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1.
Anesth Analg ; 134(1): 216-224, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1822236

ABSTRACT

At the outbreak of World War II (WWII), anesthesiology was struggling to establish itself as a medical specialty. The battlefield abruptly exposed this young specialty to the formidable challenge of mass casualties, with an urgent need to provide proper fluid resuscitation, airway management, mechanical ventilation, and analgesia to thousands. But while Europe was suffering under the Nazi boot, anesthesia was preparing to rise to the challenge posed by the impending war. While war brings death and destruction, it also opens the way to medical advances. The aim of this study is to measure the evolution of anesthesia owing to WWII. We conducted a retrospective observational bibliometric study involving a quantitative and statistical analysis of publications. The following 7 journals were selected to cover European and North American anesthesia-related publications: Anesthesia & Analgesia, the British Journal of Anaesthesia, Anesthesiology, Schmerz-Narkose-Anaesthesie, Surgery, La Presse Médicale, and The Military Surgeon (later Military Medicine). Attention was focused on journal volumes published between 1920 and 1965. After reviewing the literature, we selected 12 keywords representing important advances in anesthesiology since 1920: "anesthesia," "balanced anesthesia," "barbiturates," "d-tubocurarine," "endotracheal intubation," "ether," "lidocaine," "morphine," "spinal anesthesia," "thiopental," "transfusion," and "trichloroethylene." Titles of original articles from all selected journals editions between 1920 and 1965 were screened for the occurrence of 1 of the 12 keywords. A total of 26,132 original article titles were screened for the occurrence of the keywords. A total of 1815 keywords were found. Whereas Anesthesia & Analgesia had the highest keyword occurrence (493 citations), Schmerz-Narkose-Anaesthesie had the lowest (38 citations). The number of publications of the 12 keywords was significantly higher in the postwar than in the prewar period (65% and 35%, respectively; P < .001). Not surprisingly, the anesthesiology journals have a higher occurrence of keywords than those journals covering other specialties. The overall occurrence of keywords also showed peaks during other major conflicts, namely the Spanish Civil War (1936-1939), the Korean War (1950-1953), and the Vietnam War (1955-1975). For the first time, this study demonstrates statistically the impact of WWII on the progress of anesthesiology. It also offers an objective record of the chronology of the major advances in anesthesiology before and after the conflict. While the war arguably helped to enhance anesthesiology as a specialty, in return anesthesiology helped to heal the wounds of war.


Subject(s)
Anesthesiology/history , Military Medicine/history , Anesthesia/history , Bibliometrics , Europe , History, 20th Century , Humans , Military Personnel , World War II
2.
Pediatr Ann ; 51(4): e138-e143, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1789492

ABSTRACT

With a growing body of literature describing the coronavirus disease 2019 (COVID-19) pandemic's effect on children and adolescents, there remain few official reports regarding mental health in military connected youth. With sparse literature available specifically in youth associated with the Armed Forces, published studies on global child and adolescent mental health during the COVID-19 pandemic are first reviewed. Military connected youth have unique needs and experiences. Implications of pandemic-related stressors on their mental health are suggested based on analysis of disaster and deployment literature. Military members have continued to move and deploy throughout the pandemic. Uniformed families have high risk factors for mental health concerns. Managing the mental health of military connected youth will fall heavily on civilian providers, both in primary and subspecialty practices. As such, vigilance for psychological health concerns and familiarity with military resources are vital for the mental wellness of our military pediatric patients. [Pediatr Ann. 2022;51(4):e138-e143.].


Subject(s)
COVID-19 , Military Personnel , Adolescent , COVID-19/epidemiology , Child , Family , Humans , Mental Health , Pandemics
3.
PLoS One ; 17(4): e0266691, 2022.
Article in English | MEDLINE | ID: covidwho-1779779

