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Military Health System

Our History

Military medicine has a long and celebrated history. We apply lessons from our past to improve the care of military personnel and their families today and in the future. New surgical techniques, powerful painkillers, antibiotic drugs, and triage and evacuation procedures have revolutionized military medicine.

In this section, you'll find featured stories and information about the history of military medicine.

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The impact of deployment on COPD in active duty military personnel.

Study

Abstract

PURPOSE: To identify trends in chronic obstructive pulmonary disease (COPD) diagnoses among active duty U.S. military personnel based on deployment history and whether International Classification of Disease, 9th edition (ICD-9) coding meet criteria for the diagnosis of COPD. METHODS: A retrospective chart review using the electronic medical system was conducted for military personnel diagnosed with COPD based on ICD-9 codes for emphysema or chronic obstructive lung disease with at least three qualifying outpatient COPD-coded encounters. Clinical symptoms, smoking history, pulmonary function testing, and radiographs obtained during the diagnostic workup were reviewed. The established diagnosis of COPD was analyzed in relation to deployment. RESULTS: A total of 371 patients were identified during the study period (2005-2009). Of these patients, 194 (52.3%) deployed, whereas 177 (47.7%) did not deploy to Southwest Asia since 2003. Thirty-four percent had no documented smoking history despite the diagnosis of COPD. Airway obstruction was identified by spirometry in only 67% of individuals diagnosed with COPD. No statistically significant differences in pulmonary function testing values were identified between those deployed and nondeployed individuals. CONCLUSION: Despite evidence of increased respiratory symptoms in deployed military personnel, the impact of deployment on increased diagnosis of COPD or severity of disease appears minimal.

  • Publication Status: Published
  • Sponsoring Organization: Army
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Army
  • Release Date/Publication: November 01, 2014
  • Citation: Matthews T, Abraham J, Zacher LL, Morris MJ. The impact of deployment on COPD in active duty military personnel. Mil Med. 2014 Nov;179(11):1273-8.

The Experience, Expression, and Control of Anger Following Traumatic Brain Injury in a Military Sample.

Study

Abstract

OBJECTIVE: To investigate the impact of traumatic brain injury (TBI) on the experience and expression of anger in a military sample. PARTICIPANTS: A total of 661 military personnel with a history of TBI and 1204 military personnel with no history of TBI. DESIGN: Cross-sectional, between-group design, using multivariate analysis of variance. MAIN MEASURE: State-Trait Anger Expression Inventory-2 (STAXI-2). RESULTS: Participants with a history of TBI had higher scores on the STAXI-2 than controls and were 2 to 3 times more likely than the participants in the control group to have at least 1 clinically significant elevation on the STAXI-2. Results suggested that greater time since injury (ie, months between TBI and assessment) was associated with lower scores on the STAXI-2 State Anger scale. CONCLUSION: Although the results do not take into account confounding psychiatric conditions and cannot address causality, they suggest that a history of TBI increases the risk of problems with the experience, expression, and control of anger. This bolsters the need for proper assessment of anger when evaluating TBI in a military cohort.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Defense and Veterans Brain Injury Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: February 01, 2014
  • Citation: Bailie JM, Cole WR, Ivins B, Boyd C, Lewis S, Neff J, Schwab K. The Experience, Expression, and Control of Anger Following Traumatic Brain Injury in a Military Sample. J Head Trauma Rehabil. 2014 Feb 28.

The Epidemiology of Irritable Bowel Syndrome in the US Military: Findings from the Millennium Cohort Study.

