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Author: Patricia A Deuster (105)


Aug
2017

There is concern that sickle cell trait increases risk of exertional collapse, a primary cause of which is heat injury. However, no population-based studies among active individuals have addressed this, representing a critical evidence gap. We conducted a retrospective cohort study of sickle cell trait-tested African American soldiers on active-duty in the U.

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Dec
1969

The Metabolically Optimized Brain study explored nutritional science believed to be ready to place into practice to help improve US service members' cognitive performance and, thereby, optimize mission-readiness. A transparent, step-wise, research approach was used for informing evidence-based decisions among and for various, diverse stakeholders. A steering committee and subject-matter experts convened to devise the protocol and independent systematic reviews were performed to determine the quality of the evidence for nutritional science in 4 areas relevant to military populations: (1) caffeinated foods and beverages; (2) omega-3 polyunsaturated fatty acids; (3) plant-based foods and beverages or their phytochemical constituents; and (4) whole dietary patterns.

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Dec
1969

Optimizing cognitive performance and preventing cognitive impairments that result from exposure to high-stress situations are important to ensure mission-readiness for military personnel.
This systematic review assesses the quality of the evidence for plant-based foods and beverages, or their phytochemical constituents, across various outcomes related to cognitive function in healthy adult populations to develop research recommendations for the military.
PubMed, CINAHL, Embase, PsycInfo, and the Cochrane Library were searched.

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Sep
2017

Within the Department of Defense over the past decade, a focus on enhancing Warfighter resilience and readiness has increased. For Special Operation Forces (SOF), who bear unique burdens for training and deployment, programs like the Preservation of the Force and Family have been created to help support SOF and their family members in sustaining capabilities and enhancing resilience in the face of prolonged warfare. In this review, we describe the shift in focus from resilience to human performance optimization (HPO) and the benefits of human performance initiatives that include holistic fitness.

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Sep
2017

The limitations for self-reporting of dietary patterns are widely recognised as a major vulnerability of FFQ and the dietary screeners/scales derived from FFQ. Such instruments can yield inconsistent results to produce questionable interpretations. The present article discusses the value of psychometric approaches and standards in addressing these drawbacks for instruments used to estimate dietary habits and nutrient intake.

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Aug
2017

This is a systematic review and evaluation of the current evidence on the association between muscular endurance (ME) and/or muscular strength (MS) and musculoskeletal injury (MSK-I) risk in military and civilian populations. MEDLINE, EBSCO, EMBASE, and the Defense Technical Information Center were searched for original studies published from 1970 through 2015 that examined associations between physical fitness (ME and MS) and MSK-I in military or civilian populations. Methodological quality and strength of the evidence were determined following criteria adapted from previously published systematic reviews.

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Sep
2017

This study aims to examine blood hemostatic responses to completing a 164-km road cycling event in a hot environment.
Thirty-seven subjects (28 men and 9 women; 51.8±9.

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Jul
2017

Differences in the composition of control diets may confound outcomes in studies investigating dietary effects.
We compared the effects of two control diets commonly used in mice studies, chow (SD) and a purified low-fat diet (LFD), in relation to a chronic high-fat diet (HFD). We hypothesized that SD and LFD will have similar effects on phenotypic, metabolic, and behavioral outcomes.

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Jun
2017

Ketones and Human Performance.

J Spec Oper Med Summer 2017;17(2):112-116
Jonathan M Scott, Patricia A Deuster
Everyone is seeking nutritional strategies that might benefit performance. One approach receiving much attention is ketones, or ketosis. Ketones are very simple compounds made of hydrogen, carbon, and oxygen, and ketosis is a metabolic state whereby the body uses predominantly ketones.

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Dec
1969

Musculoskeletal injuries (MSK-Is) are a significant health problem for both military and athletic populations. Research indicates that MSK-I is associated with physical fitness; however, the association between specific components of physical fitness and MSK-I in military and athletic populations has not been systematically examined. Our goal was to systematically review the literature to provide a best evidence synthesis on the relationship between components of physical fitness and MSK-I risk in military and civilian athletic populations.

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Apr
2017

  Recent case reports on malignant hyperthermia (MH)-like syndrome in physically active populations indicate potential associations among MH, exertional heat stroke (EHS), and exertional rhabdomyolysis (ER). However, an expert consensus for clinicians working with these populations is lacking.
  To provide current expert consensus on the (1) definition of MH; (2) history, etiology, and pathophysiology of MH; (3) epidemiology of MH; (4) association of MH with EHS and ER; (5) identification of an MH-like syndrome; (6) recommendations for acute management of an MH-like syndrome; (7) special considerations for physically active populations; and (8) future directions for research.

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Mar
2017

The Precision Medicine Initiative (PMI) was launched by the White House to promote individualized medicine. Although the focus of the PMI is on curing disease, we introduce the concept of Precision Performance (P2)- advances that might "enable a new era of human performance optimization through research, technology, and policies that empower warfighters and those who support them to work together toward development of individually optimized performance" (The White House, 2015). We provide a limited review of the current state of the science in human performance optimization (HPO) and show that averages among individuals can be both misleading and potentially counterproductive.

