Comparison of Musculoskeletal Injury and Behavioral Health Diagnoses Among U.S. Army Active Duty Servicewomen in Ground Combat and Non-Ground Combat Military Occupational Specialties.

INTRODUCTION: The U.S. Army's Soldier 2020 program, which started in January 2016, was designed to achieve full integration of women in all military occupational specialties. This study was undertaken to determine differences in risk of musculoskeletal injury and behavioral health (BH) disorders among U.S. Army Active Duty Servicewomen (ADSW) in ground combat military occupational specialties (MOS) versus those in non-ground combat MOS since the start of the program until January 2019. MATERIALS AND METHODS: Using healthcare claims data from the Military Health System's Data Repository we conducted a cross-sectional study on ADSW from January 1, 2016 to January 1, 2019 and categorized them as either ground combat specialists (GCSs) or non-ground combat specialists (NGCSs). We identified all female soldiers in our cohort with a musculoskeletal injury (MSKI) and/or BH diagnosis during the study period. A multivariable logistic regression, adjusted by pregnancy or delivery status, was used to assess risk factors associated with GCS and included soldier age, race, body mass index (BMI), tobacco use, alcohol/substance use, and MSKI and BH status as predictor variables. RESULTS: A total of 92,443 U.S. Army ADSW were identified, of whom 3,234 (3.5%) were GCS (infantry, field artillery, cavalry/armor, and air defense) and 89,209 (96.5%) were in non-ground combat billets. A large difference was observed when comparing the age of the population by occupation; GCS women were predominantly between the ages of 18-23 years (71.9%), compared to NGCS women aged 18-23 (41.0%). Top MSKI and BH diagnoses for both occupations were joint pain (44.9% GCS, 50.2% NGCS) and adjustment disorders (26.2% GCS, 28.0% NGCS). GCS women had lower odds for musculoskeletal injury (0.86 AOR, 0.79-0.93 CI, P = 0.0002), obesity per BMI classification (0.82 AOR, 0.70-0.97 CI, P = 0.0214), and BH disorders (0.87 AOR, 0.80-0.95 CI, P = 0.0019); and higher odds for tobacco use (1.44 AOR, 1.27-1.63 CI, P < 0.0001), substance use (1.36 AOR, 1.04-1.79 CI, P = 0.0257), and alcohol use (1.18 AOR, 1.02-1.38 CI, P = 0.0308) when compared to NGCS women. CONCLUSIONS: With the increasing focus on soldier medical readiness in today's U.S. Army, the health of all soldiers is of paramount concern to command groups, unit leaders, and individual soldiers. The integration of women into ground combat military occupational specialties is a relatively new program; further longitudinal research of these groups should follow, focusing on their progression and improvement in soldier readiness, overall health, and the well-being of all servicewomen.

Intussusception and colonic ischemia in portal hypertension: a case report.

Intestinal intussusception is a relatively uncommon occurrence in adults in comparison to pediatric patients. While the management of intussusception in children is frequently decompression of the involved segment, adults often require surgical resection secondary to frequent association with neoplastic lead points. A less common reason for surgical removal of an intussuscepted segment in adults is the development of ischemic colitis. The authors present an unusual case of adult intussusception with associated ischemic colitis in a patient with portal hypertension awaiting liver transplantation. Portal hypertension is associated with the development of a microvascular colopathy This condition may serve as the lead point for intestinal intussusception. Furthermore, the vascular changes of portal hypertension leave the bowel unable to respond appropriately to the threat of ischemia. The colopathy of portal hypertension may have predisposed our patient to the development of colonic intussusception by submucosal vascular engorgement; it may have also rendered the intussuscepted segment more susceptible to the development of ischemia.