Free the Bun: Prevalence of Alopecia Among Active Duty Service Women, Fiscal Years 2010-2019

ABSTRACT Introduction Active duty service women (ADSW) constitute 16% of the force. The prevalence of alopecia, a dermatologic condition characterized by hair loss, is understudied in regard to hairstyle regulations across the U.S. military services. Alopecia has several causes; one of which is due to tension on the scalp secondary to tight hairstyles. In the U.S., alopecia has a lifetime prevalence of 1.7-2.1%; no previous studies which evaluated this condition in service women were found. Materials and Methods We used the Military Health System Data Repository to perform a retrospective study to assess the prevalence of alopecia in ADSW from fiscal years (FYs) 2010 to 2019. Statistical analyses included descriptive statistics on patient demographics and trend analysis on the prevalence of alopecia over the 10-year study period. Results A total of 498,219 ADSW were identified over the 10-year study period, of which 2.40% had a diagnosis of alopecia. Overall, the prevalence of alopecia decreases over the 10-year period, with two observed periods of slight increase (FY 2013 to 2014 and FY 2018 to 2019) when comparing prevalence year-to-year. Of those diagnosed, the majority were young, Black, with a senior enlisted rank, and in the U.S. Army. Conclusion The prevalence of alopecia in ADSW is slightly higher than that in civilian populations and is most likely underreported. It is more commonly diagnosed in Black women than would be expected based on ratios of this population in military service. Policy changes to ensure that traction alopecia is a qualifying medical condition for Veterans Affairs disability compensation, mechanisms are in place for more specific coding in the electronic medical record, and treatment options to be covered by TRICARE are recommended. All U.S. military services should consider updating and evaluating regulations to improve the health and quality of life of ADSW.

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

Military Medicine ◽

10.1093/milmed/usab292 ◽

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.

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Why are US military personnel prescribed transdermal fentanyl patches?

BMJ Military Health ◽

10.1136/bmjmilitary-2021-001894 ◽

2021 ◽

pp. bmjmilitary-2021-001894

Author(s):

Hailey Murray ◽

A N Gregoriou ◽

A Lepore ◽

G J Booth ◽

A H Goldman ◽

...

Keyword(s):

Military Personnel ◽

Clinical Information ◽

Opioid Therapy ◽

Active Duty ◽

Data Repository ◽

Prescription Data ◽

Transdermal Fentanyl ◽

Military Health ◽

Continuous Release ◽

Us Military

IntroductionTransdermal fentanyl is a continuous release opioid delivery system intended for use in opioid-tolerant patients requiring around-the-clock opioid therapy. The purpose of this study is to identify the most common indications for transdermal fentanyl prescriptions in active duty US military personnel, and determine whether these prescriptions meet US Food and Drug Administration (FDA) labelling.MethodsActive duty US military personnel initiating transdermal fentanyl therapy with prescriptions filled at Military Health System pharmacies between 2015 and 2019 were identified in the Military Data Repository. Electronic health records were searched for patient demographic information, clinical information and prescription data. A total of 225 patients with complete data were identified.ResultsThe most common reason for transdermal fentanyl initiation was chronic non-cancer musculoskeletal pain. Among patients with non-cancer pain, 36% received their initial prescription from an internal medicine/primary care provider, and 35% did not meet published US FDA criteria for opioid tolerance prior to treatment initiation. There was an 81% decrease in patients initiating therapy between 2015 and 2019.ConclusionsWhile a substantial minority of transdermal fentanyl prescriptions to US military personnel did not meet FDA guidelines on appropriate use, the overall number of prescriptions fell dramatically over the study period. This suggests that automated profile review or additional targeted policies to limit transdermal fentanyl prescribing are unnecessary at this time.

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Incidence of insomnia and obstructive sleep apnea in active duty United States military service members

SLEEP ◽

10.1093/sleep/zsab024 ◽

2021 ◽

Author(s):

Brian A Moore ◽

Lynn M Tison ◽

Javier G Palacios ◽

Alan L Peterson ◽

Vincent Mysliwiec

Keyword(s):

