Service members injured in combat undergo repeated surgeries and long recoveries following a traumatic injury that produce a myriad of physical and psychological symptoms.
To describe the severity of ...pain, sleep disturbance, depression, and anxiety in service members with extremity trauma sustained during combat operations at the time of discharge from the hospital and to evaluate for differences in health status between those with and without symptom burden.
Descriptive study of 130 United States Army service members.
More than 80% of the service members were classified as having symptom burden. Service members who reported one or more clinically meaningful levels of pain, sleep disturbance, depression, or anxiety reported significantly worse health status compared to those without symptom burden.
Service members with extremity trauma experience clinically significant levels of pain, sleep disturbance, depression, and/or anxiety at the time of discharge from the hospital. The greater the service members’ symptom burden, the worse their reported health status.
•Sleep disturbance and pain were the most frequently reported symptoms.•The higher the symptom burden, the worse the reported health status.•Higher symptom burden could place patients at risk for delayed recovery.
Abstract Objective Veterans from the wars in Afghanistan and Iraq (OEF/OIF) report high rates of mental distress especially affective disorders. Ensuring continuity of care across institutions is a ...priority for both the Department of Defense (DoD) and the Veterans Health Administration (VHA), yet this process is not monitored nor are medical records integrated. This study assessed transition from DoD to VHA and subsequent psychiatric care of service members traumatically injured in OEF/OIF. Methods Inpatients at a DoD trauma treatment facility discharged in FY02–FY06 (n = 994) were tracked into the VHA via archival data (n = 216 OEF/OIF veterans). Mental health utilization in both systems was analyzed. Results VHA users were 9% female, 15% Hispanic; mean age 32 (SD = 10; range 19–59). No DoD inpatients received diagnoses of post-traumatic stress disorder (PTSD); 21% had other mental health diagnoses, primarily drug abuse. In the VHA, 38% sought care within 6 months of DoD discharge; 75% within 1 year. VHA utilization increased over time, with 88–89% of the transition cohort seeking care in FY07–FY09. Most accessed VHA mental health services (81%) and had VHA psychiatric diagnoses (71%); half met criteria for depression (27%) or PTSD (38%). Treatment retention through FY09 was significantly greater for those receiving psychiatric care: 98% vs 62% of those not receiving psychiatric care (x2 = 53.3; p < .001). Limitations DoD outpatient data were not available. The study relied on administrative data. Conclusions Although physical trauma led to hospitalization in the DoD, high rates of psychiatric disorders were identified in subsequent VHA care, suggesting delay in development or recognition of psychiatric problems.
Soldiers With Musculoskeletal Injuries Jennings, Bonnie M.; Yoder, Linda H.; Heiner, Stacy L. ...
Journal of nursing scholarship,
September 2008, Letnik:
40, Številka:
3
Journal Article
Recenzirano
Purpose: To describe Soldiers' (e.g., U.S. Army personnel) perspectives of the effect of musculoskeletal injuries.
Design: Data were collected in the summer of 2003 using a prospective survey design. ...The survey was mailed to active duty Soldiers on modified work plans because of musculoskeletal injuries. These Soldiers were assigned to one Army installation in the US.
Methods: Responses to the survey questions were analyzed using descriptive statistics. The numerous handwritten comments were evaluated qualitatively.
Findings: Injuries most often involved the back and knees (18% each). At least 47% of the injuries were work related. Injuries interfered with Soldiers' abilities to perform military tasks such as road marching (80%) and organized physical training (69%). Although many respondents indicated they were not experiencing pain, at least some Soldiers reported mild pain for each of 19 anatomic locations. Severe pain was reported most often for the lower back (21%). In their written comments, Soldiers expressed a sense of frustration with their injuries, the healthcare system and providers, and their unit leaders.
Conclusions: Healthcare personnel are challenged to better manage Soldiers with musculoskeletal injuries and expedite their return to full duty. Unit leaders are challenged to create work environments that focus on injury prevention and allow injured Soldiers time to heal.
Clinical Relevance: The Soldiers in this study were often engaged in physically challenging work or sports activities when injured. Because people outside the Army engage in similar activities (e.g., construction workers, endurance athletes), the findings from this study might be applicable to nonmilitary communities. Additionally, with the number of Reserve and National Guard Soldiers currently on active duty, civilian nurses might be caring for Soldiers with musculoskeletal injuries.
