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

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.

scholarly journals Psychosocial Outcomes in Adult Survivors of Retinoblastoma

2015 ◽  
Vol 33 (31) ◽  
pp. 3608-3614 ◽  
Author(s):  
Jennifer S. Ford ◽  
Joanne F. Chou ◽  
Charles A. Sklar ◽  
Kevin C. Oeffinger ◽  
Danielle Novetsky Friedman ◽  
...  
Keyword(s):  
Traumatic Stress ◽  
Medical Condition ◽  
Cancer Recurrence ◽  
Psychosocial Outcomes ◽  
The United States ◽  
Fear Of Cancer Recurrence ◽  
Chronic Medical Condition ◽  
Post Traumatic Stress ◽  
Stress Symptoms ◽  
Post Traumatic

Purpose Survival rates for individuals diagnosed with retinoblastoma (RB) exceed 95% in the United States; however, little is known about the long-term psychosocial outcomes of these survivors. Patients and Methods Adult RB survivors, diagnosed from 1932 to 1994 and treated in New York, completed a comprehensive questionnaire adapted from the Childhood Cancer Survivor Study (CCSS), by mail or telephone. Psychosocial outcomes included psychological distress, anxiety, depression, somatization, fear of cancer recurrence, satisfaction with facial appearance, post-traumatic growth, and post-traumatic stress symptoms; noncancer CCSS siblings served as a comparison group. Results A total of 470 RB survivors (53.6% with bilateral RB; 52.1% female) and 2,820 CCSS siblings were 43.3 (standard deviation [SD], 11) years and 33.2 (SD, 8.4) years old at the time of study, respectively. After adjusting for sociodemographic factors, RB survivors did not have significantly higher rates of depression, somatization, distress, or anxiety compared with CCSS siblings. Although RB survivors were more likely to report post-traumatic stress symptoms of avoidance and/or hyperarousal (both P < .01), only five (1.1%) of 470 met criteria for post-traumatic stress disorder. Among survivors, having a chronic medical condition did not increase the likelihood of psychological problems. Bilateral RB survivors were more likely than unilateral RB survivors to experience fears of cancer recurrence (P < .01) and worry about their children being diagnosed with RB (P < .01). However, bilateral RB survivors were no more likely to report depression, anxiety, or somatic complaints than unilateral survivors. Conclusion Most RB survivors do not have poorer psychosocial functioning compared with a noncancer sample. In addition, bilateral and unilateral RB survivors seem similar with respect to their psychological symptoms.

Type 1 and Type 2 Diabetes

2019 ◽  
pp. 343-360
Author(s):  
Katherine A. S. Gallagher ◽  
Marisa E. Hilliard
Keyword(s):  
Type 2 Diabetes ◽  
Medical Condition ◽  
School Personnel ◽  
The United States ◽  
Self Management ◽  
Chronic Medical Condition ◽  
School Based ◽  
Support Students

Diabetes is a chronic medical condition that affects many children in the United States. The chapter provides an overview of type 1 and type 2 diabetes and focuses on the roles of school-based providers in helping students with diabetes, in collaboration with families and medical providers. Specific strategies, such as educating school personnel and peers about the conditions and treatments and recognizing and responding to symptoms of the conditions, are discussed. Providing assistance with, and supervision of, self-management tasks, monitoring symptoms, and identifying and implementing appropriate school-based accommodations are some key activities school-based professionals adopt to support students with diabetes. Additionally, addressing any learning or psychological concerns and assessing for possible diabetes-related contributors are critical. Included in the chapter are handouts with helpful resources for professionals, lists of measures for assessing concerns common to children with diabetes, and a tool to support student engagement in self-management activities related to diabetes care.

scholarly journals MIlitary Combat Mental Health Framework

2020 ◽  
pp. bmjmilitary-2020-001439
Author(s):  
Martin Bricknell
Keyword(s):  
Mental Health ◽  
Military Service ◽  
Current Knowledge ◽  
Armed Forces ◽  
Well Being ◽  
Therapeutic Interventions ◽  
Future Research ◽  
The Subject ◽  
Mental Well Being ◽  
Military Combat

