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Female, male service members, veterans recover from concussion differently

At an informal celebration at the AFWERX Vegas Innovation Hub earlier this month, U.S. Air Force personnel took delivery of four helmet designs that may each represent the next generation of fixed-wing aircrew equipment. In just nine months, the AFWERX innovations process generated tangible products for further Air Force testing and development. (U.S. Air Force photo by Nathan Riddle) At an informal celebration at the AFWERX Vegas Innovation Hub earlier this month, U.S. Air Force personnel took delivery of four helmet designs that may each represent the next generation of fixed-wing aircrew equipment. In just nine months, the AFWERX innovations process generated tangible products for further Air Force testing and development. (U.S. Air Force photo by Nathan Riddle)

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Traumatic Brain Injury | Women's Health | Men's Health

Female veterans may have a harder time performing some mental tasks after a mild traumatic brain injury or concussion, according to a recent study supported by the Defense and Veterans Brain Injury Center, a division of the Defense Health Agency Research and Development Directorate.

The study compared male and female veterans who had experienced concussions to more accurately assess whether each gender experienced different symptoms following injury. After adjusting for factors such as marital status, service branch, living situation, and vocation, the results showed female veterans had a harder time performing mental tasks such as difficulty concentrating and forgetfulness, which could slow recovery to normal activities. The study’s authors presented their results at the 2019 annual Military Health System Research Symposium in August.

“TBI is the signature injury experienced by service members and veterans in conflicts since 9/11,” said Navy Captain Scott Pyne, DVBIC division chief. “During this time, women have had the opportunity to serve in more combat related positions associated with increased exposures to potentially concussive events. As a result, there is a need to see whether TBI affects women and men differently.”

According to the latest figures published in Military Medicine in 2019, female service members accounted for 12.6 percent of first-time TBI diagnoses in the U.S. armed forces between 2010 and 2014.

“Women are becoming more prominent in all fields—including the military. If we don’t understand the differences in biology and/or symptomology, it could cause a major burden for society going forward. Individual differences must be analyzed through the lens of gender,” said Maheen Mausoof Adamson, DVBIC senior clinical research director and a neuroscientist at the Stanford University School of Medicine. Adamson is one of the lead scientists on the DVBIC-funded study conducted at the Veteran Affairs Palo Alto Health Care System.

To more accurately assess whether men and women experienced different symptoms following a TBI, the DVBIC-VA Palo Alto study relied on a matching technique where it looked at one male and one female in pairs. The researchers recruited participants, and then formed 49 matched pairs who were similar based on mechanism of injury, time from injury to assessment, and age at assessment. Adamson suggested the study could have long-term implications for susceptibility to dementia if these women could be followed for a number of years.

These findings suggest more research is needed to examine how TBI affects women and men. Such research provides an opportunity to test whether presumed gender differences based on biology are borne out by empirical findings. Continued research may help to realize the possibility that therapy will be tailored to each individual’s unique situation.

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TRICARE Maternity Policy Changes 2019

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4/10/2019
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Cold weather injuries during deployments, July 2012 – June 2017

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1/18/2018
During the 5-year surveillance period, 105 cold weather injuries were diagnosed and treated in service members deployed outside the U.S. of these, 39 (37%) were immersion injuries; 33 (31%) were frostbite; 16 (15%) were hypothermia; and 17 (16%) were “unspecified” cold weather injuries. Pie chart for cold weather injuries during deployments displays depicting the information above. Number of cold weather injuries bar chart: Of all 105 cold weather injuries during the surveillance period, 68% occurred during the first two cold seasons. Bar chart shows the number of cold weather injuries by year: •	2012-2013 cold season had 35 cold weather injuries •	2013-2014 cold season had 100 cold weather injuries •	2014 -2015 cold season had 13 cold weather injuries •	2015-2016 cold season had 11 cold weather injuries •	2016 – 2017 had 10 cold weather injuries Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness

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Gestational diabetes among pregnant service members, active component, U.S. Armed Forces 2012 – 2016

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1/5/2018
Gestational diabetes is an abnormal increase in blood sugar levels that can adversely affect the health of both a pregnant woman and her baby. During 2012 – 2016, 4,017 (6.3%) of active component female service members who had live births were affected by gestational diabetes. Women aged 25-34 and 35-49 years had consistently higher annual prevalences of gestational diabetes than younger females. The percentage of pregnant service members affected by gestational diabetes was more than twice as high for obese women as for non-obese women (12.4% vs. 5.5%). The percentage of live births affected by gestational diabetes increased with increasing age and was highest among Asians/Pacific Islanders. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR

This infographic documents the incidence and prevalence of gestational diabetes pregnant service members, active component, U.S. Armed Forces, 2012 – 2016.