Study

Abstract

OBJECTIVES: Functional gastrointestinal disorders occur more frequently among deployed veterans, although studies evaluating the relative impact of risk factors, including stress and antecedent infectious gastroenteritis (IGE), are limited. We examined risk factors for new-onset irritable bowel syndrome (IBS) among active duty participants in the military's Millennium Cohort Study. METHODS: Medical encounter data from 2001 to 2009, limited to Cohort members on active duty, were used to identify incident IBS cases (any and highly probable). IGE was identified using medical encounter or self-report. Covariate data were obtained from the Millennium Cohort Study surveys and analyzed using Cox proportional hazards methods. RESULTS: Overall, 41,175 Cohort members met the eligibility criteria for inclusion and 314 new-onset cases of IBS were identified among these. Significant risk factors (adjusted hazard ratio, 95% confidence interval) included antecedent IGE (2.05, 1.53-2.75), female gender (1.96, 1.53-2.52), number of life stressors (1: 1.82, 1.37-2.41; 2: 2.86, 2.01-4.06; 3+: 6.69, 4.59-9.77), and anxiety syndrome (1.74, 1.17-2.58). Limited to highly probable IBS, a stronger association with antecedent IGE was observed, particularly when based on medical encounter records (any IGE: 2.20, 1.10-4.43; medical encounter IGE only: 2.84, 1.33-6.09). Precedent anxiety or depression and IGE interacted with increased IBS risk compared with IGE alone. CONCLUSIONS: These results confirm previous studies on the association between sociodemographic or life stressors and IBS. IGE was significantly associated with IBS risk. Whether deployed or not, US service members often encounter repeated exposure to high levels of stress, which, combined with other environmental factors such as IGE, may result in long-term debilitating functional gastrointestinal disorders.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source:
  • Release Date/Publication: January 01, 2016
  • Citation: Riddle MS, Welsh M, Porter CK, Nieh C, Boyko EJ, Gackstetter G, Hooper TI. The Epidemiology of Irritable Bowel Syndrome in the US Military: Findings from the Millennium Cohort Study. Am J Gastroenterol. 2016 Jan;111(1):93-104.

The DoD Joint Pathology Center as a Resource for Researchers.

Study

Abstract

The Department of Defense's Joint Pathology Center (JPC) is the world's largest collection of human pathology specimens, comprising some 7.4 million accessions. The biorepository, which began during the Civil War as a collection of materials obtained from medical and surgical procedures performed by Army physicians, houses specimens and associated data obtained for diagnostic purposes. It also holds several collections of specimens from military personnel who shared a common, service-related exposure or medical condition. This article, which is excerpted and adapted from the 2012 Institute of Medicine report "Future Uses of the Department of Defense JPC Biorepository,"1 summarizes information on the repository, its past uses, and the future operational issues and challenges that the JPC faces as it develops a concept of operations that will allow it to move forward as a resource for researchers.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Joint Pathology Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: October 01, 2015
  • Citation: Butler DA, Baker TP. The DoD Joint Pathology Center as a Resource for Researchers. Mil Med. 2015 Oct;180(10 Suppl):85-9.

The Effect of a Golden Hour Policy on the Morbidity and Mortality of Combat Casualties.

Study

Abstract

IMPORTANCE: The term golden hour was coined to encourage urgency of trauma care. In 2009, Secretary of Defense Robert M. Gates mandated prehospital helicopter transport of critically injured combat casualties in 60 minutes or less. OBJECTIVES: To compare morbidity and mortality outcomes for casualties before vs after the mandate and for those who underwent prehospital helicopter transport in 60 minutes or less vs more than 60 minutes. DESIGN, SETTING, AND PARTICIPANTS: A retrospective descriptive analysis of battlefield data examined 21 089 US military casualties that occurred during the Afghanistan conflict from September 11, 2001, to March 31, 2014. Analysis was conducted from September 1, 2014, to January 21, 2015. MAIN OUTCOMES AND MEASURES: Data for all casualties were analyzed according to whether they occurred before or after the mandate. Detailed data for those who underwent prehospital helicopter transport were analyzed according to whether they occurred before or after the mandate and whether they occurred in 60 minutes or less vs more than 60 minutes. Casualties with minor wounds were excluded. Mortality and morbidity outcomes and treatment capability-related variables were compared. RESULTS: For the total casualty population, the percentage killed in action (16.0% [386 of 2411] vs 9.9% [964 of 9755]; P < .001) and the case fatality rate ([CFR] 13.7 [469 of 3429] vs 7.6 [1344 of 17 660]; P < .001) were higher before vs after the mandate, while the percentage died of wounds (4.1% [83 of 2025] vs 4.3% [380 of 8791]; P = .71) remained unchanged. Decline in CFR after the mandate was associated with an increasing percentage of casualties transported in 60 minutes or less (regression coefficient, -0.141; P < .001), with projected vs actual CFR equating to 359 lives saved. Among 4542 casualties (mean injury severity score, 17.3; mortality, 10.1% [457 of 4542]) with detailed data, there was a decrease in median transport time after the mandate (90 min vs 43 min; P < .001) and an increase in missions achieving prehospital helicopter transport in 60 minutes or less (24.8% [181 of 731] vs 75.2% [2867 of 3811]; P < .001). When adjusted for injury severity score and time period, the percentage killed in action was lower for those critically injured who received a blood transfusion (6.8% [40 of 589] vs 51.0% [249 of 488]; P < .001) and were transported in 60 minutes or less (25.7% [205 of 799] vs 30.2% [84 of 278]; P < .01), while the percentage died of wounds was lower among those critically injured initially treated by combat support hospitals (9.1% [48 of 530] vs 15.7% [86 of 547]; P < .01). Acute morbidity was higher among those critically injured who were transported in 60 minutes or less (36.9% [295 of 799] vs 27.3% [76 of 278]; P < .01), those severely and critically injured initially treated at combat support hospitals (severely injured, 51.1% [161 of 315] vs 33.1% [104 of 314]; P < .001; and critically injured, 39.8% [211 of 530] vs 29.3% [160 of 547]; P < .001), and casualties who received a blood transfusion (50.2% [618 of 1231] vs 3.7% [121 of 3311]; P < .001), emphasizing the need for timely advanced treatment. CONCLUSIONS AND RELEVANCE: A mandate made in 2009 by Secretary of Defense Gates reduced the time between combat injury and receiving definitive care. Prehospital transport time and treatment capability are important factors for casualty survival on the battlefield.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source:
  • Release Date/Publication: January 01, 2016
  • Citation: Kotwal RS, Howard JT, Orman JA, Tarpey BW, Bailey JA, Champion HR, Mabry RL, Holcomb JB, Gross KR. The Effect of a Golden Hour Policy on the Morbidity and Mortality of Combat Casualties. JAMA Surg. 2016 Jan 1;151(1):15-24.