This paper describes a framework for understanding military combat mental health based on the possible mental ill-health consequences of exposure to ‘potential trauma events’ for members of the armed forces and after their military service as veterans. It uses a life course approach that maps an individual’s mental well-being against four ‘states’: fit, reacting, injured and ill. It then considers five categories of factors that influence the risk of mental illness from this exposure based on research evidence; prejoining vulnerability, resilience, precipitating, treatment and recovery. This framework offers a structure to debate current knowledge, inform policy and therapeutic interventions, provide education and to guide future research into the subject.

Who Gets to Have a DREAM? Examining Public Support for Immigration Reform

2019 ◽  
Vol 54 (2) ◽  
pp. 527-558 ◽  
Author(s):  
Geoffrey P. R. Wallace ◽  
Sophia Jordán Wallace
Keyword(s):  
Military Service ◽  
Public Attitudes ◽  
Public Support ◽  
College Education ◽  
Armed Forces ◽  
The United States ◽  
Immigration Reform ◽  
Nationally Representative ◽  
Mass Attitudes ◽  
Attitudes Toward Immigration

This article assesses how different notions of citizenship shape mass attitudes toward immigration reform. We examine the underpinnings of the military service and college education provisions that were at the center of the 2010 DREAM Act, which sought to provide a path to citizenship for undocumented immigrant youth in the United States. Employing a survey experiment on a nationally representative US sample, we unpack the extent to which the mass public is willing to support immigration reform based on criteria tied to undocumented immigrants’ educational attainment or enlistment in the armed forces. While education has little effect on its own, military service significantly increases public support for a pathway to citizenship. The positive effect of military service endures when it is paired with less popular provisions, suggesting that a military criterion can serve as a basis of support for broader immigration legislation. Moreover, the effects are strongest for those groups who are traditionally viewed as being most opposed to immigration reforms that expand access to citizenship. The results of this study have implications for public attitudes toward immigration, the persistence of the citizen-soldier ideal, and the importance of framing in the policy-making process.

History and Memory of Female Military Service in the Age of World Wars

2020 ◽  
pp. 469-497
Author(s):  
Karen Hagemann
Keyword(s):  
World War Ii ◽  
Soviet Union ◽  
Military Service ◽  
Public Perception ◽  
Armed Forces ◽  
The United States ◽  
Home Front ◽  
History And Memory ◽  
War Powers ◽  
The Soviet Union

During the First and Second World Wars, women’s wartime service became increasingly important for the functioning of the home front and battlefront in Britain, Germany, Russia, the United States, and other war-powers. Hundreds of thousands of women served in the militaries of the belligerents during World War II. Scholars estimate that the percentage of women in the Allied armed forces reached up to 2–3 percent. The number of women in military service in Nazi Germany and the Soviet Union was especially high, but only in the latter were they officially enlisted as soldiers. Despite their numbers and importance, until recently, mainstream historiography and public memory have largely ignored women’s military service. This chapter takes a closer, comparative look at women’s wartime service in the Age of the World Wars in history and memory and explains the paradox that while it was increasingly needed, it has long been downplayed and overlooked in public perception and memory in all war powers and across the ideological divide of the Cold War.

UNEXPLORED CONSEQUENCES OF VIOLENCE AGAINST CIVILIANS DURING THE KOREAN WAR

2017 ◽  
Vol 17 (3) ◽  
pp. 259-283 ◽  
Author(s):  
Woo Chang Kang ◽  
Ji Yeon Hong
Keyword(s):  
South Korea ◽  
Korean War ◽  
Armed Forces ◽  
The United States ◽  
South Korean ◽  
Direct Exposure ◽  
Before And After ◽  
The Korean War ◽  
Negative Perceptions ◽  
Violence Against Civilians