ABSTRACT

SARS-CoV-2 T cell responses are associated with COVID-19 recovery, and Class I- and Class II-restricted epitopes have been identified in the spike (S), nucleocapsid (N) and membrane (M) proteins and others. This prospective COVID-19 Health Action Response for Marines (CHARM) study enabled assessment of T cell responses against S, N and M proteins in symptomatic and asymptomatic SARS-CoV-2 infected participants. At enrollment all participants were negative by qPCR; follow-up occurred biweekly and bimonthly for the next 6 weeks. Study participants who tested positive by qPCR SARS-CoV-2 test were enrolled in an immune response sub-study. FluoroSpot interferon-gamma (IFN-γ) and IL2 responses following qPCR-confirmed infection at enrollment (day 0), day 7 and 14 and more than 28 days later were measured using pools of 17mer peptides covering S, N, and M proteins, or CD4+CD8 peptide pools containing predicted epitopes from multiple SARS-CoV-2 antigens. Among 124 asymptomatic and 105 symptomatic participants, SARS-CoV-2 infection generated IFN-γ responses to the S, N and M proteins that persisted longer in asymptomatic cases. IFN-γ responses were significantly (p = 0.001) more frequent to the N pool (51.4%) than the M pool (18.9%) among asymptomatic but not symptomatic subjects. Asymptomatic IFN-γ responders to the CD4+CD8 pool responded more frequently to the S pool (55.6%) and N pool (57.1%), than the M pool (7.1%), but not symptomatic participants. The frequencies of IFN-γ responses to the S and N+M pools peaked 7 days after the positive qPCR test among asymptomatic (S pool: 22.2%; N+M pool: 28.7%) and symptomatic (S pool: 15.3%; N+M pool 21.9%) participants and dropped by >28 days. Magnitudes of post-infection IFN-γ and IL2 responses to the N+M pool were significantly correlated with IFN-γ and IL2 responses to the N and M pools. These data further support the central role of Th1-biased cell mediated immunity IFN-γ and IL2 responses, particularly to the N protein, in controlling COVID-19 symptoms, and justify T cell-based COVID-19 vaccines that include the N and S proteins.


Subject(s)
COVID-19 , Military Personnel , Antibodies, Viral , CD8-Positive T-Lymphocytes , COVID-19/diagnosis , COVID-19 Vaccines , Epitopes , Humans , Interferon-gamma , Interleukin-2 , SARS-CoV-2/genetics , Spike Glycoprotein, Coronavirus/genetics
4.
Prim Dent J ; 11(1): 58-65, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1779566

ABSTRACT

Royal Air Force (RAF) Waddington and Cranwell are both based in Lincolnshire and have Defence Primary Health Care Dental Centres on Station to provide dental care to service personnel. The facility at RAF Waddington was temporarily closed for refurbishment early 2020 and this saw the amalgamation of the two Dental Centres. This, alongside COVID, significantly impacted on the ability to deliver dental care to a combined patient group. Military dental teams are routinely deployed overseas to provide care for patients; however, the Deployed Readiness Preparation Team (DRPT) had not previously been activated in the UK in support of RAF Dental Centres. This UK-based deployment was to be innovative and able to demonstrate the wider utility of the military dental teams and portable equipment, to expand the facility at RAF Cranwell.The aim of this paper is to highlight the key principles and utility of deployable Defence dentistry by discussing the establishment and use of portable dental equipment to facilitate the increased clinical output of a dental centre. Through energetic and focused leadership, training and assurance, dentistry can be delivered with an occupational focus to provide a responsive and deployable care capability in a UK setting.


Subject(s)
COVID-19 , Military Personnel , Humans , United Kingdom
5.
Front Public Health ; 9: 744601, 2021.
Article in English | MEDLINE | ID: covidwho-1775912

ABSTRACT

Objectives: Low back pain (LBP) has negative implications for the military's combat effectiveness. This study was conducted to determine the prevalence and risk factors of LBP among pilots through a questionnaire and physical function assessments. Methods: Data on the demographic and occupational characteristics, health habits, physical activity, and musculoskeletal injuries of 217 male pilots (114 fighter, 48 helicopter, and 55 transport pilots) were collected using a self-reported questionnaire and physical function assessments. Results: LBP prevalence was 37.8% in the total cohort and 36.0, 45.8, and 34.5% among fighter, helicopter, and transport pilots, respectively. Multivariate regression analysis revealed that the risk factors significantly associated with LBP were neck pain [odds ratio (OR): 3.559, 95% confidence interval (CI): 1.827-6.934], transversus abdominis activation (OR: 0.346, 95% CI: 0.172-0.698), and hip external rotator strength (OR: 0.001, 95% CI: 0.000-0.563) in the total cohort; neck pain (OR: 3.586, 95% CI: 1.365-9.418), transversus abdominis activation (OR: 0.268, 95% CI: 0.094-0.765), hip external rotator strength (OR: 0.000, 95% CI: 0.000-0.949), and weekly flying hours (OR: 3.889, 95% CI: 1.490-10.149) in fighter pilots; irregular strength training (OR: 0.036, 95% CI: 0.003-0.507) and hip external rotator strength (OR: 0.000, 95% CI: 0.000-0.042) in helicopter pilots; and neck pain (OR: 6.417, 95% CI: 1.424-28.909) in transport pilots. Conclusions: High volume flight schedules and weak core muscle functions have significant negative effects on pilots' back health. LBP is commonly associated with high weekly flying hours, worsening neck pain, transversus abdominis insufficient activation, and reduced hip extensor/rotator strength. Risk factors vary among pilots of different aircraft. Thus, specific core muscle training would be especially important for military pilots.