The challenge of sleep management in military operations.

Study

Abstract

It has long been known that short-term (days) insufficient sleep causes decrements in mental effectiveness that put individuals at increased risk of committing errors and causing accidents. More recently, it has been discovered that chronic poor sleep (over years) is associated with a variety of negative health outcomes (metabolic syndrome, obesity, degraded behavioral health). Implementing an effective sleep health program is, therefore, in the best interests of active duty personnel and their families both in the short- and long-term. Like managing physical activity or nutrition, effectively managing sleep health comes with its unique set of challenges arising from the fact that individuals who routinely do not obtain sufficient sleep are generally desensitized to feeling sleepy and are poor at judging their own performance capabilities--and individuals cannot be compelled to sleep. For these reasons, an optimally effective sleep health program requires 3 components: (1) a rigorous, evidence-based sleep education component to impart actionable knowledge about optimal sleep amounts, healthy sleep behaviors, the known benefits of sleep, the short- and long-term consequences of insufficient sleep, and to dispel myths about sleep; (2) a nonintrusive device that objectively and accurately measures sleep to empower the individual to track his/her own sleep/wake habits; and (3) a meaningful, actionable metric reflecting sleep/wake impact on daily effectiveness so that the individual sees the consequences of his/her sleep behavior and, therefore, can make informed sleep health choices.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: October 01, 2013
  • Citation: Wesensten NJ, Balkin TJ. The challenge of sleep management in military operations. US Army Med Dep J. 2013 Oct-Dec:109-18.

The association of predeployment and deployment-related factors on dimensions of postdeployment wellness in U.S. military service members.

Study

Abstract

PURPOSE: To assess the effects of predeployment and deployment-related factors on dimensions of wellness following deployment. DESIGN: Prospective longitudinal study. The dependent variable was dimensions of wellness. Independent variables were measured in terms of modifiable, nonmodifiable, and military factors, such as sex, race/ethnicity, service branch, smoking status, and combat experience. SETTING: A large military cohort participating in the Millennium Cohort Study. SUBJECTS: Included 10,228 participants who deployed in support of the operations in Iraq and Afghanistan. MEASURES: Dimensions of wellness were measured by using standardized instruments assessing self-reported physical health, mental health, and stress. Covariates were measured by using self-reported and electronic data. ANALYSIS: Factors of postdeployment wellness were assessed by using ordinal logistic regression. RESULTS: Most participants (78.7%) were categorized as "moderately well" post deployment. Significant modifiable predeployment predictors of postdeployment wellness included normal/underweight body mass index (odds ratio [OR] = 1.72, p < .05). Military factors significantly associated with wellness included not experiencing combat (OR = .56, p < .05), member of Air Force (OR = 2.02, p < .05) or Navy/Coast Guard (OR = 1.47, p < .05), and combat specialist occupation (OR = 1.22, p < .05). CONCLUSION: Multiple modifiable factors associated with postdeployment wellness were identified, which may help inform medical and military leadership on potential strategies to ensure a well force. Those trained in combat roles were more likely to be well post deployment though this apparent benefit was not conferred onto those reporting combat experiences.

