Publications by authors named "Alan Nelson"

Objectives: To characterise intrinsic and extrinsic (climatic) risks for mild and severe exertional heat illness (EHI) among first-year army enlistees.

Methods: We examined 337 786 soldiers who enlisted between 2012 and 2019. Survival models were used to predict incident EHI from intrinsic factors (demographics, healthcare utilisation, chronic conditions, body mass index (BMI), Army Physical Fitness Test (APFT), upper/lower respiratory tract infections (URTI and LRTI), skin and soft-tissue infections (SSTI), extrinsic factors (geographical region, daily mean Universal Thermal Climate Index (UTCI), wet bulb globe temperature (WBGT)) and interactions.

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  • * It involved a retrospective analysis of medical data, comparing over 19,000 pregnant service members with non-pregnant peers to ascertain the incidence of MSK conditions after childbirth.
  • * Results indicated that the risk of MSK conditions increased significantly 3- to 6-months after pregnancy, while the risk tended to decrease after 6 months and was lower within the first 2 months post-pregnancy.
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  • Lower extremity chronic exertional compartment syndrome (LE-CECS) is a condition that affects physical activity, notably in military personnel, and fasciotomy (a surgical treatment) may influence military service separations.
  • A study of over 1 million active-duty service members from 2011 to 2017 found that LE-CECS significantly increases the risk of medical and nonmedical separations, especially in men and women undergoing certain surgical procedures.
  • The results suggest that while LE-CECS leads to higher discharge risks, fasciotomy does not appear to improve long-term military careers, highlighting the need for further research on this issue.
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Understanding the incidence and predictors of postpartum depression (PPD) among active-duty service members is critical given the importance of this population and its unique stressors. We conducted a retrospective cohort study of all active-duty U.S.

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Self-assessments are commonly used to track Army readiness in specialized communities, but they are rarely analyzed for reliability and predictive validity. Before introducing new assessments, existing ones should be reevaluated. We examined the Global Assessment Tool (GAT), an annual Army-required self-assessment with multiple psychosocial and health behavior short scales.

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Introduction: Chronic pain and associated interference with daily activities are common in the military and impact Force readiness. Chronic pain affects one-third of service members and is a leading cause of medical non-readiness (MNR) in the military. Research suggests that underlying psychological mechanisms related to trait coping styles and pain interference (PI) affect functional outcomes, but little research exists examining this relationship within an Army population.

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Background: Postpartum use of long-acting reversible contraception has been found to be effective at increasing interpregnancy intervals, reducing unintended pregnancies, and optimizing health outcomes for mothers and babies. Among female active-duty military service members, reproductive planning may be particularly important, yet little is known about postpartum long-acting reversible contraceptive use among active-duty soldiers.

Objective: This study aimed to (1) quantify postpartum uptake of long-acting reversible contraception among active-duty female US Army soldiers and (2) identify demographic and military-specific characteristics associated with use.

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Depression and post-traumatic stress disorder (PTSD) are prevalent in pregnancy, especially among military members. These conditions can lead to adverse birth outcomes, yet, there's a paucity of evidence for prevention strategies. Optimizing physical fitness is one understudied potential intervention.

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Context: The US Army embedded injury-prevention experts (IPEs), specifically athletic trainers and strength and conditioning coaches, into initial entry training (IET) to limit musculoskeletal (MSK) conditions and their negative consequences. However, little is known about the financial impact of IPEs.

Objective: To assess whether IPEs were associated with fewer sunk training costs due to MSK-related early discharges from service.

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Objectives: To determine the probability of discharge from military service among soldiers following an incident diagnosis of ankylosing spondylitis (AS), rheumatoid arthritis (RA), psoriasis or systemic lupus erythematous.

Methods: All soldiers on active duty in the US Army between January 2014 and June 2017 were included in a retrospective cohort analysis. Termination from service was ascertained using personnel records.

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Tri-plane corrective Lapidus surgery has been described as advantageous with respect to its anatomic basis and outcomes. Because the procedure has been broadly publicized, changes in overall Lapidus procedure rates due to increased numbers of patients opting for the tri-plane approach could have occurred. Data supporting this possibility appears lacking.

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The opioid epidemic is a major policy concern. The widespread availability of opioids, which is fueled by physician prescribing patterns, medication diversion, and the interaction with potential illicit opioid use, has been implicated as proximal cause for subsequent opioid dependence and mortality. Risk indicators related to chronic opioid therapy (COT) at the point of care may influence physicians' prescribing decisions, potentially reducing rates of dependency and abuse.

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Exposure to traumatic events could increase post-traumatic stress disorder (PTSD) risk among enlisted U.S. Army drone operators.