Subject(s)
Low Back Pain , Military Personnel , Humans , Low Back Pain/epidemiology , Low Back Pain/etiology , Male , Prevalence , Risk Factors , Surveys and Questionnaires
6.
Sci Rep ; 12(1): 3797, 2022 03 08.
Article in English | MEDLINE | ID: covidwho-1735276

ABSTRACT

Infectious threats, like the COVID-19 pandemic, hinder maintenance of a productive and healthy workforce. If subtle physiological changes precede overt illness, then proactive isolation and testing can reduce labor force impacts. This study hypothesized that an early infection warning service based on wearable physiological monitoring and predictive models created with machine learning could be developed and deployed. We developed a prototype tool, first deployed June 23, 2020, that delivered continuously updated scores of infection risk for SARS-CoV-2 through April 8, 2021. Data were acquired from 9381 United States Department of Defense (US DoD) personnel wearing Garmin and Oura devices, totaling 599,174 user-days of service and 201 million hours of data. There were 491 COVID-19 positive cases. A predictive algorithm identified infection before diagnostic testing with an AUC of 0.82. Barriers to implementation included adequate data capture (at least 48% data was needed) and delays in data transmission. We observe increased risk scores as early as 6 days prior to diagnostic testing (2.3 days average). This study showed feasibility of a real-time risk prediction score to minimize workforce impacts of infection.


Subject(s)
Algorithms , COVID-19/diagnosis , Monitoring, Physiologic/methods , Area Under Curve , COVID-19/virology , Humans , Military Personnel , Monitoring, Physiologic/instrumentation , ROC Curve , SARS-CoV-2/isolation & purification , User-Computer Interface , Wearable Electronic Devices
7.
Int J Environ Res Public Health ; 19(4)2022 02 21.
Article in English | MEDLINE | ID: covidwho-1732008

ABSTRACT

(1) Background: As COVID-19 transmission continues despite vaccination programs, healthcare workers (HCWs) face an ongoing pandemic response. We explore the effects of this on (1) Heartware, by which we refer to morale and commitment of HCWs; and identify how to improve (2) Hardware, or ways of enabling operational safety and functioning. (2) Methods: Qualitative e-diary entries were shared by HCWs during the early phases of the outbreak in Singapore from June to August 2020. Data were collected via an online survey of n = 3616 HCWs of all cadres. Nine institutions-restructured hospitals (n = 5), affiliated primary partners (n = 2) and hospices (n = 2)-participated. Applied thematic analysis was undertaken and organized according to Heartware and Hardware. Major themes are in italics (3) Results: n = 663 (18%) HCWs submitted a qualitative entry. Dominant themes undermining (1) Heartware consisted of burnout from being overworked and emotional exhaustion and at times feeling a lack of appreciation or support at work. The most common themes overriding morale breakers were a stoic acceptance to fight, adjust and hold the line, coupled with motivation from engaging leadership and supportive colleagues. The biggest barrier in (2) Hardware analysis related to sub-optimal segregation strategies within wards and designing better protocols for case detection, triage, and admissions criteria. Overall, the most cited enabler was the timely and well-planned provision of Personal Protective Equipment (PPE) for front-liners, though scope for scale-up was called for by those not considered frontline. Analysis maps internal organizational functioning to wider external public and policy-related narratives. (4) Conclusions: COVID-19 surges are becoming endemic rather than exceptional events. System elasticity needs to build on known pillars coupling improving safety and care delivery with improving HCW morale. Accordingly, a model capturing such facets of Adaptive Pandemic Response derived from our data analyses is described. HCW burnout must be urgently addressed, and health systems moved away from reactive "wartime" response configurations.


Subject(s)
COVID-19 , Military Personnel , COVID-19/epidemiology , COVID-19/prevention & control , Health Personnel/psychology , Humans , Organizational Innovation , SARS-CoV-2 , Singapore/epidemiology
8.
Endocr Metab Immune Disord Drug Targets ; 21(12): 2213-2219, 2021.
Article in English | MEDLINE | ID: covidwho-1714871

