage by correcting the extra-articular deformities of the lower limbs that cause osteoarthritis. This is an increasingly popular treatment in a population with high functional demand, such as the French military population. The aim of this study was to evaluate the rate of return to work and military activities at 6 months postsurgery and at last follow-up in this military population following MOWHTO. The hypothesis of this study was that MOWHTO enabled a majority of service members to return to the same level of activity within 6 months of surgery. Materials and methods This was a retrospective, multicenter study including all French military personnel operated on for MOWHTO alone for osteoarthritis of medial compartment between 2008 and 2018 in different Military Teaching Hospitals. We excluded civilian patients. For each patient, a questionnaire was used to collect epidemiological, professional, sports, and functional data. The primary endpoint was the rate of return to work at 6 months postsurgery. We also studied the recovery of sports activities and functional results at a 6.6-year follow-up by standardized questionnaires (Tegner activity scale, Lysholm, IKDC subjective (International Knee Documentation Commitee)). Results Twenty-four MOWHTOs were performed during this period in a cohort of 22 French military personnel. Return to work at 6 months was possible in 20/24 cases (83.3%). Of the four patients who did not return to work at 6 months, two changed their activities, while the other two returned to their jobs after 6 months. The rate of resumption of sporting activities at an equal or higher level was 50% (11/22). There was no difference between pre- and postoperative Tegner Activity Scale scores at the longest follow-up (P  = .08). The mean postoperative Lysholm scores were 73.5 (standard deviation 17.8) and IKDC 59 (standard deviation 8.7). No intraoperative complications were found, and one case of postoperative infection was found. Conclusions A total of 83% of the operated soldiers were able to return to their professional activities in less than 6 months. We observed a functional improvement at the last follow-up. Comparing these results with data from civilian populations, the rate of occupational recovery is comparable. However, the return to sport is much better in the series of nonmilitary patients with approximately 90% return to work and sport in the year following surgery. MOWHTO improves the functional results of the knee, enabling a return to work and sport in most cases in young, active populations such as the French military. [ABSTRACT FROM AUTHOR]

In this article, I present my views on the diversified approaches to assess the physical fitness of soldiers within selected armies worldwide. I discussed the related common features and paradoxes associated with these approaches. For the comparative analysis, national diversity was taken into account and subjective selection of the physical fitness tests conducted in the armies of the United States, Finland, Germany, India, China, Israel, Netherlands, Sweden, Switzerland, United Kingdom, and Poland was done. An analysis of the physical fitness tests reveals significant variations, despite the purpose of the assessment being the same, that is, to evaluate a soldier's physical preparedness for combat tasks. Based on the analysis, I categorize the variation in physical fitness tests of soldiers at four levels: (1) single-system function tests (e.g. push-ups, sit-ups) vs. multi-system tests (obstacle courses), (2) considering health aspects vs. not considering health aspects during physical fitness tests, (3) motor components vs. coordination components (e.g.balance), and (4) tests differentiated by gender and age vs.tests not differentiated by gender and age. In conclusion, I am in favor of multi-system tests, comprised of obstacle courses mirroring potential situations in combat tasks. In my opinion, multi-system tests are superior compared to single-system function tests since they enable a comprehensive assessment of effort, coordination, and mental predispositions necessary for functioning in real-life conditions. I also support physical fitness evaluation that is not differentiated based on a soldier's gender and age, as there is no logical justification for such distinctions. [ABSTRACT FROM AUTHOR]

Hands-on training and social media sites have heavily emphasized the use of tourniquets to treat limb injuries during the Ukraine war. Tourniquet overuse or misuse can lead to significant tragedy—limb loss, physiologic complications, and even death. Casualty evacuation in Ukraine often exceeds 6 hours, and the liberal use of limb tourniquets may have unintentionally increased morbidity. Tourniquet application was appropriate in 24.6% of the wounded with tourniquets in one recent publication by a Ukrainian vascular surgeon. The longer a limb tourniquet is in place raises the risk of compartment syndrome, vascular thrombosis, rhabdomyolysis, and irreversible myonecrosis resulting in major tissue loss and often necessitating limb amputation. If bleeding is controlled with a tourniquet, attempts to remove the tourniquet as early as possible to avoid the negative consequences are essential. Training in tourniquet use without explaining possible limb loss and other complications resulting from tourniquets left in situ more than 2 hours makes use risky. Tourniquets should be loosened at one hour if the tactical situation allows, and the injury assessed to determine if major bleeding persists or to determine if other methods of hemostasis would be effective. Ukraine must improve the training so that everyone becomes aware of the risks of prolonged or improper tourniquet use. This tourniquet training information must be transmitted to military medical leaders, Ukrainian military medics, civilian volunteers, volunteers in Ukraine, and NATO trainers in allied countries conducting medical training for Ukrainian soldiers. A trauma registry and tracking through echelons of care can enhance performance improvement through timely feedback. [ABSTRACT FROM AUTHOR]

European historiography on wars has embarked on a study of a matter of crucial significance: the involvement of ordinary individuals as perpetrators of mass casualties. This article aims to provide insights and hypotheses concerning the underlying motives behind such actions, focusing on the unique context of the Spanish Civil War. The data utilized for this study are drawn from a sample of 112 oral interviews conducted with former combatants of the Spanish Civil War, all born between 1905 and 1920. During these interviews, 112 men participated a semi structured discussion. Individual perceptions and variables of interest relevant to acts of violence were subjected to qualitative analysis. Our analysis suggests that instances of aggression often arise because of emotional triggers, alignment with fascist ideological convictions, societal pressures and a sense of duty-driven obedience. Our results refute the notion that ideological factors alone suffice as explanations. [ABSTRACT FROM AUTHOR]

