Search Results (50)

Background: Shoulder instability imposes a substantial burden in U.S. military populations, yet epidemiology and outcomes reporting is heterogeneous. This study aims to quantify the epidemiology of shoulder instability among U.S. active-duty servicemembers and to report operative management patterns and outcomes. Methods: A systematic review was performed by searching MEDLINE, EMBASE, Scopus, Cochrane, and SPORTDiscus through 1 August 2025. Eligible studies enrolled U.S. active-duty servicemembers with clinical and/or radiographic evidence of instability. After a single comprehensive search with uniform inclusion criteria, studies were assigned to two prespecified cohorts: (1) epidemiology (incidence, directionality, risk factors) and (2) operative management/outcomes (procedure distribution, failure, complications, return to duty [RTD] and return to sport [RTS]). Incidence was pooled as a person-years–weighted fixed-effect estimate; directionality proportions were meta-analyzed with random-effects (logit-transformed) models among patient-level, unidirectional cases. Results: Forty-nine studies were included (epidemiology, n = 8; outcomes, n = 41). Three epidemiologic datasets (42,310 events; 20,472,363 person-years) yielded a pooled military incidence of 2.07 per 1000 person-years (95% CI, 2.05–2.09). Among unidirectional cases (n = 916 shoulders), anterior instability comprised 83.9% (95% CI, 70.5–91.9) and posterior the remaining 16.1% (95% CI, 8.1–29.5). Outcome series most commonly reported arthroscopic Bankart repair (n = 933 shoulders), bony augmentation (e.g., Latarjet/Bristow; n = 700), posterior labral repair (n = 649), combined repairs (n = 511), and open Bankart (n = 442). Weighted mean failure ranged 4.7–23.6%; complications 5.2–10.9%; and reoperations 5.3–17.7%. RTD ranged 50.0–84.7% and RTS 4.8–75.0%. Conclusions: Shoulder instability in U.S. servicemembers occurs at rates exceeding population-based civilian estimates, with a relatively greater share of posterior and combined patterns. Operative outcomes vary substantially across procedures. Full article

Background: The post-acute sequelae of SARS-CoV-2 infection represent a growing public health concern. While associations between COVID-19 and metabolic disorders have been reported, less is known about this risk in young, healthy populations. This study aimed to quantify the risk of developing new-onset metabolic disorders following SARS-CoV-2 infection among U.S. active-duty service members. Methods: We conducted a propensity score-matched cohort study using U.S. Military Health System data between July 2020 and June 2021 of active-duty service members (ADSM) aged 18 to 65 years old. COVID-19 infections were identified through ICD-10 codes or laboratory results. A 1:2 matched cohort compared 103,789 COVID-19 exposed individuals with 207,578 controls. Outcomes included incident diagnoses of type 2 diabetes mellitus (T2DM), hypertension (HTN), hyperlipidemia (HLD), metabolic dysfunction-associated steatotic liver disease (MASLD), and metabolic syndrome (MetS) within one year. Cox proportional hazards models calculated adjusted hazard ratios (aHR) while controlling for obesity and overweight status. Results: The median age for both those with and without COVID-19 infection was 26 years (interquartile range 22–33 years), with males comprising the majority of participants (81.1% male, 18.9% female). COVID-19 infection was associated with significantly increased hazards for incident HTN (aHR 1.09; 95% CI, 1.01–1.18), HLD (aHR 1.30; 95% CI, 1.10–1.54), and MASLD (aHR 1.36; 95% CI, 1.15–1.60). However, no significant increased risk was observed for T2DM or MetS. Conclusions: COVID-19 infection was associated with significantly increased risk of developing HTN, HLD, and MASLD, highlighting important long-term metabolic consequences in a young, healthy population. Full article