ABSTRACT

AIMS: To investigate the influence of body mass index (BMI) on the association between psychological stress and physical fitness. BACKGROUND: Both obesity and psychological stress reduce exercise performance. OBJECTIVE: It is unknown whether obesity may modify the relationship. METHODS: A population of 4,080 military subjects in Taiwan was divided to three groups according to the BMI ≥27.0 kg/m2 (obesity), 24.0-26.9 kg/m2 (overweight) and 18.5-23.9 kg/m2 (normal weight). Normal, slight, and great psychological stress was evaluated by the Brief Symptoms Rating Scale (BSRS-5) score ≤5, 6-9, and ≥10, respectively. Aerobic and anaerobic fitness were respectively evaluated by time for a 3000-meter run and numbers of 2-minute sit-ups and 2-minute push-ups. Analysis of covariance (ANCOVA) with adjustments for age and sex was used to determine the relationship. RESULTS: The mean time (sec) for a 3000-meter run (standard error) under slight and great stress differed from that under normal stress in the normal weight (881.0 (11.0) and 877.9 (5.8) vs. 862.2 (1.7), p=0.089 and 0.0088, respectively) and in the obesity (928.1 (16.8) and 921.8 (10.7) vs. 895.2 (1.6), p=0.054 and 0.016, respectively), while the differences were not significant in the overweight (877.1 (12.7) and 877.5 (7.1) vs. 867.1 (2.1), both p >0.5). The impacts of the BMI on 2-minute sit-ups had a similar pattern with that on a 3000-meter run whereas the impact of the BMI on 2-minute push-ups was insignificant. CONCLUSIONS: Mental stress may not affect physical fitness in overweight military personnel. The mechanism is not clear and should be further investigated.


Subject(s)
Cardiorespiratory Fitness , Military Personnel , Body Mass Index , Hospitalization , Humans , Stress, Psychological/diagnosis , Stress, Psychological/epidemiology
9.
PLoS One ; 16(11): e0260033, 2021.
Article in English | MEDLINE | ID: covidwho-1708486

ABSTRACT

Medical leaders have warned of the potential public health burden of a "parallel pandemic" faced by healthcare workers during the COVID-19 pandemic. These individuals may have experienced scenarios in which their moral code was violated resulting in potentially morally injurious events (PMIEs). In the present study, hierarchical linear modeling was utilized to examine the role of PMIEs on COVID-19 pandemic-related difficulties in psychosocial functioning among 211 healthcare providers (83% female, 89% White, and an average of 11.30 years in their healthcare profession [9.31]) over a 10-month span (May 2020 -March 2021). Reported exposure to PMIEs was associated with statistically significant poorer self-reported psychosocial functioning at baseline and over the course of 10-months of data collection. Within exploratory examinations of PMIE type, perceptions of transgressions by self or others (e.g., "I acted in ways that violated my own moral code or values"), but not perceived betrayal (e.g., "I feel betrayed by leaders who I once trusted"), was associated with poorer COVID-19 related psychosocial functioning (e.g., feeling connected to others, relationship with spouse or partner). Findings from this study speak to the importance of investing in intervention and prevention efforts to mitigate the consequences of exposure to PMIEs among healthcare providers. Interventions for healthcare providers targeting psychosocial functioning in the context of moral injury is an important area for future research.


Subject(s)
COVID-19/psychology , Health Personnel/psychology , Pandemics , Stress Disorders, Post-Traumatic/epidemiology , Adult , COVID-19/epidemiology , COVID-19/virology , Female , Humans , Male , Middle Aged , Military Personnel/psychology , Psychosocial Functioning , Public Health , SARS-CoV-2/pathogenicity , Stress Disorders, Post-Traumatic/psychology , Veterans/psychology
10.
Int J Environ Res Public Health ; 19(4)2022 Feb 16.
Article in English | MEDLINE | ID: covidwho-1703778

ABSTRACT

(1) Background: Burnout syndrome (BOS) is defined as a psychological state of physical and mental fatigue associated with work. The COVID-19 pandemic greatly impacted the physical and mental wellbeing of health professionals. The objective of this work was to determine the impact on personnel, monitoring the frequency of BOS throughout the pandemic. (2) Methods: The Maslach Burnout Inventory (MBI) was self-applied in four periods of the pandemic according to sociodemographic and employment characteristics. In this study, all hospital personnel were included; the association of BOS with sex, age, type of participant (civilian or military), military rank and profession was analyzed. (3) Results: The frequency of BOS was 2.4% (start of the pandemic), 7.9% (peak of the first wave), 3.7% (end of the first wave) and 3.6% (peak of the third wave). Emotional exhaustion (EE) was the most affected factor, and the groups most affected were men under 30 years of age, civilians, chiefs and doctors, especially undergraduate medical doctors and specialty resident doctors, and nursing personnel were less affected. (4) Conclusions: The low BOS levels show that the containment measures and military training implemented by the hospital authorities were effective, although the chief personnel were more affected in the first wave. It is probable that this combination allowed the containment of BOS, which was not observed in civilians.