United States ◽

Obstructive Sleep Apnea ◽

Military Service ◽

Active Duty ◽

Incidence Rates ◽

Service Members ◽

United States Military ◽

Obstructive Sleep ◽

Military Service Members ◽

The U.S

Abstract Study Objectives Epidemiologic studies of obstructive sleep apnea (OSA) and insomnia in the U.S. military are limited. The primary aim of this study was to report and compare OSA and insomnia diagnoses in active duty the United States military service members. Method Data and service branch densities used to derive the expected rates of diagnoses on insomnia and OSA were drawn from the Defense Medical Epidemiology Database. Single sample chi-square goodness of fit tests and independent samples t-tests were conducted to address the aims of the study. Results Between 2005 and 2019, incidence rates of OSA and insomnia increased from 11 to 333 and 6 to 272 (per 10,000), respectively. Service members in the Air Force, Navy, and Marines were diagnosed with insomnia and OSA below expected rates, while those in the Army had higher than expected rates (p < .001). Female service members were underdiagnosed in both disorders (p < .001). Comparison of diagnoses following the transition from ICD 9 to 10 codes revealed significant differences in the amounts of OSA diagnoses only (p < .05). Conclusion Since 2005, incidence rates of OSA and insomnia have markedly increased across all branches of the U.S. military. Despite similar requirements for overall physical and mental health and resilience, service members in the Army had higher rates of insomnia and OSA. This unexpected finding may relate to inherent differences in the branches of the military or the role of the Army in combat operations. Future studies utilizing military-specific data and directed interventions are required to reverse this negative trend.

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Introduction

Combat Social Work ◽

10.1093/oso/9780190059439.003.0001 ◽

2020 ◽

pp. 1-12

Author(s):

Charles R. Figley ◽

Jeffrey S. Yarvis ◽

Bruce A. Thyer

Keyword(s):

Social Work ◽

Military Service ◽

Subsequent Development ◽

The United States ◽

Active Duty ◽

United States Military ◽

Fully Integrated ◽

History Of ◽

And Function ◽

The U.S

Social workers have a long, proud history of service in most branches of the United States military, often as commissioned officers with graduate practice degrees (Daley, 2003). Samuel Washington (1957), an active duty social worker, was the first to discuss the history and function of social work in military service. He noted that in 1945 social work was fully integrated as a separate specialty in the U.S. military and “its subsequent development to its present level [i.e., 1957] have been recognized as instrumental in maintaining and conserving the defense strength of its country” (p. 1)....

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

Military Medicine ◽

10.1093/milmed/usaa083 ◽

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.

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Prevalence of Comorbidities in Active and Reserve Service Members Pre and Post Traumatic Brain Injury, 2017-2019

Military Medicine ◽

10.1093/milmed/usab342 ◽

2021 ◽

Author(s):

Tajrina Hai ◽

Yll Agimi ◽

Katharine Stout

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Emotional Disorders ◽

Service Members ◽

Data Repository ◽

Clinical Practices ◽

Military Health ◽

Post Traumatic ◽

The Military ◽

The U.S

ABSTRACT Objective To understand the prevalence of comorbidities associated with traumatic brain injury (TBI) patients among active and reserve service members in the U.S. Military. Methods Active and reserve SMs diagnosed with an incident TBI from January 2017 to October 2019 were selected. Nineteen comorbidities associated with TBI as identified in the literature and by clinical subject matter experts were described in this article. Each patient’s medical encounters were evaluated from 6 months before to 2 years following the initial TBI diagnoses date in the Military Data Repository, if data were available. Time-to-event analyses were conducted to assess the cumulative prevalence over time of each comorbidity to the incident TBI diagnosis. Results We identified 47,299 TBI patients, of which most were mild (88.8%), followed by moderate (10.5%), severe (0.5%), and of penetrating (0.2%) TBI severity. Two years from the initial TBI diagnoses, the top five comorbidities within our cohort were cognitive disorders (51.9%), sleep disorders (45.0%), post-traumatic stress disorder (PTSD; 36.0%), emotional disorders (22.7%), and anxiety disorders (22.6%) across severity groups. Cognitive, sleep, PTSD, and emotional disorders were the top comorbidities seen within each TBI severity group. Comorbidities increased pre-TBI to post-TBI; the more severe the TBI, the greater the prevalence of associated comorbidities. Conclusion A large proportion of our TBI patients are afflicted with comorbidities, particularly post-TBI, indicating many have a complex profile. The military health system should continue tracking comorbidities associated with TBI within the U.S. Military and devise clinical practices that acknowledge the complexity of the TBI patient.

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Correlates of Depression in U.S. Military Service Members With a History of Mild Traumatic Brain Injury

Military Medicine ◽

10.1093/milmed/usy321 ◽

2019 ◽

Vol 184 (Supplement_1) ◽

pp. 148-154 ◽

Cited By ~ 2

Author(s):

