scholarly journals Incidence Rates of Gynecologic Cancers in the U.S. Active Duty Military Population

2020 ◽  
Vol 185 (9-10) ◽  
pp. e1590-e1595
Author(s):  
Steffanie Owens ◽  
Tara Blando ◽  
Yohannes B Tesema ◽  
Elizabeth Butts ◽  
Jessica Newton ◽  
...  
Keyword(s):  
Health System ◽  
Active Duty ◽  
Incidence Rates ◽  
Data Repository ◽  
Military Health System ◽  
Gynecologic Cancers ◽  
Military Health ◽  
Tumor Registry ◽  
System Data ◽  
Health System Data

Abstract Introduction Despite an increasing number of female service members, incidence rates of gynecologic cancers (other than cervical cancer) have not been previously documented in the U.S. active duty military population. This study sought to determine the incidence rates of all gynecologic, including peritoneal, malignancies in the U.S. Active Duty population compared to the general US population as reported in the Surveillance, Epidemiology, and End Results Program database. Materials and Methods Gynecologic cancers diagnosed in U.S. Active Duty women aged 20–59 between 2004 and 2013 were retrospectively ascertained. Cancer cases were identified in both the Automated Central Tumor Registry and the Military Health System Data Repository. All cases in Automated Central Tumor Registry plus cases recorded in Military Health System Data Repository, but not duplicative of Automated Central Tumor Registry cases, were included. Age-specific and age-adjusted incidence rates were calculated in military and Surveillance, Epidemiology, and End Results cases. Results In U.S. Active Duty women, 327 incident cases of gynecologic cancer were identified. There were 110 cases of cervical cancer, 40 cases of endometrial cancer, 152 cases of ovarian cancer, and 25 other gynecologic malignancies. Of the 327 cases, 154 were ascertained from the Automated Central Tumor Registry database and the remainder from Military Health System Data Repository claims data. The age-adjusted rate of all gynecologic cancers for U.S. Active Duty women was 49.17 per 105 (95%CI 37.58, 65.12), while the age-adjusted rate for Surveillance, Epidemiology, and End Results −18 was 42.09 per 105 (95%CI 41.83, 42.35). The kappa coefficient assessing the overlap between the data sources was −0.1937. Though insufficient in numbers for statistical analysis, the observed proportion of ovarian to cervical cancer cases in active duty women < 45 years of age was substantially greater than in the general population. Conclusions U.S. Active Duty women exhibited a similar age-adjusted rate of gynecologic cancer as the general US population. There was suboptimal overlap between the Automated Central Tumor Registry and Military Health System Data Repository databases, indicating the necessity of using both databases in order to obtain reliable data in the active duty population. This study is the current best estimate of a baseline rate of gynecologic cancer in U.S. active duty military women. This rate might change over time as women’s roles and exposures in recent and future military conflicts evolve.

scholarly journals Comparison of Military Health System Data Repository and American College of Surgeons National Surgical Quality Improvement Program-Pediatric

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Arin L. Madenci ◽  
Cathaleen K. Madsen ◽  
Nicollette K. Kwon ◽  
Lindsey L. Wolf ◽  
Kristin A. Sonderman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Data Repository ◽  
Military Health System ◽  
Improvement Program ◽  
Surgical Quality ◽  
Military Health ◽  
American College Of Surgeons ◽  
System Data ◽  
Health System Data ◽  
Surgical Operations