Background: This cross-sectional study assessed combat readiness, alcohol abuse and post-traumatic stress disorder (PTSD) among Uganda Peoples' Defense Forces (UPDF) soldiers returning from Operation Lightning Thunder (OLT) in South Sudan and Central African Republic. Methods: One hundred fifty participants recruited from UPDF soldiers who had recently withdrawn from OLT, and were based in Singo Peace Support Operation School were screened for combat readiness, alcohol abuse and PTSD. The Perceived Combat Readiness Questionnaire, Alcohol Use Disorder Identification Test, and PTSD checklist military version were used to measure the variables. Inferential analyses were performed to determine the association between combat readiness, alcohol abuse, and PTSD, while controlling for sociodemographic factors. Results: We found that 16% of UPDF soldiers met positive screening results for PTSD, and 21% met the positive screening results for moderate substance use disorder. UPDF soldiers who benefited from combat readiness were less likely to develop PTSD or alcohol abuse. Our results showed a mediating effect of alcohol abuse on combat readiness and PTSD among soldiers with UPDF. Conclusion: Our results highlight the high rates of PTSD and alcohol abuse among UPDF soldiers returning from military deployment. These findings provide insight into the role of combat readiness in reducing the risk of alcohol abuse and vulnerability to PTSD in the aftermath of military deployment. [ABSTRACT FROM AUTHOR]

I analyze how personal advertising affected marital and sexual culture in Finland during World War II. The practice of seeking intimate company through newspapers was nearly non-existent in Finland before the war, but in wartime grew into a nationwide mass phenomenon due to the gender imbalance caused by men's departure for the front. Wartime personal advertising was different than that in peacetime. Unlike the typical situation, when advertisements are mostly used by the middle-aged, most of the advertisers during the war were young adults in the prime age of courtship. Their active advertising accounted for the high marriage rates during the war and had a liberating effect on Finnish sexual culture. The active posting of personal advertisements by women was also noteworthy. Traditionally, they were expected to passively await men's initiatives in the marital market. However, during the war, women advertised in the same numbers as men, indicating that the freedom offered by advertisements was particularly important for them. Nevertheless, the transformation of sexual culture is not explicitly evident in the advertisements. The Finnish personal advertising culture was unique in that even adults undoubtedly seeking serious relationships only expressed wishes for correspondence in advertisements due to the conservative sexual culture of the country. The case illustrates challenges in using personal advertisements in the historical analysis of mate selection. [ABSTRACT FROM AUTHOR]

Upper extremity musculoskeletal injuries are common with active-duty Army Soldiers and result in increased limited duty days. Patient satisfaction and surgery rates improve with direct access to occupational therapy in the civilian community. Examine the amount of time from initial evaluation following an upper extremity musculoskeletal injury (MSKI) to return to full duty plus occupational therapy (OT) utilization in Army Soldiers. Retrospective observational. Electronic health records and profiles from 18,206 US active-duty Army soldiers with MSKI and OT evaluation between 2017–2018 were examined. Repeated measures generalized estimating equations provided the rate ratios (RRs) for OT healthcare utilization (total number of OT evaluations and treatment visits) by days to first OT evaluation and limited duty profile (total days on profile). Soldiers were on average 32.0 (SD = 8.9) y/o, predominantly senior enlisted (45.7%), white (58.0%), male (81.4%), 10.0 (SD = 8.4) years of service, and high school or less educated (51.3%). There were 22,617 UE MSKIs with an OT evaluation and 4936 UE MSKIs with profiles. Compared with UE MSKIs with an OT evaluation on the same day, there was a significant increase in rates of OT utilization for 1–7 days (RR: 1.4, 95% CI: 1.3, 1.5), 8–14 days (RR: 1.3, 95% CI: 1.2, 1.4), 15–30 days (RR: 1.4, 95% CI: 1.3, 1.5), 31–60 days (RR: 1.5, 95% CI: 1.4, 1.6), and +60 days later (RR: 1.6, 95% CI: 1.5, 1.7). Similar differences in rates for limited duty profiles were found. A greater number of days between diagnosis of UE MSKI and OT evaluation results in greater rates of OT utilization and longer temporary profile. Results suggest that earlier intervention by OT may decrease recovery and healthcare utilization of soldiers. • Longer time to evaluation was associated with greater utilization rates of OT. • Upper extremity injuries were predominant in senior enlisted male Soldiers. • Soldiers may benefit from early access to OT care for upper extremity injuries. [ABSTRACT FROM AUTHOR]