Jan E Kennedy ◽

Lisa H Lu ◽

Matthew W Reid ◽

Felix O Leal ◽

Douglas B Cooper

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Military Service ◽

Depressive Disorders ◽

Service Members ◽

Data Repository ◽

Military Health ◽

Increased Risk ◽

History Of ◽

Combat Deployments

AbstractObjectivesPost-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are identified as signature injuries of the Wars in Iraq and Afghanistan. Statistics have confirmed a high incidence of PTSD among military personnel with mild TBI (mTBI) who served in these conflicts. Although receiving less attention, individuals with a history of mTBI are also at increased risk for depressive disorders. This study examines the incidence and correlates of depression in service members with a history of mTBI received an average of 4–1/2 years prior to evaluation.MethodsRetrospective analysis of 184 service members with a history of mTBI extracted from a data repository maintained at a military medical center.ResultsOne-third of the sample (34.2%) was clinically diagnosed with a depressive disorder in the month preceding evaluation. Of those with depression, 81% (51 of 63) were also diagnosed with PTSD. Proportionately more women than men had depression. Depression was more common among those who were undergoing a Military Evaluation Board and those who served in more than three combat deployments.ConclusionsResults confirm chronically elevated the rates of depressive disorders and PTSD comorbidity among service members with a history of mTBI. Depression screening and treatment within the Military Health System should remain a priority for service members reporting a remote history of mTBI. Individuals with chronic PTSD, women, service members undergoing MEB and those who served in greater than three combat deployments are at particular risk.

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Associations Between Mental and Physical Health Conditions and Occupational Impairments in the U.S. Military

Military Medicine ◽

10.1093/milmed/usab021 ◽

2021 ◽

Author(s):

Michael S Dunbar ◽

Megan S Schuler ◽

Sarah O Meadows ◽

Charles C Engel

Keyword(s):

Physical Health ◽

Military Service ◽

Active Duty ◽

Health Conditions ◽

Service Members ◽

Physical Conditions ◽

Military Service Members ◽

Anxiety Depression ◽

Mental And Physical Health ◽

The U.S

ABSTRACT Introduction Prior studies have identified associations between specific health conditions and occupational impairments in the U.S. military, but little is known about the relative magnitude of impairments associated with different mental and physical health conditions among military service members. The goal of this study is to comparatively assess occupational impairment associated with mental and physical conditions among active duty military service members. Materials and Methods Data on 11,055 U.S. active duty service members were from the Department of Defense 2015 Health Related Behaviors Survey, an anonymous online health survey. Items assessed common mental and physical health conditions. Absenteeism was assessed as number of lost work days and presenteeism was assessed as number of work days with impaired functioning in the past 30 days. This research was approved by the RAND Human Subjects Protections Committee. Results Back pain (23%) and anxiety (14%) were the most prevalent conditions in the sample. Mental health conditions (anxiety, depression, and PTSD) were associated with more absentee and presentee days than physical conditions. Adjusting for physical health conditions, anxiety, depression, and PTSD showed robust associations with both absenteeism and presenteeism. Conclusions Common mental health conditions such as anxiety, depression, and PTSD showed robust associations with absenteeism and presenteeism among active duty U.S. military service members. Efforts to rigorously evaluate and improve existing military screening programs and reduce barriers to accessing and engaging in mental healthcare may help to reduce work absenteeism and presenteeism among active duty service members.

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Occupational Outcomes and Return to Running After Operative Management of Lisfranc Injuries in a High-Demand Population

Foot & Ankle Specialist ◽

10.1177/1938640020933078 ◽

2020 ◽

pp. 193864002093307

Author(s):

Logan Koehler ◽

Brian R. Waterman ◽

Nicholas A. Kusnezov ◽

James A. Blair ◽

Philip J. Belmont ◽

...

Keyword(s):

Internal Fixation ◽

Military Service ◽

Univariate Analysis ◽

Active Duty ◽

High Demand ◽

Military Health ◽

Occupational Outcomes ◽

Fracture Dislocations ◽

Lisfranc Injuries

Background: Literature evaluating outcomes following operative fixation of Lisfranc injuries has demonstrated high rates of chronic disability, particularly in those returning to prior levels of physical function. The purpose of this study is to evaluate the occupational outcomes and return to running after open reduction and internal fixation (ORIF) or arthrodesis for Lisfranc fracture-dislocations in a moderate- to high-demand military cohort. Methods: All active-duty servicemembers undergoing ORIF or primary arthrodesis (Current Procedural Terminology 28615 and 28730, respectively) for confirmed Lisfranc fracture-dislocations (International Classification of Diseases, Ninth Revision codes 838.03 or 838.13) with minimum 2-year follow-up were isolated from the Military Health System. Demographic and surgical variables were recorded. Return to military function, return to running, perioperative morbidity, and rates of reoperation for complication were the outcomes of interest. Univariate analysis followed by multivariate logistic regression determined the association between patient demographics, type of fracture fixation (ie, ORIF vs arthrodesis) and functional outcomes, including medical separation. Results: Among Lisfranc injuries, 64 patients underwent ORIF while 6 underwent primary arthrodeses with a mean age of 28.1 years. At mean follow-up of 3.5 years (range, 2.0-6.3 years), 20% of servicemembers underwent medical separation due to limitations related to their injuries. body mass index (BMI) ≥30 kg/m2 (OR 17.67; 95% CI, 3.69-84.53) and Army or Marines service branch (OR 3.86; 95% CI, 1.08-13.86) were significant independent predictors for medical separation. Among servicemembers undergoing ORIF or primary arthrodeses, 69% returned to occupationally required daily running during the follow-up period. Servicemembers with a BMI <30 kg/m2 were more likely to return to running (OR 13.14, 95% CI, 2.50-69.19). Radiographic evidence of posttraumatic Lisfranc osteoarthritis occurred in 10 (16%) servicemembers who underwent internal fixation, and 82% of ORIF patients underwent implant removal. Conclusions: At mean 3.5-year follow-up, 80% of servicemembers undergoing ORIF or primary arthrodeses for Lisfranc injuries remained on active duty or successfully completed their military service, and 69% were able to resume occupationally required daily running. Surgeons should preoperatively counsel patients with these injuries on the possibility of persistent long-term disability. Levels of Evidence: Level IV: Retrospective series

