Extension for Community Healthcare Outcomes (ECHO) Telementoring in the Military: Where We Are Now, Opportunities and Challenges

ABSTRACT Introduction In collaboration with the ECHO (Extension for Community Healthcare Outcomes) Institute since 2012, the Army, Navy, and Air Force have developed medical teleECHO programs to address various health and safety issues affecting military personnel. This article describes and compares the current state of military teleECHOs as well as the growth and change over time. Materials and Methods This study evaluated continuing education units (CEUs) offered, average session attendance, and number of spoke sites for current military teleECHO programs across the service branches. Results Between 2012 and 2019, the military teleECHO initiative grew from one program to seven different teleECHO programs, covering topics from pain to diabetes to amputee care. Military ECHOs now provide training to 10 countries and 27 states in the United States. Between October 2018 and September 2019, the military ECHO programs provided a total of 51,769 continuing medical education (CME) hours to a total of 3,575 attendees from 223 spoke sites. Conclusions The military has successfully used the ECHO model to improve the health and safety of active-duty military, retirees, and dependents.

Liberty call at sunset: U.S. military retiree bars and the outsourced reproduction of ageing masculinities in Subic Bay, Philippines

This article examines the gendered service economy of bars and restaurants catering to ageing US military retirees in Olongapo City, Philippines. During the Cold War, Olongapo housed Subic Bay Naval Base, one of the largest overseas US military installations, and today thousands of former American service members have retired here. A focus on retiree bars reveals how Filipina bartenders and waitresses facilitate an ageing masculinity for these expatriates wherein men’s internalized senses of social, economic, and sexual marginality in the US are seemingly suspended or deferred in the Philippines. Geopolitical histories of US militarism in Asia-Pacific, unequal military basing agreements, and Subic’s so-called hospitality industry endure decades later to naturalize the hierarchies of accommodation between local hostesses and foreign customers. Drawing on – and further developing – geographic scholarship on ageing and masculinities and focusing on the so-called hospitality industry’s shift over time reveals the expectations placed on service workers to accommodate men’s changing needs and desires. Years after Subic’s closure, interviews with bartenders and customers illuminate how decades of entanglement with US militarism have outsourced some of the reproductive labor that sustains this population of ageing retirees in Subic. More than mere bodies sustaining and serving the outsourced needs of ageing service members, however, through bar work Filipina hostesses experience changes to their own geographies of belonging and leverage opportunities to realize their own dreams and desires. The relations in Subic’s retiree bars attest to US militarism’s intimate afterlives and its enduring dependence on the gendered and racialized labor of local populations.

Transitioning from active duty to military retirement: Challenges impacting diabetes self-management

Objectives: Military retirement happens early in the lifespan presenting a unique transition that challenges chronic illness. The purpose of this study was to explore the factors that military retirees experience as they transition from active duty to military retirement that they perceive as inhibiting their ability to manage type 2 diabetes (T2DM) or pre-diabetes (preDM) and/or which increase their disease risk. Methods: Twenty veterans diagnosed with T2DM or preDM participated in semi-structured, face-to-face interviews in a private setting at their primary care clinic. Transcripts were analysed using constant comparative method. Participants were aged 44 to 63 ( M = 56), with 15 diagnosed with T2DM and 5 as preDM. They had been retired from the military 6 to 22 years ( M = 14 years). Results: Participants linked five inter-related challenging factors to their T2DM/preDM diagnosis (when diagnosed post-retirement) and/or to their inability to manage their disease: (1) diet/eating habits, (2) physical activity, (3) weight fluctuation, (4) health care interactions and (5) systematic barriers. Military retirees’ experiences were embedded within a ‘cultural shift’. They struggled to maintain self-management behaviours once they were no longer on active duty and had more independence as civilians. Discussion: Results provide support for diabetes education during military retirement. Military retirees need help maintaining healthy lifestyle behaviours beyond the structured, health-focused military culture. They could also benefit from patient–provider communication skills training in navigating systematic barriers and attaining the support needed to manage their disease.