  • Publication Status: Published
  • Sponsoring Organization: Navy
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source:
  • Release Date/Publication: November 01, 2013
  • Citation: Bagnell ME, LeardMann CA, McMaster HS, Boyko EJ, et. al. The association of predeployment and deployment-related factors on dimensions of postdeployment wellness in U.S. military service members. Am J Health Promot. 2013 Nov-Dec;28(2):e56-66.

The association of percentage energy from fat and colon cancer risk among members of the US military.

Study

Abstract

Epidemiologic studies have previously reported an association between high fat intake and colon cancer risk. However, findings have generally been inconclusive. This study aimed to investigate the association between fat as a percentage of energy intake and colon cancer risk. Study subjects included 215 cases and 215 matched controls identified by the Defense Medical Surveillance System. Percentage energy from fat (Pfat) was estimated using a short dietary screener developed by the National Cancer Institute for two time periods: the year before the first blood draw and the year before colon cancer diagnosis. Conditional logistic regression analysis was used to assess the relationship between colon cancer risk and Pfat. Odds ratios and 95% confidence intervals (CIs) were calculated. Compared with the lowest quartile of Pfat, the adjusted odds of having colon cancer were 2.00 (95% CI 0.96-4.18), 2.83 (95% CI 1.41-5.66), and 3.37 (95% CI 1.58-7.17), respectively, for the second, third, and highest quartiles in the year before cancer diagnosis. Similar results were observed for Pfat at an earlier time point. Our findings suggest a positive association between Pfat and colon cancer in the US military population.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source:
  • Release Date/Publication: July 01, 2014
  • Citation: Shao S, Kao TC, Eckhaus J, Bourgeois J, Perera K, Zhu K. The association of percentage energy from fat and colon cancer risk among members of the US military. Eur J Cancer Prev. 2014 Jul 29.

The association between US Army enlistment waivers and subsequent behavioral and social health outcomes and attrition from service

Study

Abstract

Soldiers granted enlistment waivers for medical concerns, misconduct, or positive alcohol/drug tests may or may not be associated with an increased likelihood of negative behavioral outcomes. Soldiers in the population examined (n = 8,943) who were granted enlistment waivers from 2003 to 2008 were significantly more likely to subsequently be screened for alcohol/substance abuse, test positive for illicit substances, or receive an Army separation for behavioral misconduct. These associations were highest among Soldiers granted waivers for nonlawful alcohol/drug violations. Soldiers granted waivers for felony offenses and serious nontraffic violations were significantly less likely to separate from the Army compared with Soldiers not granted enlistment waivers.

  • Publication Status: Published
  • Sponsoring Organization: Army
  • Sponsoring Office: US Army Institute of Public Health
  • Congressionally Mandated: No
  • Funding Source: Army
  • Release Date/Publication: March 01, 2013
  • Citation: Gallaway MS, Bell MR, Lagana-Riordan C, Fink DS, Meyer CE, Millikan AM. The association between US Army enlistment waivers and subsequent behavioral and social health outcomes and attrition from service. Mil Med. 2013 Mar;178(3):261-6.

Tdap coverage in a military beneficiary population: room for improvement.

Study

Abstract

Pertussis has had a resurgence in recent years. Women of child-bearing age and adults with infant contact are important reservoirs of infection because of waning immunity. Recent infant deaths and outbreaks led to new tetanus, diphtheria, and acellular pertussis (Tdap) vaccine recommendations, but vaccination rates remain low. A performance improvement project was started at Walter Reed Army Medical Center to target women of child-bearing age. Women treated in Gynecology had their electronic medical record screened for Tdap during their vital signs assessment. Those eligible for vaccination were directed to the Immunization Clinic. The intervention was considered successful if the patient received the vaccine within 30 days of the visit. Data were compiled on vaccination rates 1 month before and 1 and 3 months after the start of the performance improvement project. Only 13.9% of all patients had a documented Tdap at any time. During the first month following the intervention, vaccination rates within 30 days of the appointment increased from 0.38% to 6.5% (p < 0.005). The effect waned at 3 months following intervention, with only 1.1% of patients vaccinated within 30 days of the appointment. Overall vaccination rates remain low, and future studies should focus on barriers to vaccination to prevent morbidity and mortality.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: October 01, 2013
  • Citation: Lam ST, George S, Dunlow S, Nelson M, Hartzell JD. Tdap coverage in a military beneficiary population: room for improvement. Mil Med. 2013 Oct;178(10):1133-6.