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Complications and Care Related to Pregnancy, Labor and Delivery among Active Component Service Women U.S. Armed Forces, 2012 – 2016

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1/5/2018
Maternal complications and delivery outcomes are important components of the overall health and well-being of reproductive-age service women. This analysis provides an update on pregnancy complications and characterizes the counts, rates, and trends of several specific pregnancy complications. FINDINGS •	55,601 U.S. service women whose pregnancies resulted in 63,879 live births had 657,060 medical encounters •	For all age groups, percentages of live births affected by preterm labor decreased, but during 2012 – 2016, the percentages of pregnant service members diagnosed with obesity increased. •	The percentage of pregnant service members affected by gestational diabetes was more than twice as high for obese women, compared with non-obese women (12.4% vs. 5.5%). Bar graph shows the number of medical encounters with a primary (first-listed) diagnosis of any pregnancy-related complication or indication for care decreased each year between 2012 and 2016. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR  Background image: New born being provided medical attention by nurse. Secondary image: babies of diverse background on a blanket.

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Contraception among active component service women, U.S. Armed Forces, 2012 – 2016

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1/5/2018
Because the majority of women serving in the Armed Forces are of childbearing age, and women’s military career opportunities have expanded into combat roles, contraceptive health care is an increasingly important public health issue. The lack of available, population-based descriptive information on contraceptive use among U.S. service women has generated questions and concerns about ready access to these medical products. This infographic summarizes the annual prevalence of permanent sterilization, as well as use of long – and short-acting reversible contraceptives (LARCs and SARCs, respectively), contraceptive counseling services, and use of emergency contraception from 2012 through 2016, among active component service women. FINDINGS •	2012 through 2016, Sterilization decreased from 4.2% to 3.6% LARC use increased from 17.2% to 21.7%; SARC use decreased from 38.5% to 30.4%. •	Emergency contraception use increased from 0.4% to 1.9%. •	Among deployed women, the average annual prevalence of permanent sterilization was 4.2%. •	For deployed women, LARC use was 17.9% SARC use was 28.0%. •	Emergency contraception use among deployed women was 0.4%. •	262,907 (76.2%) women of childbearing potential (WOCBP) used either a LARC or a SARC at some time during the surveillance period. •	The vast majority of service women have utilized at least one form of contraception, and women are selecting LARCs in greater numbers with each passing year. The bar graph displays information on the annual prevalence of contraceptive utilization, by type, service women of child-bearing potential, active component, U.S. Armed Forces, 2012– 2016. Graphic displayed: contraception option. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR

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Live births among female service members, active component, U.S. Armed Forces, 2012 – 2016

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12/21/2017
Did you know…?  •	From 2012 – 2016, there were 63,879 live births to women of childbearing potential in the active component. The overall live birth rate was 64.9 live births per 1,000 person-years (p-yrs). The live birth rate decreased steadily from 69.8 per 1,000 p-yrs in 2012 to 59.7 per 1,000 p-yrs in 2016. The decrease was primarily driven by declining rates among women in their 20s. Overall, live birth rates were highest among women who were: •	30-34 years old •	Army members •	In healthcare occupations •	Married Of the total 63,879 live birth deliveries: •	24.7% were cesarean •	75.3% were vaginal Pie chart depicting this information displays. United States map displays showing the highest numbers of deliveries during the surveillance period reported by military hospitals at: •	Naval Medical Center Portsmouth, VA (7.4%) •	Naval Medical Center San Diego, CA (6.1%) •	The Carl R. Darnall Army Medical Center, TX (4.1%) •	Womack Army Medical Center, NC (3.8%) •	Tripler Army Medical Center, HI (3.7%) Live birth rates were broadly similar among the race/ethnicity groups, although the overall rate was slightly higher among American Indians/ Alaska Natives. Access the full report in the November 2017 MSMR (Vol. 24, No.11). Go to: www.Health.mil/MSMR

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Pregnancies among female service members, Active component, U.S. Armed Forces, 2012 – 2016