The number of children at risk for overweight/obesity has increased dramatically in the last decade worldwide. This study compares measures of obesity (body mass index BMI and body fat percentage) ...and total cholesterol in 4,013 fourth-grade students from three countries, France, Japan, and the United States. Data were analyzed using
t test, chi-square, and analysis of variance to determine differences between groups and by multiple linear regression. All variables differed significantly by group. BMI was highest in U.S. children. Body fat percentage was also highest in U.S. children and lowest in French children. Total cholesterol was highest in French children and lowest in U.S. White children. There were modest but significant associations between BMI and cholesterol in all groups except French children; associations varied by gender. Results indicate there was great variation in measures of obesity and cholesterol by country. The association between obesity and cholesterol may vary by culture, ethnicity, and gender.
The effects of filgotinib on patient-reported outcomes (PROs) from 3 trials in patients with active rheumatoid arthritis were investigated.
Methotrexate (MTX)-naïve patients received filgotinib 200 ...or 100 mg plus MTX (FIL200+MTX, FIL100+MTX), filgotinib 200 mg monotherapy (FIL200), or MTX monotherapy through 52 weeks (NCT02886728). Patients with inadequate response (IR) to MTX (MTX-IR) received FIL200+MTX, FIL100+MTX, adalimumab 40 mg +MTX (ADA+MTX), or placebo (PBO)+MTX (rerandomized to FIL200+MTX or FIL100+MTX at week 24) through 52 weeks (NCT02889796). Patients with IR to biologic disease-modifying antirheumatic drugs (bDMARD-IR) received FIL200 or FIL100 or PBO with background stable conventional synthetic (cs) DMARDs for up to 24 weeks (NCT02873936). PROs included Health Assessment Questionnaire-Disability Index (HAQ-DI), Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) physical/mental component summary (PCS/MCS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), Work Productivity and Activity Impairment Questionnaire-Rheumatoid Arthritis (WPAI-RA), and Patient Global Assessment of Disease Activity (PtGA). Data are reported as least-squares mean changes from baseline with standard error to the timepoint representing each study's primary endpoint. All statistical comparisons are of filgotinib groups vs their respective control groups.
At week 24, among MTX-naïve patients, change from baseline (standard deviation) in HAQ-DI was - 1.00 (0.03; P < 0.001) with FIL200+MTX, - 0.94 (0.04; P < 0.01) with FIL100+MTX, and - 0.91 (0.04; P < 0.05) with FIL200 alone compared with - 0.81 (0.03) with MTX alone. At week 12, among MTX-IR patients, change from baseline in HAQ-DI was - 0.69 (0.04; P < 0.001 vs PBO+MTX, P < 0.05 vs ADA) with FIL200+MTX, - 0.57 (0.04; P < 0.001 vs placebo) with FIL100+MTX, and - 0.60 (0.04) with ADA vs - 0.40 (0.04) with PBO+MTX. At week 12, among bDMARD-IR patients, change from baseline in HAQ-DI was - 0.50 (0.06; P < 0.001) with FIL200+csDMARD and - 0.46 (0.05; P < 0.001) with FIL100+csDMARD vs - 0.19 (0.06) with placebo+csDMARD. Changes in SF-36 PCS and MCS, FACIT-Fatigue, WPAI, and PtGA tended to favor filgotinib over PBO, MTX, and ADA. Greater proportions of patients experienced clinically meaningful differences with either dosage of FIL in combination with csDMARDs (including MTX) and with FIL200 monotherapy vs comparators.
Filgotinib provided improvements in PROs across patient populations. These findings suggest filgotinib can be an effective treatment option for patients with insufficient response to MTX or bDMARDs and patients who are MTX-naïve.
ClinicalTrials.gov , FINCH 1, NCT02889796 , first posted September 7, 2016; FINCH 2, NCT02873936 , first posted August 22, 2016, retrospectively registered; FINCH 3, NCT02886728 , first posted September 1, 2016, retrospectively registered.
The purpose of this study was to explore the phenomenon of fatigue and thus generate the essential structure of fatigue. Using a phenomenological research method, 11 soldiers were asked to describe ...their experience of fatigue. Four predominant themes were revealed from the data: the experience of physical fatigue, mental fatigue, mental and physical integration, and disruption of essential life patterns due to the experience of fatigue. Findings are valuable as a description of fatigue for healthy individuals, and useful in developing strategies for coping with and decreasing the effects of overwhelming fatigue experiences. With health viewed as a value and a process, nursing practice and research must include each person's own perspective of quality of life. Further qualitative studies are needed to develop descriptions of fatigue and interventions to recognize and alleviate it.
PDF