Syncope among U.S. Air Force basic military trainees, August 2012-July 2013.

Study

Abstract

Syncope is a common event with many possible etiologies, ranging from benign to severe. Syncopal episodes of any origin, however, may result in traumatic injury due to postural collapse. Based on the prevalence of internal and external stressors during training, basic military trainees may be at increased risk for syncope. Between 1 August 2012 and 31 July 2013, there were 112 unique individuals who experienced syncopal or pre-syncopal events among basic military trainees at Joint Base San Antonio-Lackland, Texas, the only basic training site in the U.S. Air Force. The overall rate was 19.6 cases per 1,000 person-years (18.4 and 36.1 per 1,000 person-years in males and females, respectively). Based upon the findings of electronic chart review of the 112 cases, a majority of events occurred either during or immediately after exercise (n=38) or during a blood draw, immunization, or laceration repair (n=22). The most common etiologies were judged to be neurocardiogenic (n=54) and orthostatic hypotension (n=40), and two cases were attributed to cardiovascular disease. These findings support current preventive measures, including anemia screening during medical in-processing, an emphasis on hydration throughout training, and a padded floor in the trainee vaccination bay.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Armed Forces Health Surveillance Center
  • Congressionally Mandated: No
  • Funding Source:
  • Release Date/Publication: November 01, 2013
  • Citation: Webber BJ, Cropper TL, Federinko SP. Syncope among U.S. Air Force basic military trainees, August 2012-July 2013. MSMR. 2013 Nov;20(11):2-4.

Survival and Racial Differences of Non-Small Cell Lung Cancer in the United States Military.

Study

Abstract

BACKGROUND: Lung cancer is the leading cause of cancer-related death in the United States (US) Military and worldwide, with non-small cell lung cancer (NSCLC) accounting for 87 % of cases. OBJECTIVES: Using a US military cohort who receives equal and open access to healthcare, we sought to examine demographic, clinical features and outcomes with NSCLC. DESIGN AND PARTICIPANTS: We conducted a retrospective cohort analysis of 4,751 patients, aged ≥ 18 years and diagnosed with a first primary NSCLC between 1 January 2003 and 31 December 2013 in the US Department of Defense (DoD) cancer registry. MAIN MEASURES: Differences by patient and disease characteristics were compared using Chi-square and t-test. Kaplan Meier curves and Cox proportional hazards regression assessed overall survival. RESULTS: The mean age at diagnosis was 66 years, 64 % were male, 72 % were Caucasian, 41 % were diagnosed at early stage, 77 % received treatment and 82 % had a history of tobacco use. Mean age at diagnosis was highest among Caucasians (67 years) and lowest among African Americans (AA; 62 years). Asian/Pacific Islanders (PI) were more likely to be female (p < 0.0001), have adenocarcinoma histology (p = 0.0003) and less likely to have a history of tobacco use (p < 0.0001) compared to other racial/ethnic groups. In multivariable survival analysis, older age, male gender, increasing stage, not receiving treatment, and tobacco history were associated with higher mortality risk. Untreated patients exhibited a 39 % higher mortality risk compared to treated patients (HR = 1.39; 95%CI = 1.23-1.57). Compared to Caucasian patients, Asian/PIs demonstrated a 20 % lower risk of death (HR = 0.80; 95%CI = 0.66-0.96). There was no difference in mortality risk between AAs and Hispanics compared to Caucasians. CONCLUSION: The lack of significant outcome disparity between AAs and Caucasians and the earlier stage at diagnosis than usually seen in civilian populations suggest that equal access to healthcare may play a role in early detection and survival.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source:
  • Release Date/Publication: October 01, 2015
  • Citation: Brzezniak C, Satram-Hoang S, Goertz HP, Reyes C, Gunuganti A, Gallagher C, Carter CA. Survival and Racial Differences of Non-Small Cell Lung Cancer in the United States Military. J Gen Intern Med. 2015 Oct;30(10):1406-12

Surveillance snapshot: states with the most pertussis diagnoses among service members and other beneficiaries of the Military Health System, January 2012-June 2014.