Background/Objectives: Equine-assisted services are being increasingly utilized as complementary interventions for military veterans who have experienced trauma. However, rigorous research is lacking, and randomized controlled trials are needed. The H.O.O.V.E.S. Intensive intervention was developed for this population. This intensive program is an equine-assisted learning approach developed for veteran and active-duty military trauma survivors. The program integrates equine-assisted learning, peer mentorship and experiential learning in a residential retreat format. The primary aim of this pilot study was to determine if more rigorous studies of this intervention are warranted. Secondary aims were to assess preliminary outcomes and explore possible relationships between changes in outcome measures. Methods: This was a pilot prospective study. Inclusion criteria for the program included veteran or active-duty military status and a history of trauma exposure. Data were collected from April–October of 2024 in Ohio, USA. Six psychological instruments were administered to participants before, immediately after and 90 days and 120 days after the intervention. These were the PTSD Checklist for DSM-5 (PCL-5), the Acceptance and Action Questionnaire II (AAQII), the Positive and Negative Affect Scale (PANAS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI) and the Posttraumatic Growth Inventory (PTGI). Analyses were conducted to assess for significant changes across the study timeframe and for relationships among the changes in psychological instrument scores. Results: Study participants were 32 veterans with trauma histories ranging in age from 30 to 67 years old. There were statistically significant pre- to post-intervention improvements for all instruments except the PTGI, suggesting short-term increased psychological flexibility (AAQII) and positive affect (PANAS-positive) as well as decreased anxiety (STAI), negative affect (PANAS-negative), depression (BDI) and PTSD symptoms (PCL-5). Changes in BDI and PCL-5 scores persisted at 120 days post-intervention whereas changes in the AAQII, PANAS and STAI did not persist. Increased psychological flexibility was correlated with reductions in negative affect, PTSD symptoms and anxiety, as well as with increases in positive affect. Conclusions: Preliminary results reported herein suggest participation is associated with psychological benefits. Further, decreased experiential avoidance/increased psychological flexibility should be explored as an underlying mechanism potentially contributing to the benefits of participation in EAS. A randomized controlled trial of the H.O.O.V.E.S. Intensive program is warranted. Full article

The primary aim of this study was to evaluate the feasibility, safety, and preliminary outcomes of the Equine Assisted Growth and Learning Association (Eagala) model of equine-assisted psychotherapy for active-duty military and veteran trauma survivors. This was a retrospective multi-site observational study. Study participants completed four psychological instruments pre- and post-intervention. These were the PTSD Checklist for DSM-5, the Patient Health Questionnaire, the Satisfaction with Life Scale and the Sheehan Disability Scale. The Client Satisfaction Questionnaire-8 was also completed post-intervention. Paired-sample t-tests were conducted to assess for changes in the primary outcome variables pre- and post-intervention. The RAPID qualitative approach was used to analyze the qualitative data and develop subthemes. Subjects were 107 participants at 12 sites. Participants ranged in age from 22 to 78 and were predominately male. Findings revealed that the Eagala model intervention can be implemented for this population across multiple sites. Further, treatment engagement may be better than found with conventional psychotherapy interventions for this population. Pre-to-post-intervention changes in scores on the psychological instruments revealed significant decreases in PTSD symptoms, depression, and disability as well as increases in satisfaction with life. Future randomized controlled trails of this intervention are warranted. Full article

Background/Objectives: Suicide is the leading cause of death among South Korean military soldiers, accounting for more than 70% of all deaths. This issue is particularly relevant in the military context due to the nature of living in groups in a controlled environment. This study was conducted active-duty south Korean male soldiers aged 18 to 28 who were performing mandatory military service for one year and six months. Additionally, it compares and analyzes the differences in suicidal ideation and risk factors between military soldiers and a comparison group consisting of males in their 20s without military experience. Methods: This study included 248 Korean soldiers and 292 general controls, totaling 540 participants. The research instruments used for evaluation included the Beck Scale of Suicide Ideation (BSI), the Childhood Trauma Questionnaire (CTQ-SF), the Perceived Stress Scale (PSS), the Difficulties in Emotion Regulation Scale (DERS-16), the Barratt Impulsiveness Scale Version 11 (BIS-11), the Rosenberg Self-Esteem Scale (RSES), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item scale (GAD-7), the UCLA Loneliness Scale (UCLAS), and the State-Beck Hopelessness Scale (S-BHS). Results: The results of this study showed that suicidal ideation, depression, anxiety, impulsivity, and self-esteem were significantly higher in the military group compared to the comparison group. Conversely, emotional dysregulation was considerably lower in the soldiers than in the comparison group. No significant differences were found in childhood trauma, stress, loneliness, and hopelessness between the two groups. Multiple regression analysis within the military group revealed that childhood trauma, hopelessness, and depression were major factors influencing suicidal ideation. Conclusions: These findings will help identify risk factors for suicide among soldiers and develop effective intervention strategies to prevent it. Full article

