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A Decade of mTBI Experience: What Have We Learned? A Summary of Proceedings From a NATO Lecture Series on Military mTBI.

ABSTRACT: Mild traumatic brain injury (mTBI, also known as a concussion) as a consequence of battlefield blast exposure or blunt force trauma has been of increasing concern to militaries during recent conflicts. This concern is due to the frequency of exposure to improvised explosive devices for forces engaged in operations both in Iraq and Afghanistan coupled with the recognition that mTBI may go unreported or undetected. Blasts can lead to mTBI through a variety of mechanisms. Debate continues as to whether exposure to a primary blast wave alone is sufficient to create brain injury in humans, and if so, exactly how this occurs with an intact skull. Resources dedicated to research in this area have also varied substantially among contributing NATO countries. Most of the research has been conducted in the US, focused on addressing uncertainties in management practices. Development of objective diagnostic tests should be a top priority to facilitate both diagnosis and prognosis, thereby improving management. It is expected that blast exposure and blunt force trauma to the head will continue to be a potential source of injury during future conflicts. An improved understanding of the effects of blast exposure will better enable military medical providers to manage mTBI cases and develop optimal protective measures. Without the immediate pressures that come with a high operational tempo, the time is right to look back at lessons learned, make full use of available data, and modify mitigation strategies with both available evidence and new evidence as it comes to light. Toward that end, leveraging our cooperation with the civilian medical community is critical because the military experience over the past 10 years has led to a renewed interest in many similar issues pertaining to mTBI in the civilian world. Such cross-fertilization of knowledge will undoubtedly benefit all. This paper highlights similarities and differences in approach to mTBI patient care in NATO and partner countries and provides a summary of and lessons learned from a NATO lecture series on the topic of mTBI, demonstrating utility of having patients present their experiences to a medical audience, linking practical clinical care to policy approaches.

SUBMITTER: Robinson-Freeman KE

PROVIDER: S-EPMC7477387 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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A Decade of mTBI Experience: What Have We Learned? A Summary of Proceedings From a NATO Lecture Series on Military mTBI.

Robinson-Freeman Katherine E KE Collins Kassondra L KL Garber Bryan B Terblanche Ronel R Risling Marten M Vermetten Eric E Besemann Markus M Mistlin Alan A Tsao Jack W JW

Frontiers in neurology 20200825

Mild traumatic brain injury (mTBI, also known as a concussion) as a consequence of battlefield blast exposure or blunt force trauma has been of increasing concern to militaries during recent conflicts. This concern is due to the frequency of exposure to improvised explosive devices for forces engaged in operations both in Iraq and Afghanistan coupled with the recognition that mTBI may go unreported or undetected. Blasts can lead to mTBI through a variety of mechanisms. Debate continues as to whe ...[more]

PMID: 32982907

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Project description:BACKGROUND:Disordered eating, ranging from occasional binge eating or restriction to behaviors associated with eating disorder diagnoses, is common among military personnel and veterans. However, there is little information on how military service affects eating habits. OBJECTIVE:To describe possible pathways between military service and disordered eating among women veterans, a high risk group. MATERIALS AND METHODS:Twenty women veterans who reported changing eating habits in response to stress participated in audio-recorded focus groups or dyadic interviews between April 2013 and October 2014. We used thematic analysis of transcripts to identify and understand women's self-reported eating habits before, during, and after military service. RESULTS:Participants reported entering the military with varied eating habits, but little disordered eating. Participants described several ways military environments affected eating habits, for example, by promoting fast, irregular, binge-like eating and disrupting the reward value of food. Participants believed military-related stressors, which were often related to gender, also affected eating habits. Such stressors included military sexual trauma and the need to meet military weight requirements in general and after giving birth. Participants also reported that poor eating habits continued after military service, often because they remained under stress. CONCLUSIONS:For some women, military service can result in socialization to poor eating habits, which when combined with exposure to stressors can lead to disordered eating. Additional research is needed, including work to understand possible benefits associated with providing support in relation to military weight requirements and the transition out of military service. Given the unique experiences of women in the military, future work could also focus on health services surrounding pregnancy-related weight change and the stress associated with being a woman in predominantly male military environments.

Project description:IntroductionAs the burgeoning roles of women afford them the opportunities to perform in all combat and combat support assignments, the impact of all environmental, occupational, physical, and psychosocial factors inherent in military training and operations on their health must be considered. A robust foundation of knowledge is necessary to ascertain, prevent, and treat the potential impacts on women's health. However, a systematic review of the literature from 2000-2015 revealed widespread gaps in scientific knowledge of the musculoskeletal, psychological, occupational, and reproductive health of military women. The purpose of this study is to determine priorities for military women's health (MWH) research that will serve to fill these gaps in knowledge.MethodsAn advisory group of 11 senior military and women's health experts conducted a structured gap analysis of the results of a scoping review of literature from 2000 to 2015 and Military Health System utilization data to identify 15 topics for prioritization in MWH research. A modified e-Delphi study was conducted and consensus was achieved after two rounds. Participants (N = 32) included subject matter experts (SME) representing various professions enrolled, 23 completed both rounds. In round 1, topics were rated on forced Likert scales for relevance and feasibility to medical readiness and comments were elicited from the SMEs. Relevance and feasibility scores and themes from the comments guided the development of the round 2 survey, in which SMEs categorized the topics in terms of urgency and forced-choice ranked the priority of each topic. The quantitative data were analyzed using multilevel regression methods. Linear mixed models were fit separately on the numeric outcomes for feasibility, relevance, and urgency with research topic as the primary predictor. To analyze the rankings of research topic priority, crude and adjusted linear regression models were fit on the numeric outcome rank.ResultsThe adjusted top five topics for research priorities as indicated by ranking were: genitourinary health, sleep, physical assault, behavioral health, and menstrual cycle research. The advisory group reviewed the findings in the context of Department of Defense strategic priorities and provided guidance on the design and dissemination of the MWH research agenda.ConclusionsThe MWH research agenda is a validated research agenda of high-priority research topics that will promote enduring efforts to ensure evidence-based practices and health policies for military women through research.

Dataset Information

A Decade of mTBI Experience: What Have We Learned? A Summary of Proceedings From a NATO Lecture Series on Military mTBI.

Publications

A Decade of mTBI Experience: What Have We Learned? A Summary of Proceedings From a NATO Lecture Series on Military mTBI.

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