Sabila Moses,1 Ezekiel Mupere,2 Joan Nangendo,1 Fred C Semitala,3 Joan N Kalyango,1 Saul Chemonges,4 Patience A Muwanguzi,5 Achilles Katamba6 1Clinical Epidemiology Unit, Makerere University, Kampala, Uganda; 2Department of Peadiatric and Child Health, Makerere University, Kampala, Uganda; 3Department of Internal Medicine, Makerere University, Kampala, Uganda; 4Department of UQ VETS- Small Animal Hospital, University of Queensland, Brisbane, Australia; 5Department of Nursing, Makerere University, Kampala, Uganda; 6Department of Medicine, Makerere University, Kampala, UgandaCorrespondence: Sabila Moses, Email sabilamoses84@gmail.comBackground: Uganda faces a significant dual challenge with tuberculosis (TB), ranking among these countries most affected by the disease worldwide. The World Health Organization (WHO) recommends isoniazid preventive therapy (IPT) for managing latent TB. However, the adherence to IPT in military settings remains under-explored in Uganda. This study aims to assess IPT adherence and identify its predictors among soldiers undergoing HIV antiretroviral therapy at a General Military Hospital in Uganda.Methodology: We conducted a cross-sectional study involving 300 HIV-positive soldiers receiving antiretroviral therapy (ART) at the General Military Hospital in Uganda. Due to the small sample size, we employed a consecutive sampling method. We utilized descriptive statistics and modified Poisson regression model for prevalence of IPT adherence and associated factors respectively.Results: Among the 300 clients, the prevalence of isoniazid preventive therapy (IPT) was 94.7%, 95% CI: 92.1– 97.2; adherence to IPT was associated with being aged ≥ 50 years, with a prevalence ratio (PR) of 1.061 and 95% CI: 1.01– 1.12; being married, with a PR of 1.438, 95% CI:1.12– 1.84; having social support, with a PR of 1.498, 95% CI:1.17– 1.92; and having social support played a significant role in IPT adherence among married participants, with a PR of 0.817,95% CI:0.72– 0.93.Conclusion: To enhance adherence to isoniazid preventive therapy among young soldiers with HIV, targeted interventions are crucial, as older individuals tend to adhere better. Implementing marital support programs and strengthening community engagement can bolster adherence through social support networks. Educational campaigns should focus on the importance of IPT, while regular follow-ups will ensure effective monitoring and support. Further research is needed to explore how social support can mitigate stigma associated with HIV. The findings highlight the importance of improving IPT adherence among married soldiers and suggest that this approach could be effective in other low-resource settings.Keywords: IPT, adherence, TB, HIV, soldiers, ART

A scrub typhus outbreak occurred among 24 soldiers from 2 Australian Defence Force infantry units following separate training events conducted in the same coastal location in tropical North Queensland, Australia, in June 2022. Seven soldiers visited a hospital, 5 requiring admission. Outbreak recognition was hampered by the geographic dispersion of soldiers after the exercise and delayed case identification resulting from such factors as prolonged incubation, cross-reactive serologic responses to other pathogens, the nonspecific symptoms of scrub typhus, and the illness’s nonnotifiable status in the state of Queensland. Our investigation focused on personal protective measures in a subanalysis of 41 soldiers, revealing an association between scrub typhus infection and the use of doxycycline chemoprophylaxis and permethrin uniform dipping.

Abstract Background This cross-sectional study assessed combat readiness, alcohol abuse and post-traumatic stress disorder (PTSD) among Uganda Peoples’ Defense Forces (UPDF) soldiers returning from Operation Lightning Thunder (OLT) in South Sudan and Central African Republic. Methods One hundred fifty participants recruited from UPDF soldiers who had recently withdrawn from OLT, and were based in Singo Peace Support Operation School were screened for combat readiness, alcohol abuse and PTSD. The Perceived Combat Readiness Questionnaire, Alcohol Use Disorder Identification Test, and PTSD checklist military version were used to measure the variables. Inferential analyses were performed to determine the association between combat readiness, alcohol abuse, and PTSD, while controlling for sociodemographic factors. Results We found that 16% of UPDF soldiers met positive screening results for PTSD, and 21% met the positive screening results for moderate substance use disorder. UPDF soldiers who benefited from combat readiness were less likely to develop PTSD or alcohol abuse. Our results showed a mediating effect of alcohol abuse on combat readiness and PTSD among soldiers with UPDF. Conclusion Our results highlight the high rates of PTSD and alcohol abuse among UPDF soldiers returning from military deployment. These findings provide insight into the role of combat readiness in reducing the risk of alcohol abuse and vulnerability to PTSD in the aftermath of military deployment.

The special military operation (SMO) has actualized ethical and ideological aspects of war, which led to the corresponding social consequences. One of them is related to the educational-ideological component and manifests itself in the fact that children and schoolchildren began to write letters, send crafts and drawings to soldiers. In turn, these messages gave rise to a response movement in the form of personal and collective letters from soldiers to schoolchildren and “walls of support” made of children’s letters and drawings in dugouts. Thus, there is a kind of correspondence which reflects not only the ideas of civilians on the SMO events but also the soldiers’ “life world” and actualized values - manifested and realized during the SMO and then recorded in its ethical and ideological discourses. The article presents an attempt of an exploratory analysis of ego-documents - letters from soldiers to children - as reflecting ideas about war. The conducted analysis is metatheoretical due to combining discourse analysis (a common refrain), narrative analysis (letters) and biographical analysis (SMO as a kind of a temporary extended epiphany which makes a person rethink one’s life in the context of collective ideals). The main categories of analysis were as follows: attitudes towards enemy; attitudes towards killing; attitudes towards death; moral imperatives for justifying military actions; space of war. The results of the analysis of these categories represent the “ethics of war” typical for today’s Russian soldiers. The conducted study is interdisciplinary due to the theoretical combination of the ideas and approaches of military sociology, theory of values and ethics. In particular, the author mentions features of the so-called “new hybrid” wars, transformations of ethics in the contemporary society, and differences between the ideological and the ethical in collected narratives. The author comes to the conclusion that in terms of values and ethics Russian soldiers are in a certain sense located in the past due to an extremely revived historical memory (feats of grandfathers and great-grandfathers and the connection with them are especially significant), and this is primarily a memory of the Soviet past: the SMO is not only identified with the events of the Great Patriotic War of 1941-1945 but also borrows its rhetoric, reproducing its ideological and ethical narratives.