Many trauma-focused psychotherapies for posttraumatic stress disorder (PTSD) focus on the most distressing trauma. However, military personnel are often exposed to multiple traumatic experiences. This study aimed to evaluate and categorize the top three traumatic experiences identified by United States (U.S.) military service members seeking treatment for PTSD and compare frequency of trauma types by demographic/military characteristics. Active duty service members and veterans (N = 110) with PTSD identified and ranked their top three most distressing experiences. Behavioral health professionals classified experiences according to one categorical and four dichotomous classification schemes. The categorical scheme included life threat to self, life threat to others, aftermath of violence, traumatic loss, moral injury by self, and moral injury by others. The Life Threat to Self classification represented the largest portion of categorical experiences (43%). Most experiences were dichotomously classified as military-related (86%), combat-related (70%), non-sexual (91%), and trainability (versus futility; 71%). Women were more likely to report sexual traumatic experiences and less likely to report military- and combat-related experiences. Military occupational specialty, number of deployments, time in military, active duty status, and marital status were also associated with different classification rates. There was noteworthy variability in types of experience across top three traumas, especially among certain subpopulations. Full article

Moral injury is a discrete form of harm affecting individuals as a potentially avoidable consequence of exposure to a morally injurious event. That injury (independent of psychological injury or illness) has been identified as a cause of physical symptoms, suicide and suicidality. Originally identified within military and veteran cohorts, it is observable in emergency responders, healthcare providers, human rights advocates and others. Its aetiology suggests that other groups where the potential for tensions between personal morals, professional ethics and occupational activities arises (such as whistleblowers, law enforcement personnel and lawyers) may be at risk. Despite increasingly diverse evidence identifying moral injury as a substantive harm with significant consequences, the legal options for redress are unclear. This article explores whether requirements for establishing a duty of care as a precursor to a negligence claim are likely to pose an insurmountable obstacle for plaintiffs, including in the context of employer–employee duty relationships. It concludes that despite popular perceptions that negligence law is unlikely to be able to accommodate moral injury claims, a closer reading of key judgments indicates that there are opportunities for it to potentially be recognised as a harm on a principled basis—consistent with existing jurisprudence and legislation—for the purposes of establishing a duty of care. In the event that normative claims for its recognition are resisted, the justification for that resistance must be found outside historical development of legal principles from case law. Full article

Vegetable intake among military Service Members (SMs) is well below public health guidelines, with only 12.9% meeting the Dietary Guidelines for Americans (DGAs). Low vegetable consumption negatively impacts diet quality as measured by the Healthy Eating Index (HEI), and poses risks to health and performance. Given the high physical and mental demands of military life, improving diet quality, including through increased vegetable intake, is crucial for optimizing health and readiness. Providing meal kits may help improve vegetable intake by reducing access-related barriers for SMs living or working on a military base. Furthermore, the addition of spices and herbs is a readily modifiable accompanying approach to address taste-related barriers and increase intake that has shown promise in other populations with poor diet quality. Background/Objectives: This study aimed to evaluate whether heat-and-serve meal kits with spices and herbs could increase vegetable intake and liking among active-duty SM by simultaneously targeting barriers to healthy eating and modifiable sensory factors. Methods: Conducted at Naval Support Activity Bethesda, the study randomly distributed heat-and-serve meal kits (n = 400) featuring either spiced (n = 200) or plain versions (n = 200) of four vegetables (broccoli, carrots, cauliflower, and kale). Each kit contained a quick response (QR) code for participants to upload post-consumption photos and rate vegetable liking on a nine-point Likert scale. Food photography (SmartIntake^®) was used to estimate vegetable consumption. Paired t-tests were used to determine differences between the intake of plain and spiced vegetables. Results: Intake of the heat-and-serve vegetables was very high for both the spiced and plain preparations (1.73 out of 2 cups, 87%). There was minimal difference (p = 0.87) between the consumption of spiced (1.75 cups) and plain (1.725 cups) vegetables, suggesting that both were well accepted. Overall, convenient and accessible meal options, alongside sensory-driven strategies, appear to improve some barriers to vegetable consumption in SM populations. Conclusions: Future studies should explore long-term outcomes and adaptability across different military environments, while considering additional factors, including convenience and time constraints, that influence dietary choices in the military. Full article

