Treatment of Chronic Ankle Instability in the Military Population: A Systematic Review

Background The high incidence of ankle sprain within the military sets the stage for prevalent chronic ankle instability. The purpose of this review was to compare and evaluate chronic ankle instability treatment strategies in the military population. Methods Electronic databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews guidelines for English-language, human studies with a military patient population that had been diagnosed with and treated for chronic ankle instability. Exclusion criteria were animal, cadaver, and review studies and case reports. Results Eight studies met the inclusion criteria, representing 695 military service members—625 males (89.9%) and 70 females (10.1%)—and 4 treatment strategies: Broström-related procedures, modified Watson-Jones procedure, Colville’s technique, and anatomic lateral ligament reconstruction using semitendinosus tendon allograft. The percentage of satisfactory outcomes was 100% for Colville’s technique, and ranged from 73.2% to 94.7% for Broström-related procedures and 72% to 80% for the modified Watson-Jones procedure. Mean American Orthopaedic Foot and Ankle Society scores, anterior drawer displacement, talar tilt, and visual analogue scale scores were also reported. Conclusion This review demonstrates that the Bröstrom procedure has consistently satisfactory outcomes within the military population, and Colville’s technique is another promising option for this patient population but would require additional studies to support this claim. Levels of Evidence: Level IV

Integration of Multiple Surveillance Systems to Track COVID-19 in the U.S. Army Population

ABSTRACT Introduction The coronavirus disease (COVID-19) pandemic presented unique challenges for surveillance of the military population, which include active component service members and their family members. Through integrating multiple Department of Defense surveillance systems, the Army Public Health Center can provide near real-time case counts to Army leadership on a daily basis. Materials and Methods The incidence of COVID-19 was tracked by incorporating data from the Disease Reporting System Internet, laboratory test results, Commanders’ Critical Incidence Reports, reports from the Centers for Disease Control and Prevention military liaison, and media reports. Cases were validated via a medical record review for all Army beneficiaries. Descriptive analyses were performed using Microsoft Excel and SAS 9.4 to measure demographic frequencies. Results In the first year of the pandemic from February 1, 2020 to February 28, 2021, a total of 96,315 COVID-19 cases were reported to the Disease Reporting System internet, the Army’s passive surveillance system, of which 95,429 (99%) were confirmed and 886 (1%) were probable. A total of 76 outbreak reports were submitted from 14 Army installations. The proportion of Army beneficiaries with severe illness was low: 2,271 (2.4%) individuals required hospitalization and 269 (0.3%) died. Installations in Texas reported the highest proportion of confirmed—not hospitalized cases (n = 19,246, 20.7%), confirmed—hospitalized cases (n = 1,037, 45.7%), and deaths (n = 137, 50.9%) as compared to other states with Army installations. Conclusions The pandemic has demonstrated the need for a robust public health enterprise with a focus on data collection, validation, and analysis, allowing leaders to make informed decisions that may impact the health of the Army.

Characterizing the fitness of Colombian military personnel

One of the great limitations in applying research involving the military population is that data are taken from other studies that do not reflect the specific characteristics or conditions of Colombian soldiers. Regardless, the outcomes are applied and appropriated as if these soldiers were, in fact, the sample of the study. In response to this situation, this work publishes the results of research involving the physical performance of Colombian military personnel to provide the academic community with descriptions of the variables that make up this population’s physical fitness training. This work is a first attempt to characterize their physical, physiological, and biomechanical capabilities using the best available evidence and state-of-the-art technology. One of this book’s main contributions to military physical training knowledge is that it is the first initiative to evaluate Colombian military personnel’s level of physical training. The scientific rigor of the studies in this compilation allows the reproducibility of the tests (external validity). It paves the way for a series of studies in military physical performance and health-related factors concerning active members of the National Army, seeking to characterize, evaluate, and determine training programs to optimize the institution’s pillars of doctrine. The ultimate goal is to drive the improvement of soldiers’ physical conditions, favoring a better quality of life and safety in operational performance.