A military-specific reaction time (RT) test was developed to explore its reliability and sensitivity to discriminate between military personnel and sport science students. Fifteen male professional Spanish soldiers and 16 male sport science students completed two RT test modalities: military-specific and nonspecific RT tests. For each RT test modality, both the Simple (i.e., one stimulus, one response) and the Go, No-Go RT (i.e., true, and false stimuli, one response) were tested. The military-specific RT test consisted of a video presented through virtual reality glasses of a forest environment in which soldiers would appear from behind different bushes (stimuli) and the response consisted of pressing the button of a gun-shaped mouse (when they saw a soldier pointing a rifle at them). Both Simple and Go, No-Go RT reached acceptable reliability in both populations (coefficient of variation ≤ 9.64%). Military personnel presented a lower RT than sport science students during the military-specific RT test (p ≤ .001), while no differences were obtained during the nonspecific RT test. RT values were not significantly correlated between the military-specific and nonspecific RT tests (r ≤ .02). These findings collectively suggest that the novel military-specific RT test is an ecologically valid alternative to evaluate the information processing abilities of military personnel. [ABSTRACT FROM AUTHOR]

Objective To investigate the influence of stress on insomnia among plateau soldiers, and explore the mediating role of parent-child alienation and the moderating role of emotion regulation strategies in this relationship. Methods A cross-sectional study design was adopted in this study.Our Self-designed General Information Questionnaire, Plateau Soldiers Stressor Scale, Insomnia Severity Index, Inventory of Alienation towards Parents, and Emotion Regulation Scale were employed to survey 2 065 plateau soldiers at an average altitude of 4 200 m.With aid of SPSS 26.0 statistics, descriptive analysis, correlation analysis and regression analysis were applied to analyze stress status, parent-child alienation, insomnia and emotion regulation in the participants, and then a structural equation model was established. Results ① The scores of stress, parent-child alienation and insomnia were significantly higher in the participants who were older, well educated (P < 0.01) and were or had been in a marital relationship (married, divorced, or widowed)(P < 0.001) than those without above conditions.② Significant pairwise positive correlations were observed among stress, parent-child alienation, insomnia, cognitive reappraisal, and expressive suppression (r=0.08~0.61, P < 0.001).③ Stress and expressive suppression could positively predict parent-child alienation (β=0.14~0.43, P < 0.001), and stress, parent-child alienation and expressive suppression could positively predict insomnia (β=0.04~0.25, P < 0.01).Cognitive reappraisal could not significantly predict parent-child alienation or insomnia.④Parent-child alienation towards parents partially mediated the relationship between stress and insomnia, with a mediation effect accounting for 7.29% of the total effect.⑤ Expressive suppression moderated the impact of stress on insomnia (β=-0.01, P < 0.001), and the higher expressive suppression level mitigated the adverse effect of stress on insomnia when compared with the lower expressive suppression level. Conclusion For plateau soldiers, stress significantly predicts insomnia, with parent-child alienation playing a mediating role.Furthermore, a higher level of expressive suppression can effectively buffer the influence of stress on insomnia.

AbstractIn this study, post-traumatic stress disorder (PTSD) was examined among 161 Israeli military reservists who were recruited to gather and identify the bodies and body parts of civilians and soldiers killed in the October 7th, 2023 Hamas terror attack on Israel. The aims were to examine PTSD levels as well as the associations between demographic variables, task-related characteristics, coping strategies, well-being, and odds of being diagnosed with PTSD. Using the PTSD Checklist for DSM-5 (PCL-5), 20% of the participants were found to have PTSD. Logistic regression indicated that a one-point increase in emotion-focused coping via distancing increased the odds of a PTSD diagnosis by 3.76 times; a one-point increase in perceived task difficulty increased the odds by 1.81; and a one-point decrease in well-being increased the odds by 1.06. A significant interaction showed that problem-focused coping was associated with a higher risk of PTSD among younger participants but a lower risk among older ones. Additionally, well-being served as a protective factor for those who perceived the task as mentally difficult. The study points to the high traumatic potential of handling bodies. It also indicates that the use of distancing oneself from one’s emotions is highly non-adaptive. [ABSTRACT FROM AUTHOR]