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12/21/2017
With the increasing numbers of service women and the expansion of roles available to women within the military, understanding the epidemiology of pregnancy is important for both the health of U.S. service women and the readiness of the U.S. fighting force, two closely related issues. Between 2012 – 2016, 344,536 unique women of childbearing potential (WOCBP) served at least 1 day in the military, and of those, 132,466 spend at least 1 day as a recruit trainee. Of the 224,718 WOCBP who served at any time in 2016, 13.1% had at least one pregnancy-related event during that year. A “pregnancy-related event,” refers to a health care encounter (visit) for which the record contains a diagnosis code for either pregnancy or a positive pregnancy test. In 2016, the highest prevalence of pregnancy-related events was among service women 30-34 years of age (16.8%) and among senior enlisted women (13.7%). Pie chart displays depicting the information. The annual prevalence of pregnancy-related events decreased slightly, from 14.2% in 2012 to 13.1% in 2016. Line plot graph displays this information. FINDINGS •	Prevalence of pregnancy-related events was approximately evenly distributed among the race/ethnicity categories and military occupation groups. •	A slightly higher percentage of WOCBP in the Army (14.5%) had pregnancy-related events compared to WOCBP in the other services. •	A higher percentage of women who were married (21.4%) had a pregnancy-related event, compared with those in the single (5.7%) or “other” (8.8) categories. •	Only 0.2% of women who served during a recruit training period in any given year had a pregnancy-related event. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to www.Health.mil/MSMR.  Graphic on infographic shows a pregnant service member.

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Pregnancies and live births among female service members

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12/21/2017
Women have been able to serve officially in the U.S. military since 1901. Both the number of women serving in the active component and their occupational roles have steadily increased and expanded. Currently, almost one in seven active component service members are female and more than 95% of military occupational specialties are open to women. This infographic summarizes data on the demographic and military characteristics of women including women of childbearing potential (WOCBP) in the active component of the U.S. Armed Forces during 2012 – 2016. Data on pregnancy-related care and birth rates are also presented. FINDINGS •	In 2016, WOCBP comprised the vast majority of active component service women. •	202,849 women served in the active component of the Army, Navy, Air Force, or Marine Corps. 197,947 (97.6%) were WOCBP. Pie chart displays depicting this information. •	In 2016, 13.1% of all WOCBP had at least one pregnancy-related event. Pie chat displays depicting this information. Female stick figures display to show visual of the largest proportions of WOCBP. Breakdown of WOCBP by service: •	Army (32.9%) •	Air Force (30.0%) •	Navy (29.7%) •	Marine Corps (7.5%) Pie chart displays to visually depict breakdown of WOCBP by service. The largest proportions of WOCBP were: •	In a communications / intelligence occupation (32.3%) •	Junior enlisted rank (46.5%) •	Non-Hispanic white (43.4%) •	20 – 24 years old (34.3%) Live births: •	There were 63,879 live births during the surveillance period. •	Overall live birth rate was 64.9 live births per 1,000 person-years (p-yrs). This rate of live births decreased steadily from 69.8 per 1,000 p-yrs in 2012 to 59.7 per 1,000 p-yrs in 2016. Line graph displays this information. Rates of live births were highest among: •	Women who were 30 – 34 years old •	Enlisted or junior officer rank •	Army •	In healthcare / intelligence occupations •	Married Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR

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Tdap vaccination coverage during pregnancy, active component service women, 2006 – 2014

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8/14/2017
Pertussis, commonly known as “whooping cough,” is a vaccine-preventable illness more common and more severe in children than in adults. Infections during the first few months of life can be particularly severe, with almost all deaths from pertussis occurring in infants less than 6 months of age. A vaccinated mother’s antibodies against pertussis protect the baby during pregnancy until it can receive the vaccine at two months of age. Approximately 400 probable and 50 confirmed cases occur annually among service members and other adult beneficiaries of the Military Health System. In 2012, the Advisory Committee on Immunization Practices recommended Tdap for every pregnancy to reduce the burden of pertussis in infants. This surveillance study assessed Tdap vaccination coverage among pregnant service women during 2006 through 2014. FINDINGS: •	There were records of a total of 137,133 live birth deliveries to service women •	Only 1%  – 3% of service women received a Tdap vaccine during pregnancy from 2006  – 2011 •	Tdap vaccination coverage increased substantially  – 8% in 2012 to 54% in 2014 •	Navy women had the highest  annual proportion of vaccine coverage at 65% in 2014 •	First deliveries had the highest vaccination coverage at 57% in 2014 •	Fourth or subsequent deliveries had the lowest coverage at 41% in 2014 More education and attention by military physicians and pregnant service women about the benefits of Tdap vaccination are needed to bring coverage closer to 100%. Learn more in MSMR Vol. 22 No. 5 May 2015 at Health.mil/MSMR  Images on graphic: •	Baby icon to depict live birth deliveries •	Pie charts showing the findings in visual form •	Line graph showing the percent vaccinated among Navy, Marine Corps, Army, Air Force and Coast Guard The line graph shows the annual percentages of active component service women with a live birth delivery who received a Tdap vaccine during pregnancy, by year of delivery and service, 2011– 2014.