Background: Headache disorders, particularly migraine, are a leading cause of disability among active-duty military personnel, significantly affecting operational readiness and fitness for duty. Despite their high prevalence, limited data exist on how headache disorders are managed within military primary care systems. This study aimed to evaluate diagnostic confidence, treatment strategies, and structural challenges in the management of headache disorders from the perspective of military primary care physicians. Methods: A prospective, nationwide cross-sectional survey was conducted between May and July 2023 among all active-duty military physicians in primary care roles. An anonymous 15-item questionnaire assessed diagnostic practices, therapeutic approaches, referral pathways, perceived knowledge gaps, and suggestions for system improvements. The survey was distributed across military medical centers and outpatient clinics in Germany. Results: Ninety military physicians participated. Migraine and tension-type headache were commonly encountered, with 70% having treated at least one headache patient in the week prior to the survey. Diagnostic confidence was high for migraine (83.4%) and tension-type headache (77.8%) but lower for medication-overuse headache (65.5%) and cluster headache (47.8%). Acute treatment was widely implemented, but only 27.8% of respondents regularly initiated preventive therapies. Awareness of clinical guidelines was limited: only 23.3% were familiar with the ICHD-3, and just 58.9% with national headache treatment guidelines. Respondents expressed strong demand for targeted education, practical diagnostic tools, and improved interdisciplinary coordination. Conclusions: Headache disorders are a prevalent and clinically significant issue in military primary care. While military physicians show high engagement, important gaps exist in preventive treatment, guideline familiarity, and access to specialist care. Structured training, standardized treatment protocols, and system-level improvements are essential to optimize headache care and maintain operational readiness. Full article

Objectives: Assessing balance in highly trained individuals, such as military pilots, poses challenges, as deficits may be underestimated when compared to general population norms. To address this, several studies have proposed tailored databases providing reference values for specific populations. This study retrospectively analyzed balance characteristics in active-duty military pilots of the Italian Air Force. Methods: We enrolled 106 subjects split into two groups: 53 military pilots from the Italian Air Force and 53 civilians without flight experience or exposure to specific vestibular stimuli. All participants underwent ENT examinations with audiometric testing to exclude related pathologies, followed by a personal history collection. Subsequently, they completed the EquiTest protocol across six standard conditions. Results: Significant differences were observed between Army Aviators and Non-Aviators. The PREF variable showed the most consistent distinction, with military pilots demonstrating a superior performance (p < 0.01). Additionally, borderline differences were noted in Condition 6 of the equilibrium scores (p = 0.056), and in the Centre of Gravity (COG) analysis along the X-axis for Conditions 1 and 5 (p = 0.090), and for Condition 2 (p = 0.050). These findings suggest enhanced postural control strategies among Army Aviators under conditions of sensory conflict. Conclusions: These findings suggest that normative balance values specific to military pilots should be used when evaluating aviators recovering from balance deficits. Such tailored benchmarks can help determine the need for rehabilitation before returning to duty, ensuring optimal performance under demanding conditions. Further research is necessary to explore the underlying mechanisms responsible for these adaptations and to identify the specific stimuli that contribute to the enhanced balance capabilities observed in this highly trained population. Full article

Despite expanded mental health services and outreach within the military, most active-duty members who endorse mental health problems do not seek services. Little is known about why this is the case, but cognitions may play a key role. In this study, cognitions relevant to service seeking were compared among three subgroups of active-duty members: those who endorse one or more mental health problems and sought services, those who endorse problems and do not seek services, and those who do not endorse problems. To examine differences and similarities among these groups, a stratified random sample of 162,340 was drawn from all active-duty members of the U.S. Department of the Air Force serving at 91 installations around the world. Each selected member was invited to anonymously complete the Air Force Community Assessment, and 63,227 members (39% of those invited) participated. Of these, one in five reported at least one mental health problem, and one in three reported receiving services within the past two years. Participants reporting problems and who had not sought services perceived more peer and institutional stigma, reported more knowledge and logistic barriers, reported more negative attitudes towards mental health services, and reported fewer attractors to mental health services compared with those who did not report problems. Those who reported problems and sought services reported more problems and more negative attitudes than those reporting problems who had not sought services. Nine of ten who reported problems but had not received services indicated they had no intention to seek them. Full article