Abstract Background Given the rarity of pediatric surgical disease, it is important to consider available large-scale data resources as a means to better study and understand relevant disease-processes and their treatments. The Military Health System Data Repository (MDR) includes claims-based information for > 3 million pediatric patients who are dependents of members and retirees of the United States Armed Services, but has not been externally validated. We hypothesized that demographics and selected outcome metrics would be similar between MDR and the previously validated American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) for several common pediatric surgical operations. Methods We selected five commonly performed pediatric surgical operations: appendectomy, pyeloplasty, pyloromyotomy, spinal arthrodesis for scoliosis, and facial reconstruction for cleft palate. Among children who underwent these operations, we compared demographics (age, sex, and race) and clinical outcomes (length of hospital stay [LOS] and mortality) in the MDR and NSQIP-P, including all available overlapping years (2012–2014). Results Age, sex, and race were generally similar between the NSQIP-P and MDR. Specifically, these demographics were generally similar between the resources for appendectomy (NSQIP-P, n = 20,602 vs. MDR, n = 4363; median age 11 vs. 12 years; female 40% vs. 41%; white 75% vs. 84%), pyeloplasty (NSQIP-P, n = 786 vs. MDR, n = 112; median age 0.9 vs. 2 years; female 28% vs. 28%; white 71% vs. 80%), pyloromyotomy, (NSQIP-P, n = 3827 vs. MDR, n = 227; median age 34 vs. < 1 year, female 17% vs. 16%; white 76% vs. 89%), scoliosis surgery (NSQIP-P, n = 5743 vs. MDR, n = 95; median age 14.2 vs. 14 years; female 75% vs. 67%; white 72% vs. 75%), and cleft lip/palate repair (NSQIP-P, n = 6202 vs. MDR, n = 749; median age, 1 vs. 1 year; female 42% vs. 45%; white 69% vs. 84%). Length of stay and 30-day mortality were similar between resources. LOS and 30-day mortality were also similar between datasets. Conclusion For the selected common pediatric surgical operations, patients included in the MDR were comparable to those included in the validated NSQIP-P. The MDR may comprise a valuable clinical outcomes research resource, especially for studying infrequent diseases with follow-up beyond the 30-day peri-operative period.

scholarly journals Relationship Between Body Mass Index and Diagnosis of Obesity in the Military Health System Active Duty Population

2021 ◽  
Author(s):  
Daren Yang ◽  
Alexis Beauvais ◽  
Whitney L Forbes ◽  
Darrick Beckman ◽  
Jason Estes ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Health System ◽  
Body Mass ◽  
Military Service ◽  
Active Duty ◽  
Service Members ◽  
Data Repository ◽  
Military Health System ◽  
Military Health ◽  
The Military

ABSTRACT Objective The overall rate of obesity is rising in the USA; this is also reflected in the military population. It is important that providers appropriately diagnose obesity and discuss treatment options with their patients. The purpose of this study was to investigate diagnosis of obesity compared to documented body mass index (BMI) in the military health system. Methods Institutional review board approval was obtained by the 59th Medical Wing (Lackland Air Force Base, Texas) as an exempt study. This study included active duty military service members aged 18-65 years who sought outpatient care at a military treatment facility from September 2013 to August 2018 with a weight within the range of 31.8-226.8 kg and height between 121.9 and 215.9 cm. Data were collected from the Clinical Data Repository vitals and M2 encounter data to determine the percentage of each sub-population with a diagnosis of obesity according to BMI (≥30 kg/m2) and International Classification of Diseases diagnosis codes. Results Using BMI, 19.2% of female and 26.8% of male service members can be diagnosed with obesity; however, only 42.2% and 35.1%, respectively, with a BMI ≥30 was diagnosed as such. This discrepancy was consistent among all service branches and BMI ranges. Conclusion This study demonstrates that obesity is underdiagnosed compared to BMI. This may result in insufficient resources being provided to patients to reduce weight. Further investigation is warranted to identify causes of underdiagnosis and potential barriers to diagnosis.

scholarly journals Common Symptoms of Mild Traumatic Brain Injury and Work Functioning of Active-Duty Service Members with a History of Deployment

2021 ◽  
Vol 18 (15) ◽  
pp. 8079
Author(s):  
Patrick Richard ◽  
Nilam Patel ◽  
Daniel Gedeon ◽  
Regine Hyppolite ◽  
Mustafa Younis
Keyword(s):  
Health System ◽  
Brain Injuries ◽  
Active Duty ◽  
Emergency Department Visits ◽  
Service Members ◽  
Data Repository ◽  
Work Functioning ◽  
Military Health System ◽  
Military Health ◽  
The Military