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The amplification of coastal hazards such as distant-source tsunamis under future relative sea-level rise (RSLR) is poorly constrained. In southern California, the Alaska-Aleutian subduction zone has been identified as an earthquake source region of particular concern for a worst-case scenario distant-source tsunami. Here, we explore how RSLR over the next century will influence future maximum nearshore tsunami heights (MNTH) at the Ports of Los Angeles and Long Beach.

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Objective: Incidence rates of ankylosing spondylitis (AS) among males versus females are poorly understood. Results of prior research have been mixed, including findings of a 3:1 incidence ratio for males versus females, but with increasing AS rates among females. The objective was to estimate the incidence of AS among members of the US military.

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Background: The relationships of sickle cell trait (SCT), body mass index (BMI), and physical fitness to venous thromboembolism (VTE) in young adults have received little attention.

Objectives: To test for associations among SCT, BMI, fitness, and VTE.

Patients/methods: We conducted a retrospective cohort study of 48,316 SCT-tested, African American individuals in the US Army during 2011-14.

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Although largely benign, sickle cell trait (SCT) has been associated with exertion-related events, to include sudden death. In 2011, a summit on SCT introduced the term exercise collapse associated with SCT (ECAST). A series of ECAST deaths in military personnel in 2019 prompted reevaluation of current efforts and led to a second summit in October 2019 hosted by the Consortium for Health and Military Performance of the Uniformed Services University in Bethesda, MD.

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  • This study focuses on identifying and quantifying the risk of occupational disability among U.S. Army service members based on specific risk factors like extreme body mass index, low physical fitness, and substance use (tobacco and opioids).
  • It analyzed a large dataset of over 600,000 active-duty soldiers from 2011 to 2014, finding that 13.4% were medically unfit during the study period, with certain risk factors notably increasing the likelihood of medical nonreadiness.
  • The findings suggest that addressing these high-risk factors, especially opioid use and body weight issues, could be crucial for early prevention strategies in military personnel.
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Objective: To determine the incidence of pelvic floor disorders (PFD) among active-duty US Army female soldiers.

Materials And Methods: We studied 102,015 women for incident PFD using the Stanford Military Data Repository, which comprises medical, demographic and service-related information on all soldiers on active duty in the US Army during 2011-2014. Cox proportional hazards estimated adjusted associations with PFD diagnoses.

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Stressful life changes may tax people's adaptive capacity. We sought to determine if and when experiences of stressful life changes were associated with increased odds of adverse nutrition-related health outcomes among US Army soldiers relative to those who did not experience the same stressful life change. An additional aim was to determine which stressful life changes had the greatest association with these outcomes and if there were gender differences in the magnitude of the associations.

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  • During 1999-2016, over 350,000 Americans died from prescription opioid overdoses, leading to policy changes aimed at reducing overprescribing practices.
  • This study focused on assessing the impact of a policy to shorten initial opioid prescriptions using a model based on 827,265 US Army soldiers.
  • Results indicate that transitioning 10,000 patients to shorter prescriptions could save around $3.1 million and generate 4,451 additional opioid-free months, suggesting that modifying prescriber behavior is a cost-effective strategy.
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Sickle cell trait and certain renal disorders are disproportionately prevalent among African American individuals, so a clear understanding of their association is important. We conducted a longitudinal study using the Stanford Military Data Repository to examine sickle cell trait in relation to the incidence of acute kidney injury (AKI) and chronic kidney disease (CKD). Our study population consisted of African American U.

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Establishing the shape and determinants of trajectories of body mass index (BMI) among Soldiers is critical given the importance of weight management to military service requirements. To establish the shape and determinants of BMI trajectories among Soldiers, we aimed to (1) model the overall BMI trajectory of Soldiers, (2) find the most common trajectory groups among Soldiers, (3) investigate the relationship between BMI trajectories and sociodemographic and military-specific characteristics, and (4) determine if there were Soldiers with large fluctuations in BMI. The study population included all US Army Soldiers on active-duty between 2011 and 2014 who were age 17-62 ( = 827,126).

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Importance: Concern about the renal effects of nonsteroidand al anti-inflammatory drugs (NSAIDs) among young, healthy adults has been limited, but more attention may be warranted given the prevalent use of these agents.

Objective: To test for associations between dispensed NSAIDs and incident acute kidney injury and chronic kidney disease while controlling for other risk factors.

Design, Setting, And Participants: This retrospective, longitudinal cohort study used deidentified medical and administrative data on 764 228 active-duty US Army soldiers serving between January 1, 2011, and December 31, 2014.

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