Subject(s)
Burnout, Professional , COVID-19 , Military Personnel , Burnout, Professional/epidemiology , Burnout, Professional/psychology , Burnout, Psychological , COVID-19/epidemiology , Humans , Male , Pandemics , Personnel, Hospital , SARS-CoV-2 , Surveys and Questionnaires , Tertiary Care Centers
11.
Prehosp Disaster Med ; 37(1): 139-141, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1692727

ABSTRACT

Following the Taliban influx in August 2021, several Western countries repatriated nationals and evacuated others from Kabul Airport in Afghanistan. This report aimed to describe medical experiences from the consular repatriation and evacuation operation.Memos from personal conversations with seven professionals involved in these operations formed the basis for this report.Minor trauma, gastrointestinal symptoms, dehydration, fever, and mental distress were common. Bandages, oral rehydration solution, and the administration of paracetamol were needed, in addition to medical evaluation of acuity. In consular repatriation and humanitarian evacuations, medical attendance should be prioritized to manage medical needs of individuals being evacuated, but also from a public health perspective. The medical needs covered a broad specter of infection disease symptoms, trauma, and mental health problems among patients of all ages. Since the nature of consular repatriations and evacuations can be challenging from safety and infrastructural aspects, general medical emergency awareness with an ability to effectively evaluate and manage both somatic and mental health emergencies on the ground and in the air, among both children and adults, is needed.


Subject(s)
Communicable Diseases , Military Personnel , Adult , Afghanistan , Child , Humans , Research Report , Retrospective Studies
13.
Int J Environ Res Public Health ; 19(3)2022 01 31.
Article in English | MEDLINE | ID: covidwho-1677689

ABSTRACT

Previous research shows a nonlinear dependency between hair cortisol concentrations and perceived stress levels. This may be due to stress being targeted at the individual level despite it also being a social phenomenon which is often affected by group dynamics. Therefore, the objective of this study was to determine the influence of perceived stress on the hair cortisol level, considering the impact of the variables of group dynamics (interpersonal, task, and norm cohesion). Information was collected on 11 groups of, in total, 112 young men in three phases of time during their compulsory military training (covering nine months in total). The classification and regression tree (C&RT) method was used to predict hair cortisol concentrations in groups. The results show that the variability of the hair cortisol level in young men groups can be explained by perceived stress only when the groups were in formation process (47.7% normalised importance in Model 1) and when the groups were working on their final tasks (37.80% normalised importance in Model 3); meanwhile, the importance of perceived stress in explaining hair cortisol concentrations is low when the group is in a routine period of a group life-span (28.9% normalised importance in Model 2). Interpersonal cohesion (normalised importance 100% in Model 1 and 80.0% in Model 3) and task cohesion (normalised importance 78.6% in Model 2) were the most important predictors in the study area. These results point to the importance of the elements of group dynamics when it comes to explaining the nature of hair cortisol as accumulated stress biomarkers in young men.


Subject(s)
Hydrocortisone , Military Personnel , Humans , Lithuania , Longitudinal Studies , Male , Stress, Psychological
14.
Aerosp Med Hum Perform ; 93(2): 94-98, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1674314

ABSTRACT

BACKGROUND: The coronavirus epidemic originated in China, having its epicenter in Wuhan. This was the first place in the world to adopt social distancing measures to contain the disease on January 23rd, 2020. After the initial isolation, several countries started making diplomatic plans to evacuate and repatriate their citizens, with the permission of the Chinese authorities. Due to the high risk of exposure of the transported passengers, evacuations were conducted with preventive measures against contamination by biological agents.CASE REPORT: We report the air evacuation of 39 passengers from China to Brazil. Five passengers were transported to Poland and the remaining 34 went to Brazil, where they remained in quarantine for 14 d. The mission was triggered on February 4th, named "Operation Return to Brazil" (Operação Regresso à Pátria Amada Brasil), and conducted by military personnel of the Brazilian Air Force. The mission was accomplished in 6 days; the flight from Wuhan lasted 25 h 20 min; and, additionally, there were on-ground preparations.DISCUSSION: Only with adequate isolation and protective measures was it possible to air evacuate the potentially contaminated passengers in the initial phase of the pandemic. Specific protective equipment (Personal Protective Equipment - PPE) is mandatory for missions in which the properties of the potentially contagious biological agent are not fully known, as was the case. Due to the risk of contamination of passengers and the likely evolution of the transport into an aeromedical evacuation, protocols stating the minimum safety conditions for this kind of patient transport must be followed, with consideration for the patient as well as the crew.Gomes ED, Ronconi MABR, Santos MB, Júnior PP, Franco AZP, Haberland DF, Borges LL. Air evacuation of citizens during the COVID-19 epidemic. Aerosp Med Hum Perform 2022; 93(2):94-98.