This study used data from the Military Health System Data Repository to examine the association between mild traumatic brain injuries (mTBI) and work functioning such as work duty limitations, hospital emergency room visits and inpatient admissions for active-duty service members (ADSMs). Further, this study assessed the role that common symptoms of mTBI play in work functioning. Multivariate results showed that having a mTBI diagnosis is not a major factor that results in being “released with work duty limitations”. However, findings from these regression models also showed that the interaction of mTBI with cognitive and linguistic symptoms resulted in odds of 3.63 (CI: 1.40–9.36, p < 0.01) for being “released with work duty limitations” and odds of 4.98 (CI: 1.16–21.39, p < 0.05) for having any emergency department visits compared to those with no diagnosis of mTBI and none of these symptoms. Additionally, the interaction of mTBI with sleep disturbance and chronic pain showed odds of 2.72 (CI: 1.31–5.65, p < 0.01) and odds of 11.56 (CI: 2.65–50.44, p < 0.01) for being “released with work duty limitations” compared to those with no diagnosis of TBI and none of these symptoms, respectively. Further research is needed to investigate the association between mTBI and duration of time off work to provide a comprehensive understanding of the effect of mTBI on work functioning in the Military Health System.

Comparison of Nurse-Midwife and Physician Birth Outcomes in the Military Health System

2021 ◽  
pp. 152715442199407
Author(s):  
Lynette Hamlin ◽  
Lindsay Grunwald ◽  
Rodney X. Sturdivant ◽  
Tracey P. Koehlmoos
Keyword(s):  
Health System ◽  
Birth Outcomes ◽  
Health Care Systems ◽  
Vaginal Birth ◽  
Data Repository ◽  
Military Health System ◽  
Provider Type ◽  
Pregnancy Risk ◽  
Military Health ◽  
The Military

The purpose of this study is to identify the socioeconomic and demographic characteristics of women cared for by Certified Nurse-Midwives (CNMs) versus physicians in the Military Health System (MHS) and compare birth outcomes between provider types. The MHS is one of America’s largest and most complex health care systems. Using the Military Health System Data Repository, this retrospective study examined TRICARE beneficiaries who gave birth during 2012–2014. Analysis included frequency of patients by perinatal services, descriptive statistics, and logistic regression analysis by provider type. To account for differences in patient and pregnancy risk, odds ratios were calculated for both high-risk and general risk population. There were 136,848 births from 2012 to 2014, and 30.8% were delivered by CNMs. Low-risk women whose births were attended by CNMs had lower odds of a cesarean birth, induction/augmentation of labor, complications of birth, postpartum hemorrhage, endometritis, and preterm birth and higher odds of a vaginal birth, vaginal birth after cesarean, and breastfeeding than women whose births were attended by physicians. These results have implications for the composition of the women’s health workforce. In the MHS, where CNMs work to the fullest scope of their authority, CNMs attended almost 4 times more births than our national average. An example to other U.S. systems and high-income countries, this study adds to the growing body of evidence demonstrating that when CNMs practice to the fullest extent of their education, they provide quality health outcomes to more women.

scholarly journals Total Joint Arthroplasty Volume in the Military Health System

2020 ◽  
Vol 185 (7-8) ◽  
pp. e1051-e1056
Author(s):  
Ashley B Anderson ◽  
George C Balazs ◽  
Daniel I Brooks ◽  
Jonathan F Dickens ◽  
Benjamin K Potter
Keyword(s):  
Health System ◽  
Total Joint Arthroplasty ◽  
Active Duty ◽  
Joint Arthroplasty ◽  
Service Members ◽  
Military Health System ◽  
Military Health ◽  
Male Patients ◽  
The Military ◽  
To Receive