AbstractIn this paper, we examine the extent to which wartime violence against civilians during the Korean War affects people's current attitudes toward South Korea and other involved countries. Using a difference-in-differences (DID) approach that compares the cohorts born before and after the war, we find that direct exposure to wartime violence induces negative perceptions regarding perpetrator countries. As many of the civilian massacres were committed by the South Korean armed forces, prewar cohorts living in violence-ridden areas during the war demonstrate significantly less pride in South Korea today. In contrast, postwar cohorts from those violent areas, who were exposed to intensive anti-communist campaigns and were incentivized to differentiate themselves from the victims, show significantly greater pride in South Korea, and greater hospitality toward the United States than toward North Korea, compared to prewar cohorts in the same areas and to the same cohorts born in non-violent areas.

scholarly journals Adenoviral Respiratory Infection-Associated Mortality in Children: A Retrospective Case Series

2020 ◽  
Author(s):  
Michael C. Spaeder ◽  
Claire Stewart ◽  
Matthew P. Sharron ◽  
Julia R. Noether ◽  
Natalia Martinez-Schlurman ◽  
...  
Keyword(s):  
Respiratory Infection ◽  
Medical Condition ◽  
Case Series ◽  
The United States ◽  
Chronic Medical Condition ◽  
Icu Admission ◽  
Increased Risk ◽  
Immunocompromised State ◽  
To Receive ◽  
Viral Respiratory

AbstractViral respiratory infections are a leading cause of illness and hospitalization in young children worldwide. Case fatality rates in pediatric patients with adenoviral lower respiratory tract infection requiring intensive care unit (ICU) admission have been reported between 7 and 22%. We investigated the demographics and clinical characteristics in pediatric mortalities associated with adenoviral respiratory infection at 12 academic children's hospitals in the United States. There were 107 mortality cases included in our study, 73% of which had a chronic medical condition. The most common chronic medical condition was immunocompromised state in 37 cases (35%). The incidences of pediatric acute respiratory distress syndrome (78%) and multiple organ dysfunction syndrome (94%) were profound. Immunocompetent cases were more likely to receive mechanical ventilation within the first hour of ICU admission (60 vs. 14%, p < 0.001) and extracorporeal membrane oxygenation (27 vs. 5%, p = 0.009), and less likely to receive continuous renal replacement therapy (20 vs. 49%, p = 0.002) or have renal dysfunction (54 vs. 78%, p = 0.014) as compared with immunocompromised cases. Immunocompromised cases were more likely to have bacteremia (57 vs. 16%, p < 0.001) and adenoviremia (51 vs. 17%, p < 0.001) and be treated with antiviral medications (81 vs. 26%, p < 0.001). We observed a high burden of nonrespiratory organ system dysfunction in a cohort of pediatric case fatalities with adenoviral respiratory infection. The majority of cases had a chronic medical condition associated with an increased risk of complications from viral respiratory illness, most notably immunocompromised state. Important treatment differences were noted between immunocompromised and immunocompetent cases.

scholarly journals HPV-Related Cancers: A Growing Threat to U.S. Military Health and Readiness

2021 ◽  
Author(s):  
Julia Seay ◽  
Rayna Matsuno ◽  
Jennifer Buechel ◽  
Karen Tannenbaum ◽  
Natalie Wells
Keyword(s):  
Cervical Cancer ◽  
Hpv Vaccination ◽  
The United States ◽  
Hpv Infection ◽  
Active Duty ◽  
Future Research ◽  
Policy Recommendations ◽  
Military Health ◽  
Cancer Screenings ◽  
Uptake Rates

ABSTRACT The incidence of human papillomavirus (HPV) related cancers is growing in the United States. Active duty service members (ADSM) have higher rates of HPV infection than civilians and are therefore at greater risk of developing HPV-related cancers. The purpose of this commentary is to examine the burden of HPV-related cancers in ADSM. The current HPV vaccination and cervical cancer screening uptake rates of U.S. ADSM are presented, including a literature review of military-focused studies on HPV vaccination and cervical cancer screenings. We provide directions for future research, interventions, and policy recommendations to improve HPV-related cancer prevention among ADSM.

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