Previous research suggests a high prevalence of suicidal ideation among military personnel. Suicidal ideation is associated with suicide attempts and death. This study focused on the association between belongingness—a component of the Interpersonal Psychological Theory of Suicide—and alcohol misuse on suicidal ideation among the different categories of military branch and military service status. Using the Military Suicide Research Consortium Common Data Elements database (N = 2516), we conducted linear regression analyses to examine the moderating effect of belongingness and alcohol misuse on the association between military branch and military service status (i.e., Active Duty) on suicidal ideation. Results showed a negative significant association between belongingness and suicidal ideation, and a positive significant association between alcohol and suicidal ideation. The results indicated that alcohol misuse moderated the association between military branch and suicidal ideation, but did not moderate the association between military service status and suicidal ideation. Additionally, the results indicated that belongingness moderated the association between military branch and suicidal ideation and the association between military service status and suicidal ideation. The results highlight the differences across military branches and military service statuses and suggest the importance of developing tailored suicide prevention programs to address the specific needs of each military subpopulation. Full article

Due to the unique mental and physical health challenges military service members (MSVMs) often face as a result of their service, MSVMs are a key demographic of interest. Interaction with natural environments may play a positive role in MSVMs’ overall health. Although previous research has been conducted on various population preferences and emotional responses to different types of gardens, there is a lack of data focused specifically on the garden preferences and emotional responses of MSVMs. To address this deficiency, an online survey was conducted featuring a series of questions with images related to landscape types and flower colors. The survey was disseminated via social media and military organizations to both civilians and military personnel (N = 366, with a 90.6% completion rate). Emotional responses were measured using a semantic differential scale. Most respondents were male, White, and between 25 and 35 years of age. MSVM respondents were primarily in the army and were either on active duty or honorably discharged. MSVMs and civilians showed similar garden and flower color preferences, each favoring wild landscape types and warm flower colors. However, the semantic differential analysis revealed MSVMs had significantly more negative emotional responses towards landscape types and flower colors compared to civilians. This indicates that the findings offer valuable insights into the unique emotional challenges faced by MSVMs, emphasizing the need for targeted interventions. Among military respondents, tropical landscapes were perceived more negatively. While it is crucial to incorporate preferred landscape elements into a design, understanding the emotional perceptions of these preferences is likely to aid garden designers in the creation of an environment that enhances overall well-being in an urban environment. Full article

Background: Warfighters, often called tactical athletes, seek dietary supplementation to enhance training and recovery. Roughly 69% of active-duty US military personnel have reported consuming dietary supplements. The objective of this systematic review was to examine the impact of dietary supplements on muscle-related physical performance and recovery in active-duty military personnel. Methods: Randomized controlled trials and quasi-experimental controlled trials of oral dietary supplementation in active-duty military members were examined. A protocol was registered (PROSPERO CRD42023401472), and a systematic search of MEDLINE and CINAHL was undertaken. Inclusion criteria consisted of studies published between 1990–2023 with outcomes of muscle performance and recovery among active-duty military populations. The risk of bias was assessed with the McMaster University Guidelines and Critical Review Form for Quantitative Studies. Results: Sixteen studies were included. Four were conducted on protein or carbohydrate; four on beta-alanine alone, creatine alone, or in combination; two on mixed nutritional supplements; two on probiotics alone or in combination with beta hydroxy-beta methylbutyrate calcium; and four on phytonutrient extracts including oregano, beetroot juice, quercetin, and resveratrol. Ten examined outcomes related to physical performance, and six on outcomes of injury or recovery. Overall, protein, carbohydrate, beta-alanine, creatine, and beetroot juice modestly improved performance, while quercetin did not. Protein, carbohydrates, beta-alanine, probiotics, and oregano reduced markers of inflammation, while resveratrol did not. Conclusions: Nutrition supplementation may have small benefits on muscle performance and recovery in warfighters. However, there are significant limitations in interpretation due to the largely inconsistent evidence of ingredients and comparable outcomes. Thus, there is inadequate practical evidence to suggest how dietary supplementation may affect field performance. Full article

Humor is generally known to effectively help individuals manage distress. Yet a variety of ways exist to engage in humor, and not all of them may be equally associated with desirable outcomes. The purpose of this study is to examine the extent to which dark humor is associated with the subjective well-being of United States military veterans. An online survey was announced on several social media pages populated by US veterans, to which 93 fully responded. Our findings indicate that the use of dark humor does not appear to be associated with a sense of connectedness, but the reported use of self-defeating types of dark humor was associated with lower levels of life satisfaction. Our hypothesis that increased feelings of connectedness to civilian and veteran/active-duty friends would predict increased reports of overall subjective well-being was supported. The implications of these findings for understanding the functions of dark humor are discussed. Full article