ABSTRACT Introduction The relationship between volume and outcome of total knee arthroplasties is a concern in both the civilian and military patient populations. We sought to compare surgeons and hospital procedure volumes performed on military service members and define factors leading to increased civilian referrals. Materials and Methods The Military Health System Data Repository (MDR) contains patient information on all healthcare beneficiary encounters, including care provided both in Military Health System (MHS) facilities and in civilian network facilities. The Military Analysis and Reporting Tool (M2) queried the MDR for all patients between 2011 and 2015 with a CPT code for hip or knee arthroplasty associated with a provider HIPAA taxonomy code for orthopedic surgery. M2 enrollee encounters were used to calculate the total number of arthroplasty procedures performed by both military and civilian orthopedic surgeons on MHS enrollees as well as the incidence rate of arthroplasty procedures. Logistic regression was used to predict which cases were more likely to have been treated at military treatment facilities using patient gender, sponsor service branch, age, and beneficiary category. Results During the study period, a total of 12,627 military facility arthroplasty cases and a total of 142,637 civilian facility arthroplasty cases were performed on TRICARE enrolled patients. The total number of military surgeons performing arthroplasty on TRICARE enrolled patients was 323, while the total number of civilian surgeons performing arthroplasty was 10,245 during the same time period; the number of military surgeons performing arthroplasty on active duty patients was 176, and the total number of civilian surgeons performing arthroplasty on military patients was 1045. Overall, including retirees and activity duty service members, more procedures are performed by civilian network surgeons than military surgeons in all states. In an adjusted model, male patients were slightly more likely to receive care at an military treatment facilitie than female patients (OR = 1.47, 95% CI: 1.41–1.53). Furthermore, with respect to service, patients with Air Force (OR: 1.08, 95% CI: 1.02–1.15) and Navy sponsors (OR: 1.61, 95% CI: 1.51–1.71) were more likely to receive military care than patients with Army sponsors. Conclusions Based on our findings, we recommend the MHS focus attention to recapturing the Army active duty male patients who are more likely to receive care outside of the military healthcare network. Further analysis of the many factors including, but not limited to, referral process for total joint arthroplasty, time to procedure, and facility resources is required, in addition to assessing patient outcomes following the procedures.

Malignant Hyperthermia—A Case From Camp Humphreys, South Korea, and Lessons for the Military Health System

2021 ◽  
Author(s):  
Paige Wren ◽  
Sung Min Chun ◽  
Robert Vietor
Keyword(s):  
South Korea ◽  
Malignant Hyperthermia ◽  
Health System ◽  
Community Hospital ◽  
Active Duty ◽  
Military Health System ◽  
Military Health ◽  
Dantrolene Sodium ◽  
Bilateral Sagittal Split Osteotomy ◽  
The Military

ABSTRACT Although malignant hyperthermia (MH) is a well-known complication of anesthesia, it presents unique considerations in the military health system. In this case report, the authors present a 26-year-old male active duty service member who experienced an MH crisis during a routine bilateral sagittal split osteotomy. The case presented here, which occurred at Brian D Allgood Army Community Hospital at Camp Humphreys, South Korea, highlights the challenges presented when caring for these patients in minimally staffed environments with frequent turnover of staff. The authors discuss the challenges to the military system such as the importance of adequate documentation of MH-susceptible service members, the benefits of rapidly dissolving dantrolene sodium nanosuspension, and the necessity for frequent training of military medical staff in the recognition and management of MH.

scholarly journals The prevalence of M. tuberculosis among acid fast bacilli cultures from military health system and veterans affairs beneficiaries in Hawaii and the Pacific Islands from 2002 to 2019

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254312
Author(s):  
Elena M. Crecelius ◽  
Michael B. Lustik ◽  
Timothy S. Horseman ◽  
Milissa U. Jones
Keyword(s):  
Health System ◽  
Pacific Islands ◽  
Pacific Islander ◽  
Incidence Rates ◽  
Veterans Affairs ◽  
Military Health System ◽  
Military Health ◽  
Asian Pacific Islander ◽  
The Pacific ◽  
Asian Pacific