Clinical Outcomes of Bariatric Surgery Among Military Retirees and Beneficiaries: A Retrospective Cohort Study

Objectives Obesity prevalence is estimated at 34% in U.S. military retirees and 28% in beneficiaries of military healthcare, with common comorbidities being type 2 diabetes (T2D), hypertension, and hyperlipidemia. Stressors experienced during active duty service result in higher risk for disabling musculoskeletal injuries, psychological trauma, and alcohol abuse; all of which debilitate healthy weight loss efforts. No literature exists on the demographics and clinical outcomes of military retirees who elect bariatric surgery. The purpose of this study was to assess demographics and determine clinical outcomes of retirees and beneficiaries following bariatric surgery. It was hypothesized that pre-operative weights and comorbidity remission would be higher in the military retiree group. Methods A retrospective cohort study assessed military retirees and beneficiaries who underwent sleeve gastrectomy or gastric bypass surgery at a military treatment facility in 2014. Percent total weight loss (%TWL) and remission of pre-existing comorbidities (T2D, hypertension, and hyperlipidemia) at one year follow-up were primary outcomes and compared using Student's T tests and chi-squared contingency analysis. Additional statistical analyses included a Wilcoxon-Mann-Whitney test and backwards stepwise regression. Results Ninety-eight patients (64 beneficiaries and 34 retirees) were included with mean ages of 48 and 52 years, respectively. Student's T test and Wilcoxon-Mann-Whitney test confirmed that beneficiaries achieved greater %TWL at one year follow-up, 30.2% vs. 25.8% (p < 0.05) and 55.5 vs. 38.2 mean rank (p < 0.01), respectively. Beneficiaries and retirees achieved similar remission of T2D, hypertension, and hyperlipidemia. Patient's sex and surgery type were significant predictors of %TWL variation between groups at one year follow-up. These variables accounted for 9% of the %TWL variance. Conclusions Retirees who elect bariatric surgery lose less weight than their beneficiary counterparts. Etiology of this poorer outcome remains unclear, but further research may demonstrate need for improving healthcare resources provided to military retirees. Funding Sources No funding was received to support this study.

A phenomenological study of military retirees: Reasons for retirement and post-retirement employment in Turkish military staff

Recently, an increasing number of retired individuals decide to return to work and seek for post-retirement employment. Although research has already focused on individual and organizational based factors in retirement and post-retirement, the works are limited in some observable settings and well-known professions. The purpose of this study is to delve into the reasons for retirement and post-retirement employment and describe how human capital and social capital takes role in post-retirement employment. A qualitative approach was used with a descriptive phenomenological research design. Ten volunteer military retirees constitute the participants; in-depth semi-structured interviews were conducted for data collection. Findings indicate that social and human capital heavily affect the retirement process, and trigger the return to work. The higher the hierarchy of the military staff, the more the social factors are motivating them to post-retirement employment, contrarily. For lower hierarchy, financial issues are more dominant for returning to work. Additionally, the effect of social capital on the post-retirement employment varies according to individual differences such as dependents, beliefs, and passions. The study contributes to theoretical discussions related to retirement and post-retirement employment reasons that can be linked to existing explanations.

RECENT BACKWARD OF NATIONAL MILITARY NAVAL MEDICINE

Here is the contribution of K. N. Kostur in the development of national military naval medicine based on documentary data. K. N. Kostur was born on May 6, 1921 in the village of Kuzmin, Gorodok district of the Khmelnitsky region of the Ukrainian SSR. After graduating secondary school with ten years of study, he entered the Naval Medical School (NMS). He passed the first practice in August 1940 on the cruiser «Aurora», which was in Kronstadt. In late October 1941, after an early release from NMS, he was sent to the «Road of Life». The convoy of the Red Banner Baltic Fleet (RBBF), where he served, took the wounded, women and children out of besieged Leningrad. Konstantin Nikolaevich Kostur, being a senior medical assistant, was part of the Railway Artillery Battery of the 263rd Division of Railway Artillery of the 1st Guards Brigade of the Red Banner Baltic Fleet. He participated in combat operations to break the blockade of Leningrad, liberate the islands in the Vyborg gulf, and also liberate the Baltic states and East Prussia. Several post-war years participated in the combat demining of the Finland gulf. Then — 5 years of study at the Naval Medical Academy (NMS), service on the cruiser «Maxim Gorky» as the head of the medical service, and also — 22 years of hard work in the 1st order of Lenin Naval Hospital of the Leningrad Naval Base. Here K. N. Kostur went from the young attending doctor to the head of the gastroenterological department and the lead therapist of the hospital. After the release to the reserve, Konstantin Nikolayevich until the last day was actively working as a therapist at the 285th Polyclinic of 1st order of Lenin Naval Hospital of the Leningrad Naval Base, assisting military personnel, members of their families, military retirees and civilians. Despite high positions and great administrative and medical work, K. N. Kostur conducted deep research studies on topical issues of naval therapy and gastroenterology, was actively engaged in inventive and rationalization activities.