Study

Abstract

According to the Centers for Disease Control and Prevention, so far in 2014, reported cases of pertussis in the U.S. have increased 24% over the previous year; by June 16, a total of 9,964 cases of pertussis had been reported by 50 states and the District of Columbia. On June 13, the California Department of Public Health announced that the state was experiencing a pertussis (“whooping cough”) epidemic. As of June 10, a total of 3,458 cases had been reported in the state; this number of pertussis cases exceeds the number of cases reported in the entire year in 2013. Th e MSMR has previously reported on spatiotemporal clusters of pertussis in the military that were associated with outbreaks in neighboring non-military communities; this association was clearly demonstrated during a previous 2010 outbreak in California. Between January 2012 and June 2014, the greatest number of pertussis cases (both confi rmed and probable) diagnosed in military benefi ciaries occurred in California, Texas, Washington, Virginia, and Florida (Figure); 90 cases have been diagnosed in California since January 2014, which is more than was reported in all of 2012 (n=68) or 2013 (n=89).

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Armed Forces Health Surveillance Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: June 01, 2014
  • Citation: Armed Forces Health Surveillance Center (AFHSC). Surveillance snapshot: states with the most pertussis diagnoses among service members and other beneficiaries of the Military Health System, January 2012-June 2014. MSMR. 2014 Jun;21(6):18.

Surveillance snapshot: Bacterial meningitis among beneficiaries of the military health system, 1998-2013.

Study

Abstract

From 1998 to 2013 (partial year), 3,782 beneficiaries of the Military Health System (MHS) were diagnosed as cases of bacterial meningitis. Cases were ascertained from diagnoses recorded in special electronic reports of meningococcal meningitis (a Reportable Medical Event in the MHS) or in records of inpatient hospital stays in which bacterial meningitis was documented in the primary or secondary diagnostic position. Among the three types of benefi ciary groups, the proportions of meningitis cases by bacterial type varied. In active and Reserve/Guard component service members, meningococcal meningitis was the most commonly documented specifi ed type of bacterial meningitis. Among all other benefi ciaries (e.g., spouses, children, retirees, etc.) streptococcal meningitis was the most commonly specifi ed type of bacterial meningitis. Meningococcal meningitis was diagnosed among 91 active component service members, 14 Reserve/Guard service members, and 251 other benefi ciaries (Figure 2). Th e overall rate in active component service members was 0.41 per 100,000 person-years. The incidence rate was relatively stable from 1998 to 2008, and then varied greatly from 2009 through 2013. In 2009 and 2011, there were no cases of meningococcal meningitis in active component service members. During the entire surveillance period, there were documented an additional 266 cases of meningococcal disease that were not recorded as meningitis. These included meningococcemia (n=150), carditis (n=13), and other specified and unspecifi ed meningococcal infections (n=103). These cases affected 38 active component members, 6 Reserve and Guard members, and 222 other benefi ciaries.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Armed Forces Health Surveillance Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: November 01, 2013
  • Citation: AFHSC. Surveillance snapshot: Bacterial meningitis among beneficiaries of the military health system, 1998-2013. MSMR. 2013 Nov;20(11):15.

Suicide incidence and risk factors in an active duty US military population.

Study

Abstract

OBJECTIVES: The goal of this study was to investigate and identify risk factors for suicide among all active duty members of the US military during 2005 or 2007. METHODS: The study used a cross-sectional design and included the entire active duty military population. Study sample sizes were 2,064,183 for 2005 and 1,981,810 for 2007. Logistic regression models were used. RESULTS: Suicide rates for all services increased during this period. Mental health diagnoses, mental health visits, selective serotonin reuptake inhibitors (SSRIs), sleep prescriptions, reduction in rank, enlisted rank, and separation or divorce were associated with suicides. Deployments to Operation Enduring Freedom or Operation Iraqi Freedom were also associated with elevated odds ratios for all services in the 2007 population and for the Army in 2005. CONCLUSIONS: Additional research needs to address the increasing rates of suicide in active duty personnel. This should include careful evaluation of suicide prevention programs and the possible increase in risk associated with SSRIs and other mental health drugs, as well as the possible impact of shorter deployments, age, mental health diagnoses, and relationship problems

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Defense Health Agency (formerly TRICARE Management Activity)
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: March 01, 2013
  • Citation: Hyman J, Ireland R, Frost L, Cottrell L. Suicide incidence and risk factors in an active duty US military population. Am J Public Health. 2012 Mar;102 Suppl 1:S138-46.
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Last Updated: September 21, 2022
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