Subject(s)
COVID-19 , Military Personnel , Brazil , China/epidemiology , Humans , SARS-CoV-2
15.
PLoS One ; 17(2): e0263472, 2022.
Article in English | MEDLINE | ID: covidwho-1666780

ABSTRACT

Health inequalities based on race are well-documented, and the COVID-19 pandemic is no exception. Despite the advances in modern medicine, access to health care remains a primary determinant of health outcomes, especially for communities of color. African-Americans and other minorities are disproportionately at risk for infection with COVID-19, but this problem extends beyond access alone. This study sought to identify trends in race-based disparities in COVID-19 in the setting of universal access to care. Tripler Army Medical Center (TAMC) is a Department of Defense Military Treatment Facility (DoD-MTF) that provides full access to healthcare to active duty military members, beneficiaries, and veterans. We evaluated the characteristics of individuals diagnosed with SARS-CoV-2 infection at TAMC in a retrospective, case-controlled (1:1) study. Most patients (69%) had received a COVID-19 test within 3 days of symptom onset. Multivariable logistic regression analyses were used to identify factors associated with testing positive and to estimate adjusted odds ratios. African-American patients and patients who identified as "Other" ethnicities were two times more likely to test positive for SARS-CoV-2 relative to Caucasian patients. Other factors associated with testing positive include: younger age, male gender, previous positive test, presenting with >3 symptoms, close contact with a COVID-19 positive patient, and being a member of the US Navy. African-Americans and patients who identify as "Other" ethnicities had disproportionately higher rates of positivity of COVID-19. Although other factors contribute to increased test positivity across all patient populations, access to care does not appear to itself explain this discrepancy with COVID-19.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , Military Personnel/statistics & numerical data , SARS-CoV-2/isolation & purification , COVID-19/epidemiology , COVID-19/virology , Case-Control Studies , Female , Hawaii/epidemiology , Humans , Male , Retrospective Studies
16.
Int J Environ Res Public Health ; 19(3)2022 01 29.
Article in English | MEDLINE | ID: covidwho-1667148

ABSTRACT

INTRODUCTION: Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events leaving them at risk of developing mental health conditions such as post-traumatic stress disorder (PTSD). Increasing concern is being raised regarding the mental health impacts, specifically PTSD, among military personnel and firefighters. OBJECTIVE: There is an increased exposure of firefighters and military personnel to traumatic events and the attendant risk of developing post-traumatic stress disorder. It is crucial to ascertain the level of PTSD amongst this cohort and determinants to formulate policies and practices that mitigate the risk and protect public safety personnel. This scoping review sought to determine the prevalence of PTSD among this cohort globally and to explore determinants of this mental health condition. METHODS: A literature search in databases including MEDLINE, CINAHL, PubMed, PsycINFO, and EMBASE was conducted electronically from May 2021 to 31 July 2021. Two reviewers independently assessed full-text articles according to the predefined inclusion criteria and screening process undertaken to identify studies for the review. Articles were screened with a third reviewer, resolving conflicts where necessary and further assessing them for eligibility. During article selection, the PRISMA checklist was adopted, and with the Covidence software, a total of 32 articles were selected for the final examination. For the eligible studies, data extraction was conducted, information was collated and summarized, and the findings were reported. Original qualitative and quantitative data on the prevalence and predictors of PTSD among veterans, military, and firefighters were reported. RESULTS: The prevalence of PTSD was 57% for firefighters and 37.8% for military personnel. Demographic factors, job factors, social support, injuries, physical and psychological factors, and individual traits were the main predictors of PTSD in this cohort. CONCLUSION: This information is vital for developing and implementing prevention and intervention strategies for PTSD in military personnel and firefighters. Recognizing and addressing factors that predict PTSD will help to improve mental wellbeing and increase productivity. More peer-reviewed studies are needed on the prevalence of PTSD amongst these cohorts.


Subject(s)
Firefighters , Military Personnel , Stress Disorders, Post-Traumatic , Humans , Military Personnel/psychology , Prevalence , Public Policy , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology
17.
J Med Microbiol ; 71(1)2022 Jan.
Article in English | MEDLINE | ID: covidwho-1662162

ABSTRACT

Coronavirus disease 2019 (COVID-19) is transmitted person-to-person mainly by close contact or droplets from respiratory tract. However, the actual time of viral shedding is still uncertain as well as the different routes of transmission. We aimed to characterize RNA shedding from nasopharyngeal and rectal samples in prolonged cases of mild COVID-19 in young male soldiers. Seventy patients from three different military locations were monitored after recommending to follow more strict isolation measures to prevent the spread of the virus. Then, nasopharyngeal, rectal, and blood samples were taken. SARS-CoV-2 RNA was detected by RT-PCR and specific antibodies by chemiluminescent immunoassays. The median nucleic acid conversion time (NACT) was 60 days (IQR: 7-85 days). Rectal swabs were taken in 60 % of patients. Seven patients (10 %) were positive in nasopharyngeal and rectal swabs, and five (7.14 %) remained positive in rectal swabs, but negative in nasopharyngeal samples. Four patients (5.71 %) that had been discharged, were positive again after 15 days. No significant difference was found in nucleic acid conversion time between age groups nor clinical classification. Maintaining distancing among different positive patients is essential as a possible re-exposure to the virus could cause a longer nucleic acid conversion time in SARS-COV-2 infections.