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Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2016

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6/19/2017
Did you know  … ? In 2016, essential hypertension accounted for 52,586 encounters for health care among 29,612 active component service members in the U.S. Armed Forces. Of all cardiovascular diseases, essential hypertension is by far the most common specific condition diagnosed among active duty service members. Untreated hypertension increases the risks of subsequent ischemic heart disease (heart attack), cerebrovascular disease (stroke), and kidney failure. CHART: Healthcare burdens attributable to cardiovascular diseases, active component, U.S. Armed Forces, 2016 Major condition: •	For all other cardiovascular the number of medical encounters was 70,781, Rank 29, number of individuals affected was 35,794 with a rank of 30. The number of bed days was 4,285 with a rank of 21. •	For essential hypertension the number of medical encounters was 52,586, rank 35, number of individuals affected was 29,612 with a rank of 35. The number of bed days was 151 with a rank of 86. •	For cerebrovascular disease the number of medical encounters was 7,772, rank 79, number of individuals affected was 1,708, with a rank of 96. The number of bed days was 2,107 with a rank of 32. •	For ischemic heart disease the number of medical encounters was 6,629, rank 83, number of individuals affected 2,399 with a rank of 87. The number of bed days was 1,140 with a rank of 42. •	For inflammatory the number of medical encounters was 2,221, rank 106, number of individuals affected 1,302 with a rank of 97. The number of bed days was 297 with a rank of 72. •	For rheumatic heart disease the number of medical encounters was 319, rank 125, number of individuals affected 261, with a rank of 121. The number of bed days was 2 with a rank of 133. Learn more about healthcare burdens attributable to various diseases and injuries by visiting Health.mil/MSMRArchives. #LoveYourHeart Infogaphic graphic features transparent graphic of a man’s heart illuminated within his chest.

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5/25/2017
Erectile dysfunction (ED) is defined as the persistent inability to achieve and sustain an erection that is adequate for sexual intercourse. ED can result from a problem with any of the above: •	Hormones •	Emotions •	Nerves •	Muscles •	Blood vessels These factors are required for an erection include. Picture is a brain (left) and a male figure (right) showing the heart and main arteries of the body. The top three most common ED diagnoses are: 1.	Psychosexual dysfunction 2.	Hypoactive sexual desire disorder 3.	Male orgasmic disorder Image shows a couple outside together during sunset. House displays in background. Causes of ED (Shows cut out of male body highlighting areas of the body where causes happen) •	Unrealistic sexual expectations •	Depression/ Anxiety/ Stress or other mental health issues •	High blood pressure •	Diabetes •	Obesity •	Injuries that affect the pelvic area or spinal cord •	Low testosterone •	Aging, Substance Abuse Demographics: •	Incidence rate of erectile dysfunction are higher among black, non-Hispanic servicemen when compared to other race/ethnicity groups. •	Black non-Hispanic service members have higher incidence rates of several conditions known to be risk factors for erectile dysfunction, including hypertension, obesity and diabetes. •	Separated, divorced and widowed servicemen had a higher incidence rate of ED than servicemen never married. •	Servicemen never deployed had the highest crude incidence rate of erectile dysfunction. Get the facts •	Erectile dysfunction is the most common sexual complaint reported by men to healthcare providers •	Among male service members nearly half of erectile dysfunction cases related predominantly or exclusively to psychological factors. •	Incidence rates of psychogenic erectile dysfunction are greater than organic erectile dysfunction for service members. •	Organic erectile dysfunction can result from physical factors such as obesity, smoking, diabetes, cardiovascular disease or medication use. •	Highest incidence rates were observed in those aged 60 years or older. •	Those 40 years or older are most commonly diagnosed with erectile dysfunction. Effective against erectile dysfunction •	Regular exercise  ( Shows soldier running) •	Psychological counseling (Shows two soldiers engaging in mental health counseling. They are seating on a couch).  •	Quit smoking ( shows lit cigarette)  •	Stop substance abuse ( Shows to shot glasses filled with alcohol) •	Nutritional supplements ( Shows open pill bottle of supplements) •	Surgical treatment ( Shows surgical instruments) Talk to your partner Although Erectile Dysfunction (ED) is a difficult issue for sex partners to discuss, talking openly can often be the best way to resolve stress and discover underlying causes. If you are experiencing erectile dysfunction, explore treatment options with your doctor. Learn more about ED by reading ‘Erectile Dysfunction Among Male Active Component Service Members, U.S. Armed Forces, 2004 – 2013.’ Medical Surveillance Monthly Report (MSMR) Vol. 21 No. 9 – September 2014 at www.Health.mil/MSMRArchives. Follow us on Twitter at AFHSBPAGE. #MensHealth

