Naval Health Research Center

Brooks, KY, United States

Naval Health Research Center

Brooks, KY, United States
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News Article | March 2, 2017
Site: www.eurekalert.org

New Rochelle, NY, March 1, 2017--A study of U.S. Navy healthcare personnel has shown that when comparing the prevalence of post-traumatic stress disorder (PTSD) among women and men who had similar deployment experiences, and especially combat experience, the risk of PTSD was significantly higher among women. PTSD risk rose for both men and women with an increasing number of combat exposures, as reported in Journal of Women's Health, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. The article is available free on the Journal of Women's Health website until April 1, 2017. Andrew MacGregor, PhD, MPH, Mary Clouser, PhD, MPH, Jonathan Mayo, MPH, and Michael Galarneau, Naval Health Research Center, San Diego, CA, present their findings in the article entitled, "Gender Differences in Posttraumatic Stress Disorder Among U.S. Navy Health Care Personnel." The researchers reviewed gathered data from the deployment records and post-deployment health assessments of more than 4,200 men and women who served in the U.S. Navy and supported military operations in Iraq and Afghanistan. "As the numbers of women in the military increase and their roles continue to expand in health care and other combat-related areas, it is important to be aware of any gender differences in risk for PTSD," says Susan G. Kornstein, MD, Editor-in-Chief of Journal of Women's Health, Executive Director of the Virginia Commonwealth University Institute for Women's Health, Richmond, VA, and President of the Academy of Women's Health. "Understanding specific factors that may increase or reduce PTSD risk, including those related to deployment, can contribute to improved prevention and treatment strategies" Journal of Women's Health, published monthly, is a core multidisciplinary journal dedicated to the diseases and conditions that hold greater risk for or are more prevalent among women, as well as diseases that present differently in women. Led by Editor-in-Chief Susan G. Kornstein, MD, Executive Director of the Virginia Commonwealth University Institute for Women's Health, Richmond, VA, and President of the Academy of Women's Health, the Journal covers the latest advances and clinical applications of new diagnostic procedures and therapeutic protocols for the prevention and management of women's healthcare issues. Complete tables of content and a sample issue may be viewed on the Journal of Women's Health website. Journal of Women's Health is the official journal of the Academy of Women's Health and the Society for Women's Health Research. Academy of Women's Health is an interdisciplinary, international association of physicians, nurses, and other health professionals who work across the broad field of women's health, providing its members with up-to-date advances and options in clinical care that will enable the best outcomes for their women patients. The Academy's focus includes the dissemination of translational research and evidence-based practices for disease prevention, diagnosis, and treatment of women across the lifespan. Journal of Women's Health and the Academy of Women's Health are co-presenters of Women's Health 2017: The 25th Anniversary Congress which will take place April 28-30, 2017 in Washington, DC. Mary Ann Liebert, Inc., publishers is a privately held, fully integrated media company known for establishing authoritative peer-reviewed journals in many promising areas of science and biomedical research, including LGBT Health, Transgender Health, Population Health Management, and Breastfeeding Medicine. Its biotechnology trade magazine, GEN (Genetic Engineering & Biotechnology News), was the first in its field and is today the industry's most widely read publication worldwide. A complete list of the firm's 80 journals, books, and newsmagazines is available on the Mary Ann Liebert, Inc., publishers website.


Sgaier S.K.,Bill and Melinda Gates Foundation | Sgaier S.K.,University of Washington | Reed J.B.,Office of the U.S. Global AIDS Coordinator | Thomas A.,Naval Health Research Center | Njeuhmeli E.,United States Agency for International Development
PLoS Medicine | Year: 2014

Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009-2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection "Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up." The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform.