Subject(s)
Antibodies, Viral/blood , COVID-19 , Immunoglobulin G/blood , RNA, Viral/analysis , COVID-19/diagnosis , COVID-19/prevention & control , Disease Outbreaks , Humans , Male , Military Personnel , SARS-CoV-2 , Virus Shedding
18.
Eur J Psychotraumatol ; 13(1): 2013651, 2022.
Article in English | MEDLINE | ID: covidwho-1650963

ABSTRACT

Background: Does exposure to events that transgress accepted norms, such as killing innocent civilians, prompt the psychological and emotional consequences of moral injury among soldiers? Moral injury is associated with negative emotions such as guilt, shame and anger, and a sense of betrayal and is identified among veterans following exposure to potentially morally injurious events (PMIE). Objective: We experimentally investigate how PMIE characteristics affect the intensity of MI and related negative moral emotions in participants with varied military experience. Method: We conducted three controlled, randomized experiments. Each exposed male respondents with active combat experience (Study 1) and varied military experience (Study 2) to four textual vignettes describing PMIE (child/adult and innocent/non-innocent suspect) that transpire at an Israeli checkpoint in the West Bank. In study 3, we exposed participants to two scenarios, where descriptions of police officers enforcing COVID 19 restrictions confronted lockdown violators. Results: Participants assigned to vignettes describing killing an innocent civilian exhibited more intense levels of shame and guilt than those assigned to vignettes describing killing a person carrying a bomb. Religiosity and political ideology were strong predictors of guilt and shame in response to descriptions of checkpoint shootings. These effects disappeared in Study 3, suggesting that political ideology drives MI in intergroup conflict. Conclusions: Background and PMIE-related characteristics affect the development of moral injury. Additionally, lab experiments demonstrate the potential and limitations of controlled studies of moral injury and facilitate an understanding of the aetiology of moral injury in a way unavailable to clinicians. Finally, experimental findings and methodologies offer further insights into the genesis of moral injury and avenues for therapy and prophylaxis.


Antecedentes: ¿La exposición a eventos que transgreden las normas aceptadas, como matar a civiles inocentes, provocan las consecuencias psicológicas y emocionales del daño moral entre los soldados? El daño moral (DM) se asocia con emociones negativas como la culpa, la vergüenza y la ira, y un sentido de traición y es identificado entre los veteranos después de la exposición a eventos potencialmente dañinos moralmente (EPDM).Objetivo: Investigamos experimentalmente cómo las características de EPDM afectan la intensidad del DM y emociones moralmente negativas relacionadas en participantes con vasta experiencia militar.Método: Realizamos tres experimentos controlados y aleatorizados. Cada varón expuesto respondió con experiencia en combate activo (Estudio 1) y vasta experiencia militar (Estudio 2) a cuatro viñetas textuales que describen EPDM (niño/adulto y sospechoso inocente/no inocente) que suceden en un puesto de control israelí en Cisjordania. En el estudio 3, expusimos a los participantes a dos escenarios, donde las descripciones de los agentes de policía que aplicaban las restricciones de COVID-19 enfrentaron a los infractores del confinamiento.Resultados: Los participantes asignados a viñetas que describen el asesinato de un civil inocente exhibieron niveles más intensos de vergüenza y culpa que los asignados a las viñetas que describen el asesinato de una persona llevando una bomba. La religiosidad y la ideología política fueron fuertes predictores de culpa y vergüenza en respuesta a descripciones de tiroteos en puestos de control. Estos efectos desaparecieron en el Estudio 3, lo que sugiere que la ideología política impulsa al DM en los conflictos intergrupales.Conclusiones: Los antecedentes y las características relacionadas con el EPDM afectan el desarrollo del daño moral. Adicionalmente, los experimentos de laboratorio demuestran el potencial y las limitaciones de los estudios de daño moral y facilitan una comprensión de la etiología del daño moral de una manera no disponible para los clínicos. Por último, los hallazgos y las metodologías experimentales ofrecen perspectivas adicionales en la génesis del daño moral y las vías para la terapia y la profilaxis.