Epidemiological Indicators of SARS-CoV-2 (COVID-19) and Vaccination Effectiveness on the Report of Positive Cases in the Colombian Army

The description of the epidemiological indicators of SARS-CoV-2 (COVID-19), such as the mortality rate (MR), the case fatality rate (CFR), and the attack rate (AR), as well as the geographical distribution and daily case reports, are used to evaluate the impact that this virus has had within the Colombian Army and its health system. As military forces around the world represent the force that defends sovereignty, independence, the integrity of the national territory, and the constitutional order, while maintaining migration controls in blocked border areas during this critical pandemic times, they must carry out strict epidemiological surveillance to control the situation among the servicemen. Up to date, the Colombian Army has faced a very high attack rate (AR = 8.55%) due, among others, to living conditions where active military personnel share bedrooms, bathrooms, and dining facilities, which facilitate the spread of the virus. However, being a mainly young and healthy population, the MR was 1.82 deaths/1,000 ha, while the CFR = 2.13% indexes consistently low if compared with those values reported for the national population. In addition, the effectiveness of vaccination is shown in daily cases of COVID-19, where, for the third peak, the active military population presented a decrease of positive patients compared to the dynamics of national transmission and the total population of the military forces (active, retired, and beneficiaries).

Evaluating Smartphone App Based Dietary Tracking in a Military Population: Validation Study (Preprint)

BACKGROUND Collecting dietary intake data is a key component for a majority of nutritional epidemiology studies. Smartphone technology advancements allow researchers to use health and nutrition apps as alternatives to currently available tools (food frequency questionnaires, 24-hour recalls, and food diaries). Service Members (SM) can greatly benefit from the always-available information and easily accessible nature of smartphones to track their intake. Clinicians working with military units can help provide these SM with the skills to evaluate their intake for performance benefits. Understanding the accuracy of these apps is important to determine their effectiveness for use in clinical and research settings. OBJECTIVE This study evaluated the relative validity of self-reported intake with the HealthWatch 360 (HW 360) app compared to the Automated Self-Administered 24-hour Dietary Assessment (ASA24). METHODS Recruitment targeted Army and Air Force SM from Joint Base Lewis-McChord, WA and Joint Base San Antonio-Lackland, TX who currently or previously failed to meet body composition standards. Participants (n=53) completed a demographic questionnaire, baseline anthropometric measurements, and recorded daily intake on the HW 360 app. They returned approximately two weeks later to complete a 24-hour recall using the ASA24. Agreement and relative validity were evaluated using Bland-Altman plots and two one-sided tests at a ± 10% equivalency range of ASA24 mean nutrient intake values between HW 360 and ASA24 data. Multilinear regressions analyzed relationships between participant demographics and relative validity. RESULTS HW 360 was not significantly equivalent to the ASA24. Large levels of underreporting were found in total energy (Mean Difference (Mdiff) = -503.3 kcal, 90% CI: -649.8 to -356.7 kcal), carbohydrates (Mdiff = -52.2 g, 90% CI: -70.4 to -34.1 g), protein (Mdiff = -20.4 g, 90% CI: -29.4 to -11.3 g), and fat (Mdiff = -24.6 g, 90% CI: -32.5 to -16.7 g). Bland-Altman plots failed to illustrate agreement. No significant correlations existed for demographic variables and relative validity. CONCLUSIONS Differences between all variables tested were above clinically significant values and limit the usage of this application in research and clinical settings. Further research is needed to determine the potential causes of underreporting and evaluate methods to minimize this effect. Understanding these effects allows the implementation of a tailored app for use with SM. It has the potential to be an invaluable asset for this population due the unpredictable nature of deployments and training exercises. CLINICALTRIAL ClinicalTrials.gov NCT04959318; https://clinicaltrials.gov/ct2/show/NCT04959318