News Article | November 4, 2015
Site: www.nature.com

In 2009, following the abuse of prisoners at its Guantanamo Bay detention camp, the US government made a significant decision. It moved the responsibility for 'enhanced interrogation techniques' from the CIA to a new government organization: the High-Value Detainee Interrogation Group (HIG). The move upset many CIA insiders; torture had been in their toolkit since the early days of the cold war. The remarks of one official at a HIG-organized conference on torture in Washington DC can be summed up as: how could a new agency, created to both conduct and study torture, replace the decades of practice and perfection attained by the CIA? By adding a scientific component, responded the newly appointed head of the HIG. This exchange highlights the theme of neuroscientist Shane O'Mara's Why Torture Doesn't Work. Rightly, O'Mara takes a moral stand against torture (forced retrieval of information from the memories of the unwilling). However, instead of simply providing utilitarian arguments, he argues that there is no evidence from psychology or neuroscience for many of the specious justifications of torture as an information-gathering tool. Providing an abundance of gruesome detail, O'Mara marshals vast, useful information about the effects of such practices on the brain and the body. For instance, he explains why, physiologically, it is ludicrous to claim that stress, pain and fear will coerce a suspect to surrender critical information. The prolonged release of stress hormones such as cortisol damages the hippocampus — a brain structure crucial for encoding and retrieving memories — as well as the prefrontal cortex, which is implicated in decision-making and executive control processes. Such damage works in opposition to the goal of torture. Furthermore, chronic stress creates a negative feedback loop, causing enlargement and hyperresponsiveness of the amygdala, the brain structure that underlies emotional salience, directs attention, enables learning and communicates with most of the brain. Another striking example that O'Mara discusses is the effect on the brain of sleep deprivation. The practice was described in the 'Torture Memos' — legal memoranda drafted in 2002 by US deputy assistant attorney general John Yoo, advising the CIA and President George W. Bush on the use of torture. Officially limited to a maximum of 180 hours, and often combined with physical restraint, isolation, starvation and beatings, sleep deprivation has been used to coerce subjects into revealing information. The memos further argue that sleep deprivation is harmless. O'Mara, however, discusses research suggesting that it erodes memory processes and general cognitive function by flooding the brain with glucocorticoid hormones. Even military scientists have produced literature that admits psychophysiological issues with sleep deprivation. In 1990, Paul Naitoh and his colleagues at the US Naval Health Research Center in San Diego, California, published evidence that the practice leads to an increase in circulating stress hormones and the development of psychomotor epileptic discharges (P. Naitoh et al. Occup. Med. 5, 209–237; 1990). They argued, too, that if combined with other stressors, such as food and water deprivation and waterboarding, sleep deprivation could negatively affect respiratory–cardiovascular function. Yet some officials and politicians continue to make announcements that run counter to such scientific evidence. Former Pennsylvania senator and Republican presidential hopeful Rick Santorum, for instance, commented in a 2011 interview that after being broken, people become cooperative. Most shocking may be this year's revelation that a handful of officials in the American Psychological Association were complicit in torture by the United States after the September 2001 attacks on New York and the Pentagon, thus providing a veil of scientific legitimacy to the practice. Torture also affects the torturer. The cognitive dissonance required to inflict suffering results in symptoms similar to those of post-traumatic stress disorder, O'Mara warns. He cites Joshua Phillips's None of Us Were Like This Before (Verso, 2010), which describes how many US veterans who had engaged in torture in Iraq experienced intense guilt or turned to substance abuse once back in the United States. Interviews with former interrogators in Northern Ireland, published by Ian Cobain in Cruel Britannia (Portobello, 2012), reveal that many believed what they had done was wrong, but saw it as a desperate attempt to end the violence engulfing their society. Given that information obtained under torture is rarely reliable (because the victim will generally say anything to make the pain stop) O'Mara recommends an alternative: conversation. Having a conversation with a detainee may yield results comparable, and probably superior, to those obtained from torture. He cites three pieces of evidence. First is a 1993 study by Stephen Moston and Terry Engelberg of police interrogations, which found that of more than 1,000 detainees, only 5% refused to talk (S. Moston and T. Engelberg Polic. Soc. 3, 223–237; 1993). Second, research by Robin Dunbar and his colleagues finds that 40% of what we reveal in conversation is related to the self, suggesting that refusing to self-disclose is very difficult ( et al. Hum. Nat. 8, 231–246; 1997). Third, a study by Diana Tamir and Jason Mitchell showed that people are willing to forgo money to talk to others about themselves. Indeed, the nucleus accumbens (part of the brain's reward circuitry) activates during such an opportunity, suggesting that people find disclosure intrinsically rewarding ( and Proc. Natl Acad. Sci. USA 109, 8038–8043; 2012). O'Mara does acknowledge that the difficulties of having such a conversation with a non-compliant person demand advanced social skills that are comparable to those of clinical psychologists and psychiatrists, who often deal with non-compliant patients. He suggests that alternative approaches such as virtual reality and role playing may be useful for information gathering during interrogation. Why then, given its uselessness in eliciting valuable information, do people torture? It is a form of vengeance or punishment, intended to discourage the victim from future transgressions and to communicate to others that harm will not be tolerated. In some cases, it occurs because the torturer believes that terrorists have mental illnesses. In science, however, punishment is not a viable response to someone with such an illness — just as torture is not a viable method for gathering information, as O'Mara repeatedly points out.