Introduction: Given a high amount of workplace stressors, burnout syndrome, as a depression-related syndrome, is highly relevant for medical service soldiers. This study aims to examine their effects with regard to moral injuries and personal values following foreign deployment. Materials and methods: This longitudinal study included 91 soldiers of the German Armed Forces Medical Service. Participants completed the Maslach Burnout Inventory (MBI) and the Portrait-Value-Questionnaire (PVQ) before and after a foreign deployment as well as the Moral Injury Scale (SMBE) after deployment. Analysis has been conducted using t-tests to assess potential changes in MBI and PVQ scales between pre-test - t1 (2-4 weeks before deployment) and post-test - t2 (up to 6 months after deployment). In addition, correlations were examined between moral injuries (MI) after deployment and MBI scores at t1 and t2 as well as between personal values (PVQ t1) and MBI scores at t1 and t2. Results: The MBI subscales showed mild to moderate burnout symptoms at both pre- and post-tests, with a slight deterioration during the study period, albeit not significant. There were no significant mean differences in PVQ between measurement points. Nevertheless, PVQ self-direction and tradition at t1 correlated negatively with MBI INV at t2 (PVQ SD r = -.21, p = .043) and MBI PA at t2 (PVQ TR r = -.23, p = .027). Furthermore, the subscale PVQ power at t1 correlated positively with MBI PA at t2 (PVQ PO r = .28, p = .006), meanwhile PVQ universalism at t1 correlated positively with MBI INV at t1 (PVQ UN r = .25, p = .018). Furthermore, positive correlations were found between moral injuries at t2 (SMBE total score, SMBE_Sub1, SMBE_Sub2) and MBI subscales Emotional Exhaustion (EE; r = -.54, p = .001), Depersonalization (DP; r = .38, p = .001), and Involvement (INV; r = .30, p = .004) before and after the deployment period. No correlation was found between MI and MBI subscale Personal Accomplishment (PA). Conclusion: The results indicate that medical service soldiers exhibit mild to moderate burnout symptoms even before deployment. Significant associations between moral injuries and burnout were found in 3 out of 4 MBI subscales (EE, DP, INV). There was a significant association with a stronger moral injury and higher burnout levels, persisting both before and after the study period. Furthermore, our results suggest that personal value orientations might be meaningful predictors of burnout. Hence, causal questions regarding general work stress among medical service soldiers should be further explored in more detailed studies. Further research could lay the foundation for future approaches in psychotherapy as well as primary and secondary prevention in this field. [ABSTRACT FROM AUTHOR]

Introduction Destructive interpersonal relationships at work may result in negative feelings among employees that hinder personal and organizational productivity, which may also result in high levels of job disengagement and subsequent career turnover intentions. Leaders play a key role in creating work environments conducive to optimizing employee performance, organizational culture, and workplace well-being. Social support, which may include support from one's supervisor, colleagues, and loved ones, has been shown to reduce strains and perceived stressors at work. In the Army, the Judge Advocate General's Corps (JAGC) personnel have a unique position as lawyers and legal staff and have been shown to have high rates of burnout. To promote soldier health, well-being, and career longevity, it is important to understand the impact interpersonal relationships have on career intentions. The current study assesses the relationship between perceived leadership effectiveness and career intentions as moderated by burnout measured by job disengagement and team care activities in JAGC personnel. Materials and Methods The Walter Reed Army Institute of Research conducted a survey to understand factors affecting the well-being of the JAGC's soldier and civilian personnel as requested by the JAGC. JAGC personnel were administered several questionnaires covering a range of work and mental health topics. Job disengagement, career intentions, team care activities, and general leadership were assessed. A total of 831 JAGC personnel completed the survey, the majority (92%) of which were soldiers. Among soldiers, first lieutenants and captains (∼49%) were the majority. The sample largely consisted of men (∼63%), White individuals (∼76%), married individuals, (70%), and individuals with graduate degrees (∼81%). Results One in four participants (∼29%) experienced high levels of disengagement, with their work. Over two-thirds of participants agreed that their immediate supervisor is an effective leader. When asked about career intentions, the majority of JAGC participants (54%) indicated that they would probably or definitely stay in the JAGC until retirement. Ordinal logistic regressions were conducted to assess the relationship between perceived leader effectiveness and career intentions, assessing the main effects of job disengagement and team care activities, and the interactions between those variables. No interaction effects were found to be significant, but main effects for perceived leader effectiveness were significant. Conclusions JAGC personnel reported higher levels of job disengagement for those with career intentions that were undecided or definitely leaving the JAGC after their current obligation. Those who were engaged in more team care activities had lower levels of disengagement. While the majority of the JAGC participants indicated career intentions to stay in the JAGC until retirement, increasing perceived effectiveness of leaders could help increase attrition and career intentions to stay in the JAGC beyond one's current obligation. [ABSTRACT FROM AUTHOR]