Erectile dysfunction (ED) is defined as the persistent inability to achieve and sustain an erection that is adequate for sexual intercourse. This infographic provides details on the ways ED impacts male active component services members of the U.S. Armed Forces.

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Diagnoses of Traumatic Brain Injury Not Clearly Associated with Deployment, Active Component, U.S. Armed Forces, 2001 – 2016

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4/4/2017
Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force.  TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment). Categorization of person time during surveillance period included four categories: Group 1 (Never deployed/TBI before first-ever deployment), Group 2 (Currently deployed or within 30 days of return), Group 3 (previously deployed but not currently deployed nor within 30 days of return) and Censored after Diagnosis of TBI. From 2001-2016, 276,858 active component service members received first-time diagnoses of TBI. The crude overall incidence rate of TBI among deployed service members was 1.5 times that of service members assigned to Group 1 and 1.2 times that of service members in Group 3 during the surveillance period.  Total TBI cases by group were Group 1 42.8%, Group 2 13.2% and Group 3 44.0%. Incidence rates by group (per 100,000 person-years) were Group 1 1,141.3, Group 2 1,690.5, and Group 3 1,451.2. Learn more at www.Health.mil/MSMR and see fact sheets at www.Health.mil/AFHSB

Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force. TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment).

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3/24/2017
This graphic shows the results of routine screening for antibodies to Human Immunodeficiency Virus (HIV) among both male civilian applicants for U.S. military service and male service members of the U.S. Armed Forces, active component - Army during  January 2015 through June 2016 surveillance period. 368,369 males out of 463,132 civilian applicants for U.S. military service were tested for antibodies to HIV. Out of 124 civilian applicants that were HIV positive, 114 were male. Throughout the period, seroprevalences were much higher among males than females.  As for U.S. Armed Forces active component, 467,011 male service members out of 548,974 were tested for antibodies to HIV. Out of 120 soldiers that were HIV positive 117 were male. Annual seroprevalences for male active component Army members greatly exceed those of females. During the 2015, on average, one new HIV infection was detected among active duty army soldiers per 5,265 screening tests.  HIV-1 is the cause of Acquired Immune Deficiency Syndrome (AIDS) and has had major impacts on the health of populations and on healthcare systems worldwide. Of 515 active component soldiers diagnosed with HIV infections since 2011, a total of 291 (57%) were still in the military. Get tested and learn more by reading the Medical Surveillance Monthly Report at Health.Mil/MSMR.

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5 Major Categories of Abdominal Hernia

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3/17/2017
An abdominal hernia is an abnormal protrusion of an organ or tissue through a defect in the abdominal wall. This infographic provides information on incident diagnoses of the five types of abdominal hernia that were documented in health records of 72,404 active component service members from 1 January 2005 through 31 December 2014.  A total of 87,480 incident diagnoses of the five types of abdominal hernia were documented in health records of 72,404 active component service members. Here are highlights of the findings from this study: •	The give types of abdominal hernia categories used in this analysis were: inguinal, umbilical ventral/ incisional, femoral and “other.” •	 During the 10-year interval, incidence rates for most of the five types of hernia trended downward but increased for umbilical hernias in both males and females and ventral/ incisional hernias among females. •	Overall incidence rate of inguinal hernias among males was six times the rate among females. •	Incidence rates of femoral, ventral/ incisional and umbilical hernias were higher among females than males. •	For most types of hernia incidence rates tend to be higher among older age groups.  Abdominal hernias are diagnosed most frequently in the inguinal, umbilical, and femoral regions, but another category of relatively common hernias of the anterior abdominal wall includes ventral and incisional hernias. Health records contained documentation for 35,624 surgical procedures whose description corresponded to the types of hernia diagnoses in U.S. military service members. Learn more about the findings of the study at Health.mil/MSMR

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6/21/2016
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