Subject(s)
Military Personnel/psychology , Stress Disorders, Post-Traumatic/psychology , Veterans/psychology , Adult , Anger , COVID-19/epidemiology , Child, Preschool , Guilt , Humans , Israel/epidemiology , Male , Pandemics/legislation & jurisprudence , Shame , Stress Disorders, Post-Traumatic/epidemiology , Surveys and Questionnaires
19.
J Korean Med Sci ; 37(3): e23, 2022 Jan 17.
Article in English | MEDLINE | ID: covidwho-1637689

ABSTRACT

BACKGROUND: The military was one of the first groups in Korea to complete mass vaccination against the coronavirus disease 2019 (COVID-19) due to their high vulnerability to COVID-19. To confirm the effect of mass vaccination, this study analyzed the patterns of confirmed cases within Korean military units. METHODS: From August 1 to September 15, 2021, all epidemiological data regarding confirmed COVID-19 cases in military units were reviewed. The number of confirmed cases in the units that were believed to have achieved herd immunity (i.e., ≥ 70% vaccination) was compared with the number of cases in the units that were not believed to have reached herd immunity (< 70% vaccination). Additionally, trends in the incidence rates of COVID-19 in the military and the entire Korean population were compared. RESULTS: By August 2021, 85.60% of military personnel were fully vaccinated. During the study period, a total of 174 COVID-19 cases were confirmed in the 39 units. More local transmission (herd immunity group vs. non-herd immunity group [%], 1 [0.91] vs. 39 [60.94]) and hospitalizations (12 [11.01] vs. 13 [27.08]) occurred in the units that were not believed to have achieved herd immunity. The percentage of fully vaccinated individuals among the confirmed COVID-19 cases increased over time, possibly due to the prevalence of the delta variant. Nevertheless, the incidence rate remained lower in military units than in the general Korean population. CONCLUSION: After completing mass vaccination, the incidence rates of COVID-19 infection in the military were lower than those in the national population. New cluster infections did not occur in vaccinated units, thereby suggesting that herd immunity has been achieved in these military units. Further research is needed to determine the extent to which levels of non-pharmacological intervention can be reduced in the future.


Subject(s)
COVID-19/epidemiology , Mass Vaccination/statistics & numerical data , Military Personnel/statistics & numerical data , COVID-19/prevention & control , COVID-19 Vaccines , Hospitalization/statistics & numerical data , Humans , Immunity, Herd/immunology , Incidence , Republic of Korea/epidemiology , SARS-CoV-2/immunology
20.
BMC Psychiatry ; 22(1): 41, 2022 01 17.
Article in English | MEDLINE | ID: covidwho-1636483

ABSTRACT

BACKGROUND: Trauma-focused psychotherapies for combat-related posttraumatic stress disorder (PTSD) in military veterans are efficacious, but there are many barriers to receiving treatment. The objective of this study was to determine if cognitive processing therapy (CPT) for PTSD among active duty military personnel and veterans would result in increased acceptability, fewer dropouts, and better outcomes when delivered In-Home or by Telehealth as compared to In-Office treatment. METHODS: The trial used an equipoise-stratified randomization design in which participants (N = 120) could decline none or any 1 arm of the study and were then randomized equally to 1 of the remaining arms. Therapists delivered CPT in 12 sessions lasting 60-min each. Self-reported PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5) served as the primary outcome. RESULTS: Over half of the participants (57%) declined 1 treatment arm. Telehealth was the most acceptable and least often refused delivery format (17%), followed by In-Office (29%), and In-Home (54%); these differences were significant (p = 0.0008). Significant reductions in PTSD symptoms occurred with all treatment formats (p < .0001). Improvement on the PCL-5 was about twice as large in the In-Home (d = 2.1) and Telehealth (d = 2.0) formats than In-Office (d = 1.3); those differences were statistically large and significant (d = 0.8, 0.7 and p = 0.009, 0.014, respectively). There were no significant differences between In-Home and Telehealth outcomes (p = 0.77, d = -.08). Dropout from treatment was numerically lowest when therapy was delivered In-Home (25%) compared to Telehealth (34%) and In-Office (43%), but these differences were not statistically significant. CONCLUSIONS: CPT delivered by telehealth is an efficient and effective treatment modality for PTSD, especially considering in-person restrictions resulting from COVID-19. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT02290847 (Registered 13/08/2014; First Posted Date 14/11/2014).


Subject(s)
COVID-19 , Cognitive Behavioral Therapy , Military Personnel , Stress Disorders, Post-Traumatic , Telemedicine , Veterans , Humans , SARS-CoV-2 , Stress Disorders, Post-Traumatic/therapy , Treatment Outcome
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