Jeffrey L. Moore

Return to combat duty after concussive blast injury

Little data exist regarding the acute assessment of blast concussion and the course of recovery in the combat zone, as most research has examined service members long after they have returned home. This manuscript examined a case series of 377 service members seen for acute concussion evaluation following medical evacuation from the battlefield in Helmand Province, Afghanistan. Of these, 111 were assessed for concussion prior to their return to the continental USA for other severe physical injuries. Of the remainder, and when comparing those who returned to duty (RTD)/recovered from concussion in the combat zone and those who did not, data indicate that those who did not RTD were older and were more likely to endorse symptoms of combat stress. Quicker recovery times were associated with less severe headaches and fewer acute symptoms at the time of injury as well as the absence of combat stress reaction. Variables that were not associated with RTD and/or recovery were Military Acute Concussion Evaluation (MACE) cognitive scores and whether or not individuals suffered loss of consciousness. While MACE scores were not associated with recovery, they were deemed clinically useful as a part of a serial concussion evaluation if the initial MACE was given within 6 h of the blast. Implications for battlefield concussion assessment and management as well as future research directions are discussed.

Menstrual suppression for combat operations: advantages of oral contraceptive pills.

BACKGROUND increasing numbers of women are deployed to austere settings in which menstruation may impose logistical challenges. Minimal data exists about the use of oral contraceptive pills (OCPs) for menstrual suppression in this population. Post-deployment survey was undertaken to establish prevalence of continuous OCP use, perceived barriers, and associations with menstrual burden in a military population within the austere environment. METHODS voluntary and anonymous 44-item questionnaire. RESULTS of 500 women, 78% (n = 390) had personal experience using OCPs and 66% (n = 330) desired menstrual suppression. However, only 40% (n = 192) reported any OCP use and only 21% (n = 99) reported continuous use during deployment. Sixty-seven percent of women reported some difficulty in daily pill compliance and nearly half (45%) missed ≥ 1 pill per week in the austere setting. Continuous users were nearly twice as compliant as conventional users (p = .019) and compliant OCP users reported significantly less menstrual burden than noncompliant users (p = .017). Almost all women (85%) desired mandatory education about menstrual suppression through OCPs. CONCLUSION despite OCP experience and desire for amenorrhea, prevalence of extended cycle OCP use in this population is low. Extended OCPs users in the austere setting report improved compliance and reduced menstrual burden compared with conventional users. Education about OCPs is highly desirable for most military women and may benefit those in austere settings.

Menstrual Suppression Using Oral Contraceptives: Survey of Deployed Female Aviation Personnel

INTRODUCTION Increasing numbers of women perform aviation duties in the combat flight environment. Oral contraceptive pills (OCPs) afford numerous health and operational benefits, including prevention of anemia and suddenly incapacitating conditions, as well as menstrual suppression when taken continuously. Until now, the use of OCPs in the combat flight environment has not been examined. METHODS An anonymous, voluntary questionnaire was distributed to 62 female U.S. Army aviation personnel who had recently deployed in support of combat flight operations to characterize continuous OCP use and perceived barriers to this practice, as well as to determine associations with menstrual burden. RESULTS There were 81% (N=50) of the women who had personal experiences using OCPs and 93% (N=58) were aware that continuous use can suppress menstruation. For deployment, 66% (N=41) desired menstrual suppression, yet only 33% (N=20) reported any OCP use. Even fewer (15%; N=10) reported using continuously. Of the women who did not use OCPs continuously, 35% had insufficient knowledge about OCPs and 44% of women reported difficulty in remembering to take a daily pill. Continuous OCP users were more compliant (P = 0.019), reported less spotting (P = 0.007) and fewer unexpected menstrual cycles (P = 0.03) than conventional OCP users. A trend toward reduced cramping was noted (P = 0.064). Most women (60%) desired standardized entry-level education about menstrual suppression through OCPs. CONCLUSIONS The use of continuous OCPs is low in deployed women with aviation-related duties, yet a majority desires menstrual suppression. Continuous OCP use in this setting is associated with significantly improved compliance and significant reductions in specific menstrual burdens. Entry-level education is desirable and may reduce barriers to continuous OCP use by addressing risks, side effects, and daily pill adherence strategies. Flight surgeons should provide further education and consider continuous OCP dosing in the austere environment of combat flight.

Fexofenadine effects on cognitive performance in aviators at ground level and simulated altitude.

INTRODUCTION Antihistamines are used for the treatment of allergic rhinitis (AR) symptoms. However, the cognitive effects of some antihistamines can dramatically impair individuals in occupations that require sustained vigilance. METHODS The cognitive effects of fexofenadine were compared to a placebo (passive control) and cetirizine (active control) in healthy naval flight personnel. All subjects received one dose of each treatment in one of six possible sequences with two washout periods in between, and were assessed for aviation-related cognitive skills using the Aeromedical Vigilance Test (AVT) at both ambient atmospheric conditions and normobaric hypoxic conditions. Drowsiness was self-assessed by participants using a visual analog scale (VAS). RESULTS There was no significant difference between fexofenadine and placebo over the entire 60-min test period, under ambient atmospheric conditions, or under either hypoxic condition. Compared with placebo, cetirizine significantly increased AVT errors over the entire 60-min test period, at 10,000 ft, and at 15,000 ft. No statistical difference was found between treatments under ambient atmospheric conditions, although cetirizine treatment resulted in a greater change from baseline in adjusted average number of AVT errors (0.2124 +/- 0.06) than fexofenadine treatment (0.1989 +/- 0.07) and placebo (0.0745 +/- 0.07). Furthermore, at 10,000 ft there were significantly more AVT errors with cetirizine than with fexofenadine. There were no significant increases in self-reported drowsiness (VAS) for both cetirizine and fexofenadine compared with placebo. CONCLUSION Fexofenadine is comparable to placebo in its effect on the cognitive skills important for piloting an aircraft, while cetirizine impairs cognition and may affect piloting ability.

Personality traits in clinically referred aviators: two clusters related to occupational suitability.

BACKGROUND The Five Factor Model (FFM) of normal personality provides a compelling framework for investigating personality subtypes in large military populations. The FFM was used to determine whether a sample of clinically referred military aviators exhibited commonly occurring personality clusters. METHODS The Revised NEO Personality Inventory (NEO-PI-R) was used to evaluate 956 clinically referred U.S. Naval aviators and flight officers on the domains of neuroticism (N), extroversion (E), openness (O), agreeableness (A), and conscientiousness (C). The scores were subjected to model-based cluster analysis and emergent clusters were compared with respect to their scores and clinical outcomes. RESULTS A two-cluster model provided the best fit to the data. MANOVA indicated significant differences between the two cluster groups with respect to four of the five factors (N, E, A, and C). The greatest differences were for N and E, with the smaller group (Group 1, N = 291) being significantly more neurotic and less extroverted than Group 2 (N = 665). Cluster membership had more specificity (0.74) than sensitivity (0.59) for predicting adverse clinical outcome, with the probability of an adverse clinical outcome increasing from 0.14 to 0.28 for those in the neurotic and introverted Group 1. CONCLUSIONS Elevated neuroticism and depressed extraversion were the defining traits of the personality cluster less suited for aviation duty (Group 1). Results support assessment of neuroticism and extroversion during clinical mental health evaluations related to military aviation duty.