Introduction Musculoskeletal injuries (MSKIs) among active duty soldiers result in more than 10 million limited duty days each year and account for more than 70% of the medically nondeployable population. Overuse injuries in lower limbs from running, foot marching long distances with heavy loads, and lifting heavy objects are the most common types of injuries in the military. Physical training and rehabilitation exercises for greater resiliency through aerobic, muscle strength, endurance, and agility conditioning programs can prevent or reduce the effects of MSKIs if Soldiers adhere to proper biomechanics and training techniques. We are introducing a three-dimensional (3D) camera-based platform for Optical Screening and Conditioning for Injury Resilience (OSCIR) that is designed to identify and correct high-risk movement patterns based on quantifiable biomechanical measurements in clinical or field settings. Our goal is to improve resilience to MSKI by offering greater access to quality of movement skills in warfighters through an autonomous device that can be used in Sports Medicine and Reconditioning Team (SMART) clinics and High-Intensity Tactical Training (HITT) sites. Materials and Methods OSCIR fuses four pairs of Kinect Azure cameras into a concise footprint to achieve suitable sampling rates and an unobstructed field of view for accurate dynamic movement tracking using a custom point cloud solution. We designed a unique multistage 3D joint tracking algorithm architecture to methodically isolate the human body point cloud from the background, identify individual limb segments, and perform iterative joint optimization at the global and local joint levels. We evaluated the feasibility of our prototype system among N  = 12 control participants (6 M/6 F; 21-37 years) in compliance with the Western Institutional Review Board (Tracking #20225920, approved on November 4, 2022). Five task-specific MSKI outcome metrics identified by end-user physical therapists and athletic trainers as indicators for movement quality were assessed across 7 lower-extremity exercises derived from standardized MSK assessment/conditioning batteries used in the military. Data were recorded concurrently by OSCIR and a reference standard Vicon motion capture system for validating system accuracy. Results Task-specific MSKI indicators for knee flexion and hip flexion range of motion achieved an average error of 4.05 ± 2.34°, while 3D position-based postural outcomes of left-right foot distance, left-right hand distance, and step length obtained mean absolute errors of 2.58 ± 2.30 cm. Results support the feasibility of our system in achieving outcomes that are comparable to currently accepted laboratory standards. Conclusions Our study describes the integration process for a 3D camera-based clinical system for MSKI conditioning and rehabilitation. The impact of our system will enable key stakeholders in the military to manage MSKIs in warfighters by automating key assessment and rehabilitation test batteries; making tests more readily accessible, and interpretations more accurate by providing objective biomechanical measures. OSCIR is undergoing turn-key design features to serve as a screening tool for warfighters to readily assess susceptibility to MSKI or as a training platform to help guide exercise techniques to achieve resiliency against future injuries. [ABSTRACT FROM AUTHOR]

Introduction Computational head injury models are promising tools for understanding and predicting traumatic brain injuries. However, most available head injury models are "average" models that employ a single set of head geometry (e.g. 50th-percentile U.S. male) without considering variability in these parameters across the human population. A significant variability of head shapes exists in U.S. Army soldiers, evident from the Anthropometric Survey of U.S. Army Personnel (ANSUR II). The objective of this study is to elucidate the effects of head shape on the predicted risk of traumatic brain injury from computational head injury models. Materials and Methods Magnetic resonance imaging scans of 25 human subjects are collected. These images are registered to the standard MNI152 brain atlas, and the resulting transformation matrix components (called head shape parameters) are used to quantify head shapes of the subjects. A generative machine learning model is used to generate 25 additional head shape parameter datasets to augment our database. Head injury models are developed for these head shapes, and a rapid injurious head rotation event is simulated to obtain several brain injury predictor variables (BIPVs): Peak cumulative maximum principal strain (CMPS), average CMPS, and the volume fraction of brain exceeding an injurious CMPS threshold. A Gaussian process regression model is trained between head shape parameters and BIPVs, which is then used to study the relative sensitivity of the various BIPVs on individual head shape parameters. We distinguish head shape parameters into 2 types: Scaling components |${T_{xx}}$|⁠ , |${T_{yy}}$|⁠ , and |${T_{zz}}$| that capture the breadth, length, and height of the head, respectively, and shearing components (⁠|${T_{xy}},{T_{xz}},{T_{yx}},{T_{yz}},{T_{zx}}$|⁠ , and |${T_{zy}}$|⁠) that capture the relative skewness of the head shape. Results An overall positive correlation is evident between scaling components and BIPVs. Notably, a very high, positive correlation is seen between the BIPVs and the head volume. As an example, a 57% increase in peak CMPS was noted between the smallest and the largest investigated head volume parameters. The variation in shearing components |${T_{xy}},{T_{xz}},{T_{yx}},{T_{yz}},{T_{zx}}$|⁠ , and |${T_{zy}}$| on average does not cause notable changes in the BIPVs. From the Gaussian process regression model, all 3 BIPVs showed an increasing trend with each of the 3 scaling components, but the BIPVs are found to be most sensitive to the height dimension of the head. From the Sobol sensitivity analysis, the |${T_{zz}}$| scaling parameter contributes nearly 60% to the total variance in peak and average CMPS; |${T_{yy}}$| contributes approximately 20%, whereas |${T_{xx}}$| contributes less than 5%. The remaining contribution is from the 6 shearing components. Unlike peak and average CMPS, the VF-CMPS BIPV is associated with relatively evenly distributed Sobol indices across the 3 scaling parameters. Furthermore, the contribution of shearing components on the total variance in this case is negligible. Conclusions Head shape has a considerable influence on the injury predictions of computational head injury models. Available "average" head injury models based on a 50th-percentile U.S. male are likely associated with considerable uncertainty. In general, larger head sizes correspond to greater BIPV magnitudes, which point to potentially a greater injury risk under rapid neck rotation for people with larger heads. [ABSTRACT FROM AUTHOR]