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Diabetes by Air, Land, and Sea: Effect of Deployments on HbA1c and BMI

Military Medicine ◽

10.1093/milmed/usz311 ◽

2019 ◽

Vol 185 (3-4) ◽

pp. 486-492

Author(s):

Irene Folaron ◽

Mark W True ◽

William H Kazanis ◽

Jana L Wardian ◽

Joshua M Tate ◽

...

Keyword(s):

Military Service ◽

Medical Condition ◽

Armed Forces ◽

The United States ◽

Chronic Medical Condition ◽

Future Research ◽

Military Health ◽

Dipeptidyl Peptidase 4 ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Before And After

Abstract Introduction Service members (SMs) in the United States (U.S.) Armed Forces have diabetes mellitus at a rate of 2–3%. Despite having a chronic medical condition, they have deployed to environments with limited medical support. Given the scarcity of data describing how they fare in these settings, we conducted a retrospective study analyzing the changes in glycated hemoglobin (HbA1c) and body mass index (BMI) before and after deployment. Materials and Methods SMs from the U.S. Army, Air Force, Navy, and Marine Corps with diabetes who deployed overseas were identified through the Military Health System (MHS) Management Analysis and Reporting Tool and the Defense Manpower Data Center. Laboratory and pharmaceutical data were obtained from the MHS Composite Health Care System and the Pharmacy Data Transaction Service, respectively. Paired t-tests were conducted to calculate changes in HbA1c and BMI before and after deployment. Results SMs with diabetes completed 11,325 deployments of greater than 90 days from 2005 to 2017. Of these, 474 (4.2%) SMs had both HbA1c and BMI measurements within 90 days prior to departure and within 90 days of return. Most (84.2%) required diabetes medications: metformin in 67.3%, sulfonylureas in 19.0%, dipeptidyl peptidase-4 inhibitors in 13.9%, and insulin in 5.5%. Most SMs deployed with an HbA1c < 7.0% (67.1%), with a mean predeployment HbA1c of 6.8%. Twenty percent deployed with an HbA1c between 7.0 and 7.9%, 7.2% deployed with an HbA1c between 8.0 and 8.9%, and 5.7% deployed with an HbA1c of 9.0% or higher. In the overall population and within each military service, there was no significant change in HbA1c before and after deployment. However, those with predeployment HbA1c < 7.0% experienced a rise in HbA1c from 6.2 to 6.5% (P < 0.001), whereas those with predeployment HbA1c values ≥7.0% experienced a decline from 8.0 to 7.5% (P < 0.001). Those who deployed between 91 and 135 days had a decline in HbA1c from 7.1 to 6.7% (P = 0.010), but no significant changes were demonstrated in those with longer deployment durations. BMI declined from 29.6 to 29.3 kg/m2 (P < 0.001), with other significant changes seen among those in the Army, Navy, and deployment durations up to 315 days. Conclusions Most SMs had an HbA1c < 7.0%, suggesting that military providers appropriately selected well-managed SMs for deployment. HbA1c did not seem to deteriorate during deployment, but they also did not improve despite a reduction in BMI. Concerning trends included the deployment of some SMs with much higher HbA1c, utilization of medications with adverse safety profiles, and the lack of HbA1c and BMI evaluation proximal to deployment departures and returns. However, for SMs meeting adequate glycemic targets, we demonstrated that HbA1c remained stable, supporting the notion that some SMs may safely deploy with diabetes. Improvement in BMI may compensate for factors promoting hyperglycemia in a deployed setting, such as changes in diet and medication availability. Future research should analyze in a prospective fashion, where a more complete array of diabetes and readiness-related measures to comprehensively evaluate the safety of deploying SMs with diabetes.

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