To describe current efforts and future potential for understanding long-term health of military service members by linking the Millennium Cohort Study data to exposures and health outcomes. The Millennium Cohort Study launched in 2001, before September 11 and the start of combat operations in Afghanistan and Iraq. Other substantial Department of Defense (DoD) health, personnel, and exposure databases are maintained in electronic form and may be linked by personal identifiers. More than 150,000 consenting members comprise the Millennium Cohort from all services, and include active duty, Reserve, and National Guard current and past members, and represent demographic, occupational, military, and health characteristics of the U.S. military. These prospective data offer symptom assessment, behavioral health, and self-reported exposures that may complement and fill gaps in capability presented by other DoD electronic health and exposure data. In conjunction with Millennium Cohort survey data, prospective individual-level exposure and health outcome assessment is crucial to understand and quantify any long-term health outcomes potentially associated with unique military occupational exposures.


Macera C.A.,Naval Health Research Center | Aralis H.J.,Naval Health Research Center | Rauh M.J.,Naval Health Research Center | MacGregor A.J.,Naval Health Research Center
Sleep | Year: 2013

Study Objectives: Military members screening positive for blast-related traumatic brain injury (TBI) may subsequently screen positive for posttraumatic stress disorder (PTSD) or depression. The role of sleep as a mediating factor in the development of mental health symptoms was explored. Design: Prospective study with symptoms evaluated at two time points. Setting: Postdeployment service in Iraq, Afghanistan, or Kuwait during 2008 and 2009. Participants: There were 29,640 US Navy and Marine Corps men (29,019 who did not screen positive for PTSD at baseline, 27,702 who did not screen positive for depression at baseline, and 27,320 who did not screen positive at baseline for either condition). Measurements and Results: After controlling for sleep problems, the adjusted odds of receiving a positive PTSD screening at follow-up decreased from 1.61 (95% confidence interval [CI] 1.21-2.14) to 1.32 (95% CI 0.99-1.77) for a subject screening positive for TBI relative to a subject screening negative, suggesting that sleep problems mediated 26% of TBI's effect on development of PTSD. Likewise, after controlling for sleep problems, the adjusted odds of receiving a positive depression screening decreased from 1.41 (95% CI 1.11-1.80) to 1.15 (95% CI 0.90-1.47), suggesting that sleep problems mediated 41% of TBI's effect on development of depression. Results were similar for those with either PTSD or depression (37% mediated). Conclusions: These results suggest that sleep problems mediate the effect of a positive TBI screening on the development of mental health disorders, and sleep problems may be an early indicator of risk for PTSD or depression.


Crum-Cianflone N.F.,Naval Health Research Center | Jacobson I.,Naval Health Research Center
Epidemiologic Reviews | Year: 2014

Despite the marked expansion of roles for women in the US military over the last decade, whether differences by gender exist in regard to the development of mental health conditions postdeployment is unclear. This comprehensive review of the literature (2001-2012) examined whether US servicewomen were more likely than men to experience post-traumatic stress disorder (PTSD) after returning from deployments to the Iraq and Afghanistan conflicts. Findings from 18 studies from 8 unique study populations were reviewed. Seven studies found that women had a higher risk for screening positive for PTSD compared with men, including prospectively designed studies that evaluated new-onset PTSD among members from all service branches. Although results from studies with Veterans Affairs samples found women at decreased risk in 4 analyses, these studies used the same source databases, were conducted in treatment-seeking populations, and were mostly unable to account for combat experience. Seven studies detected no differences by gender. In summary, women appeared to have a moderately higher risk for postdeployment PTSD, although there was a lack of consensus among the studies, and even those with the most rigorous methods were not designed specifically to evaluate potential gender differences. Given the limitations of the published literature, further research should use longitudinal study designs and comprehensive evaluations of deployment experiences while adjusting for predeployment factors to confirm that gender differences exist with regard to postdeployment PTSD. © 2013 Published by Oxford University Press.


Andrews J.A.,Naval Health Research Center | Neises K.D.,Naval Health Research Center
Journal of Neurochemistry | Year: 2012

Post-traumatic stress disorder (PTSD) is a complicated CNS syndrome. Looking beyond the CNS, recent studies suggest that peripheral blood mononuclear cells could cause and/or exacerbate PTSD. This review summarizes the literature, describes associations between circulating peripheral blood cells and PTSD, proposes a novel mechanism, and analyzes several biomarkers that appear to associate with PTSD symptoms. Several experimental animal models have shown that peripheral blood mononuclear cell activity can cause hippocampal volume loss and PTSD-like symptoms. Data from these models suggest that a traumatic event and/or traumatic events can trigger peripheral cells to migrate, mediate inflammation, and decrease neurogenesis, potentially leading to CNS volume loss. Biomarkers that associate with PTSD symptoms have the potential to differentiate PTSD from traumatic brain injury, but more work needs to be done. Research examining the mechanism of how traumatic events are linked to peripheral blood mononuclear cell functions and biomarkers may offer improved diagnoses and treatments for PTSD patients. © Published 2011. This article is a US Government work and is in the public domain in the USA.