Introduction Musculoskeletal injuries are one of the primary causes of Soldiers' inability to be medically ready, comprising over 80% of such causes. The electronic profile (e-Profile) is the way that musculoskeletal injuries are documented so that commanders will know the type of injury as well as the length of the time that the Soldier will need limited duty. A previous study of e-Profiles in an Army MTF Integrated Pain Management Center showed that the median length of an e-Profile was 30 days. It is in the best interest of the Army to have the Soldier out of the fight the minimum amount of time for recovery to ensure the unit readiness. The goal of this study was to utilize e-Profile data to see if a machine learning model can be developed to determine the appropriate time a Soldier needs to be on profile for a given diagnoses. Materials and Methods Institutional Review Board approval was obtained from the USAMRDC (protocol #M-10966). The initial dataset provided to the research team consisted of a single pipe delimited ("|") text file containing 2.9 million rows of e-Profile data. Linear regression, decision trees, and random forests (RFs) were evaluated to see which model would best predict the number of days needed for an e-Profile. Results Linear regression had an adjusted R-squared of 0.165. The positive predictive value of decision trees (0-to-30-day range of e-Profiles) was 73.6%, and the negative predictive value (30-90 days) was 60.9% with an area under the receiver operating characteristic curve (AUC) of 0.694 for the model. The positive predictive value of RFs was 85.3% (for the 0-30 range), and the negative predictive value was 58.7% (for the 30-90 range) with an AUC of 0.794. An AUC that approaches 1 indicates a more accurate prediction. Conclusions The 3 models (linear regression, decision trees, and RF) studied as part of this project did not predict the days on e-Profile with a high degree of certainty. Future research will focus on adding additional data to the e-Profile dataset in order to improve model accuracy. [ABSTRACT FROM AUTHOR]

Introduction The DoD has prioritized programs to optimize readiness by enhancing resilience of its service members. Problematic anger in the military is an issue that impacts psychological well-being and resilience. Leader support is a potential tactic for reducing anger and its effects. Currently military resilience training is focused on individual level resilience. A gap exists in such training and there is a need to train leaders to provide mental health and resilience support to their subordinates. The present study developed and tested a theory-based training aimed at platoon leaders that focused on how to engage in proactive and responsive mental health and resilience-supportive behaviors through guided discussion, scenarios, and computer-based training with embedded quizzes. Materials and Methods We conducted an Institutional Review Board–approved cluster randomized controlled trial to test the effects of a leadership training with Army platoon leaders (n  = 99) and soldiers (n  = 276) in 2 brigades at an active duty military installation in the USA. Training was conducted in person with a computer-based component. Soldiers completed online surveys 1 month prior and again 3 months after the leader training. Results Post-training results demonstrated significant leader learning effects (Cohen's d  = 1.56) and leader positive reactions to the training information, with leaders reporting the information as useful and relevant to their work. Service members in the treatment group reported significantly lower levels of anger at time 2 (b  = −0.18, SE  = 0.06, P  = .002, pseudo Δ R 2 = 0.01; d  = 0.27) compared to the control group. We also found an indirect effect of the intervention on increased life satisfaction at time 2 via decreased anger (b  = 0.035, SE  = 0.023, 95% CI = [0.004-0.24]). Conclusions This study provides an initial evaluation of training for platoon leaders that educates them on proactive and responsive behavioral strategies to support the mental health and resilience of their service members via decreased problematic anger and increased well-being. Further adaptations and evaluations should be conducted with other military branches and civilian occupations, as the benefits of the relatively brief and noninvasive training could be widespread. [ABSTRACT FROM AUTHOR]

Introduction Future multidomain operational combat environments will require combat medics to play a larger role in managing behavioral health (BH) conditions in forward environments, as soldiers in small teams may have them as their sole medical support for extended periods of time. Previously they were not expected to serve in this role, and thus, they receive minimal BH training. It is unknown to what extent combat medics consider BH tasks as falling within their scope of practice and how often they engage with their soldiers currently related to BH. Qualitative research suggests that many medics feel inadequately prepared to handle BH problems. Our aim is to further assess medic attitudes and behaviors related to BH to better understand the landscape of medic preparedness to fill an expanded role. Materials and Methods Data from 292 medics were collected before their participation in the BH Guidelines for mEdic Assessment and Response training, a day-long training for medics expected to deploy to far-forward environments. We investigated whether combat medics engage with their soldiers in areas related to BH, the extent to which they consider BH-related tasks as part of their scope of practice, and how confident they feel engaging in various BH-related tasks. We explored associations between medics' attitudes related to BH scope of practice and confidence performing BH tasks with gender, rank, component (National Guard vs. Active Duty), work-related BH experience, having suicide training in the past year, and having ever sought help for BH. Results Results indicated that in the past month, 61.4% of medics discussed BH issues, 48.3% assessed BH problems, and 41.3% provided interventions for BH problems with at least one soldier in their unit. Assessment tasks were more frequently endorsed as falling within medic's scope of practice (75%-95%) than intervention tasks (62%-83%). More medics felt confident doing assessments (39%-49% moderately confident or greater) than providing interventions (31%-37% moderately confident or greater). Medics expressed highest confidence in assessing for suicide risk (49% moderate confidence or greater). Medics with a lot of prior BH work experience and non-commissioned officers (as compared to junior enlisted) reported greater confidence in most tasks. Receiving suicide training in the past year was associated with greater confidence assessing for suicide, as well as providing interventions for suicide, general BH problems, and substance abuse. Conclusions Most medics agreed that numerous BH tasks fell within the scope of their work, but few felt confident engaging in those tasks. These findings support a need for additional training in BH-related tasks across the force. Exploring ways to provide medics BH-related work rotations would augment their general proficiency as first-line treatment providers for soldiers in combat units, and increased training in BH-related tasks should be studied to determine its ability to increase competency and confidence. If medics can learn to assess and recognize BH concerns before they escalate to needing specialty BH care, this could potentially reduce the burden on BH clinics, as well as strengthen the overall force. [ABSTRACT FROM AUTHOR]