The prevalence of tuberculosis among military health system (MHS) and Veterans Affairs (VA) beneficiaries in Hawaii and the Pacific Islands has not been previously reported. Our analysis evaluates the prevalence of M. tuberculosis (MTB) among acid fast bacilli culture(s) (AFB) tested at Tripler Army Medical Center (TAMC) on Oahu, HI and describes demographic factors associated with positive samples. We analyzed 9,768 AFBs from 4,129 individuals with AFB specimens processed at TAMC from January 2002 to November 2019: of those who were tested 3,178 were MHS beneficiaries and 951 were VA beneficiaries. There were a total of 40 individuals with MTB-positive cultures over the period of study: 31 MHS beneficiaries and 9 VA beneficiaries. Of the MTB-positive specimens, 93% were from pulmonary samples while the remainder were from lymph node aspirates (5%) and peritoneal samples (2%). Cumulative incidence rates of MTB-isolation were 1.8 per 100,000 MHS beneficiaries and 1.2 per 100,000 VA beneficiaries, both of which were lower than reported incidence rates in Hawaii, the U.S.-affiliated Pacific Islands and the United States for the study period. MHS beneficiaries of Asian-Pacific Islander race or ethnicity had nearly 20 times higher odds of positive AFB than white MHS beneficiaries (OR = 19.56, 95% CI 5.52, 69.29, p = < 0.001). This study demonstrated a higher odds of MTB-positivity associated with Asian-Pacific Islander race or ethnicity and low incidence rates of TB among MHS and VA beneficiaries in Hawaii and the Pacific Islands when compared with the civilian population.

Postpartum Opioid Use among Military Health System Beneficiaries

2021 ◽  
Author(s):  
Julie A. Watters ◽  
Amanda Banaag ◽  
Jason C. Massengill ◽  
Tracey P. Koehlmoos ◽  
Barton C. Staat
Keyword(s):  
Health Care ◽  
Health System ◽  
Mode Of Delivery ◽  
Care Facility ◽  
Data Repository ◽  
Opioid Use ◽  
Military Health System ◽  
Opioid Prescription ◽  
Military Health ◽  
Military Health Care

Objective The aim of the study is to evaluate the prevalence and factors associated with opioid prescriptions to postpartum patients among TRICARE beneficiaries receiving care in the civilian health care system versus a military health care facility. Study Design We evaluated postpartum opioid prescriptions filled at discharge among patients insured by TRICARE Prime/Prime Plus using the Military Health System Data Repository between fiscal years 2010 to 2015. We included women aged 15 to 49 years old and excluded abortive pregnancy outcomes and incomplete datasets. The primary outcome investigated mode of delivery and demographics for those filling an opioid prescription. Secondary outcomes compared prevalence of filled opioid prescription at discharge for postpartum patients within civilian care and military care. Results Of a total of 508,258 postpartum beneficiaries, those in civilian health care were more likely to fill a discharge opioid prescription compared with those in military health care (OR 3.9, 95% CI 3.8–3.99). Cesarean deliveries occurred less frequently in military care (26%) compared with civilian care (30%), and forceps deliveries occurred more frequently in military care (1.38%) compared with civilian care (0.75%). Women identified as Asian race were least likely to fill an opioid prescription postpartum (OR 0.79, 95% CI 0.75–0.83). Women aged 15 to 19 years had a lower odds of filling an opioid prescription (OR 0.83, 95% CI 0.80–0.86). Women associated with a senior officer rank were less likely to fill an opioid prescription postpartum (OR 0.83, 95% CI 0.73–0.91), while those associated with warrant officer rank were more likely to fill an opioid prescription (OR 1.14, 95% CI 1.06–1.23). Conclusion Our data indicates that women who received care in civilian facilities were more likely to fill an opioid prescription at discharge when compared with military facilities. Factors such as race and age were associated with opioid prescription at discharge. This study highlights areas for improvement for potential further studies. Key Points

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