Evidence links dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) to crucial military health issues, including operational stress, resilience, and traumatic brain injury. This study evaluated the anabolic, neuroprotective, and neuroexcitatory properties of DHEA(S) in healthy military men. A salivary sample was obtained from 42 men and assayed for DHEA(S), testosterone, nerve growth factor (NGF; which supports nerve cell proliferation), and salivary alpha amylase (sAA; a proxy of sympathetic nervous system function). Separate regression analyses were conducted with DHEA and DHEAS as independent variables, and testosterone, NGF, and sAA as dependent variables, respectively. The models explained 23.4% of variance in testosterone (p < 0.01), 17.2% of variance in NGF (p < 0.01), and 7.4% of variance in sAA (p = 0.09). Standardized beta coefficients revealed that DHEA independently influenced testosterone (b = 0.40, p < 0.01), whereas DHEAS independently influenced NGF (b = 0.48, p < 0.01) and sAA (b = 0.36, p < 0.05). DHEA demonstrated anabolic properties, whereas DHEAS demonstrated neuroprotective and neuroexcitatory properties in military men. This area of study has broad implications for stress inoculation, traumatic brain injury rehabilitation, and regenerative medicine in military personnel. © Association of Military Surgeons of the U.S. All rights reserved.


Seelig A.D.,Naval Health Research Center
American journal of epidemiology | Year: 2012

Previous research has shown that military women often experience potentially severe health outcomes following deployment. Data from the Millennium Cohort Study, a 21-year longitudinal study examining the health effects of military service, were used to examine this issue. In longitudinal analyses (2001-2008) carried out among US military women (n = 17,481), the authors examined positive screens for depression, anxiety, panic, and posttraumatic stress disorder in relation to deployment in support of the operations in Iraq and Afghanistan, while adjusting for relevant baseline and time-varying covariates. Women who were deployed and reported combat-related exposures had greater odds than nondeployed women of reporting symptoms of a mental health condition (odds ratio = 1.91, 95% confidence interval: 1.65, 2.20), after adjustment for demographic, military, and behavioral covariates. In addition, higher stress, problem drinking, and a history of mental illness were significantly associated with increased risk of later mental health conditions. In contrast, women in the Reserves or National Guard and those with higher education were at decreased risk of mental health conditions (all P 's < 0.01). As the roles and responsibilities of women in the military expand and deployments continue, designing better prevention and recovery strategies specifically for women are critical for overall force health protection and readiness.


Holbrook T.L.,Naval Health Research Center | Holbrook T.L.,Soar Consulting | Galarneau M.R.,Naval Health Research Center | Dye J.L.,Naval Health Research Center | And 2 more authors.
New England Journal of Medicine | Year: 2010

BACKGROUND: Post-traumatic stress disorder (PTSD) is a common adverse mental health outcome among seriously injured civilians and military personnel who are survivors of trauma. Pharmacotherapy in the aftermath of serious physical injury or exposure to traumatic events may be effective for the secondary prevention of PTSD. METHODS: We identified 696 injured U.S. military personnel without serious traumatic brain injury from the Navy-Marine Corps Combat Trauma Registry Expeditionary Medical Encounter Database. Complete data on medications administered were available for all personnel selected. The diagnosis of PTSD was obtained from the Career History Archival Medical and Personnel System and verified in a review of medical records. RESULTS: Among the 696 patients studied, 243 received a diagnosis of PTSD and 453 did not. The use of morphine during early resuscitation and trauma care was significantly associated with a lower risk of PTSD after injury. Among the patients in whom PTSD developed, 61% received morphine; among those in whom PTSD did not develop, 76% received morphine (odds ratio, 0.47; P<0.001). This association remained significant after adjustment for injury severity, age, mechanism of injury, status with respect to amputation, and selected injury-related clinical factors. CONCLUSIONS: Our findings suggest that the use of morphine during trauma care may reduce the risk of subsequent development of PTSD after serious injury. Copyright © 2010 Massachusetts Medical Society.

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