Introduction Obstructive sleep apnea (OSA) is a treatable cause of daytime sleepiness and associated medical problems that can negatively impact soldier readiness and performance. This study examined adherence to positive airway pressure (PAP) by soldiers who were newly diagnosed with OSA and prescribed PAP therapy and participated in a Knowledge, Skills, and Attitudes (KSA) behavioral intervention class. Materials and Methods The KSA was a one-time, interactive 90-minute class attended by up to 10 patients per class. PAP adherence was examined using Medicare standard at 30-, 60-, 90-, and 180 days post class. The analytic sample comprised 379 active duty patients (93% men; mean age 40.21 ± 8.06) categorized into 3 groups: KSA (n  = 235), did not show (DNS; n  = 61), and mandatory education class (MEC; n  = 83). The MEC group comprised patients from an education class in a previous year. Results Baseline scores on the apnea hypopnea index, body mass index, sleepiness, insomnia severity, and age were non-significant among the 3 groups. At 30 days, significantly more patients in KSA (48%) and MEC (51%) were adherent than the DNS group (16%). At 60 days, the adherence rates for the KSA, DNS, and MEC were significantly different at 39%, 22%, and 27%, respectively. At 90- and 180 days, the adherence rates among the KSA, DNS, and MEC groups did not differ significantly at 34%, 17%, and 26% (90 days) and 34%, 27%, and 25% (180 days), respectively. Consistently, more patients in KSA were adherent than those in DNS and MEC, except at 30 days. Additionally, adherence rates for KSA intervention declined more gradually over the 6 month period. The mean PAP usage on nights used was 4.6 hours that computed to a 34% non-use rate based on an optimal 7-hour/night sleep time. Conclusion KSA could be a behavioral intervention that enhances PAP adherence with a booster session implemented at the 90 days mark. [ABSTRACT FROM AUTHOR]

Introduction Suicidal ideation and attempts are considered to be graduated risks for suicide, yet they remain under studied. Suicide is among the leading causes of death in the U.S. for all individuals between the ages of 10 and 64 years. Suicide is a critical problem in the U.S. Military. The U.S. Army suicide rates surpassed civilian rates in 2008 and continue to climb steadily; with U.S. Army soldiers at more than twice the risk than U.S. civilians, and enlisted personnel at more than twice the risk of officers. Suicidal ideation and attempts are routinely reported within U.S. Army brigades using suicide-related serious incident reports (SR-SIRs). These reports could form a useful source of information for prevention planning, but to date there have been no efforts to summary these reports. This paper analyzes SR-SIRs among enlisted personnel for a 4-year period for 1 Army brigade, to test the usefulness of this information and to explore whether risk factors for attempts compared to ideation can be identified. Materials and Methods This report analyzes 130 de-identified reports of suicidal ideation (n  = 102) and suicide attempts (n  = 28) reported as SR-SIRs from August 2018 to June 2022 among enlisted personnel in an airborne infantry brigade combat team (BCT) outside the continental U.S. Analysis of de-identified data was not considered research by brigade and university human subject/IRB authorities. Fourteen soldier characteristics and context factors were examined to determine if they differentiate the two types of incidents, suicidal ideations and suicide attempts. Results Unit location and alcohol use at the time of the incident were strongly associated with suicide attempts compared to ideation. Attempts occurred disproportionately during off duty hours, and attempters were more likely to have had prior contact with behavioral health services than ideators; however, these differences did not attain conventional statistical significance. Conclusions The study can help inform unit-specific suicide prevention and intervention strategies. Off duty hours and alcohol use are risk factors for attempts, particularly among soldiers who have sought behavioral health care. Plans to engage and support soldiers who have sought behavioral health care during off duty hours, and information regarding the risks of alcohol use, could meaningfully reduce their risk. This is the first known attempt to examine active duty U.S. Army brigade combat team SR-SIRs, and they are a potentially valuable source of health and mental health-related information. [ABSTRACT FROM AUTHOR]

Introduction Military personnel frequently experience stressful, morally challenging situations that can lead to posttraumatic stress disorder (PTSD). The relationships between moral identity, transgressive acts, and symptoms related to posttraumatic stress disorder (i.e. posttraumatic stress symptoms; PTSS) among U.S. Army Soldiers were assessed. Materials and Methods A convenience cohort of 1,547 soldiers completed a survey assessing moral identity and PTSS before deployment. A subset of 505 soldiers completed another survey assessing transgressive acts and PTSS during deployment. Exploratory and confirmatory factor analyses were conducted to determine the underlying factor structure of the measures of moral identity and transgressive acts. Generalized linear modeling, robustness checks, and sensitivity analysis were used to evaluate the predictive relationships. Results Moral identity did not directly predict PTSS during deployment. However, self-attributed and betrayal-based transgressive acts were significant predictors. Specifically, self-attributed transgressive acts and PTSS were moderated by internalized moral identity; individuals with a higher internalized moral identity experienced more severe PTSS following self-attributed transgressive acts. These findings were consistent across various model checks, including covariate adjustments, data imputation, and the application of a data quality filter. Conclusions The study highlights the significant role of self-attributed moral transgressions during deployment in the development of PTSS among military service members—especially in those with a strong internalized moral identity. This finding suggests a "target of opportunity" for the development of intervention strategies that mitigate PTSS by addressing the moral dimensions of military service. [ABSTRACT FROM AUTHOR]