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Jul
2017

Poor self-rated health (SRH) is linked to an increased risk of injury, future healthcare services utilization, and morbidity and mortality. This study aimed to identify correlates of a single-item measure of health in 8070 US Army personnel.
Responses were collected from the Army's global assessment tool (GAT) 2.

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Feb
2017

Musculoskeletal injuries (MSK-I) are a significant health problem for both military and athletic populations. Research indicates MSK-I is associated with physical fitness; however, the association between specific components of physical fitness and MSK-I in military and athletic populations has not been systematically examined. Our goal was to systematically review the literature to provide a best evidence synthesis on the relationship between components of physical fitness and MSK-I risk in military and civilian athletic populations.

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Jan
2017

Caffeine and Performance.

J Spec Oper Med Winter 2016;16(4):64-70
Angela M Yarnell, Patricia A Deuster
The role of caffeine in enhancing performance has been studied for years, and there is no doubt that caffeine can be performance enhancing. Also, a wealth of information allows for an interesting distinction between physical and cognitive performance. Most adults in America consume moderate doses of caffeine in various forms on a daily basis as caffeine is typically found in coffee, tea, soft drinks, dietary supplements, energy drinks, energy shots, and chocolate, as well as over-the-counter pills and gums.

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Oct
2016

Many studies have found that some dietary supplement product labels do not accurately reflect the actual ingredients. However, studies have not been performed to determine if ingredients in the same dietary supplement product vary over time. The objective of this study was to assess the consistency of stimulant ingredients in popular sports supplements sold in the United States over a 9-month period.

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Sep
2016

Supplement adulteration with anabolic-androgenic steroids (AAS) has been reported and AAS-associated drug-induced liver injury is clinically variable.
We present two cases of AAS-associated drug-induced liver injury in deployed service members, including the first report of clinical hepatotoxicity with desoxymethyltestosterone. We highlight variable hepatotoxicity patterns of AAS, raise concern with inaccurate supplement labeling and identify educational resources.

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Sep
2016

The use of energy beverages is high among the general population and military personnel. Previous studies have reported discrepancies between the actual amount of caffeine in products and the amount of caffeine on stated labels. Thus, the purpose of this study was to examine the content of caffeine listed on the labels of various energy drinks and energy shots.

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Aug
2016

Studies have suggested that sickle cell trait elevates the risks of exertional rhabdomyolysis and death. We conducted a study of sickle cell trait in relation to these outcomes, controlling for known risk factors for exertional rhabdomyolysis, in a large population of active persons who had undergone laboratory tests for hemoglobin AS (HbAS) and who were subject to exertional-injury precautions.
We used Cox proportional-hazards models to test whether the risks of exertional rhabdomyolysis and death varied according to sickle cell trait status among 47,944 black soldiers who had undergone testing for HbAS and who were on active duty in the U.

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Jul
2016

The intense physical demands and dangerous operational environments common to Special Operations Forces (SOF) result in a variety of painful conditions, including musculoskeletal pain, headaches, and acute and chronic pain from combat injuries. Pain is a wellaccepted barrier to human performance. The Pain Management Task Force and the development of the Defense Veterans Pain Rating Scale (DVPRS) are discussed to provide a framework for changing the culture of pain management away from intensity of pain to interference with function and performance.

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Jul
2016

The Consortium of Health and Military Performance hosted a symposium in April 2015 entitled "Androgens, Anabolic Steroids, and Related Substances: What We Know and What We Need to Know" in response to concerns from the field regarding Anabolic Androgenic Steroids use by U.S. service members.

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Dec
1969

Screening for primary musculoskeletal injury (MSK-I) is costly and time-consuming. Both the Functional Movement Screen (FMS) and the Y-Balance Test (YBT) have been shown to predict future MSK-I. With a goal of optimizing the efficiency of primary MSK-I screening, we studied associations between performance on the FMS and YBT and whether history of MSK-I influenced FMS and YBT scores.

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Jan
2016

The Women in Combat Symposium was held at the Defense Health Headquarters April 29 to May 1, 2014, cohosted by the Office of the Assistant Secretary of Defense for Health Affairs and the Consortium for Health and Military Performance. The conference was a call to renew and extend research investment and policy commitment to recognize operational scenarios, requirements, health priorities, and combat-related injury exposures uniquely relevant to the performance and well-being of female Service members. Symposium participants worked in groups to identify knowledge and capability gaps critical to the successful integration, health, and performance of female Service members in combat roles and to develop recommendations for researchers and policy makers to address gaps in three specific areas of concern: Leadership and Peer Behavior, Operational Performance, and Health and Well-Being.

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Jan
2016


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Dec
2015

Variations of baseline plasma concentrations of creatine kinase (CK), heat shock protein 70 (HSP70), and interleukin 6 (IL-6) have been reported. We report categorical associations which may influence these protein levels. Methods.

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Dec
2015

Military recommendations for dietary protein are based on the recommended dietary allowance (RDA) of 0.8 g of protein per kilogram of body mass (BM) established by the Food and Nutrition Board, Institute of Medicine (IOM) of the National Academies. The RDA is likely adequate for most military personnel, particularly when activity levels are low and energy intake is sufficient to maintain a healthy body weight.

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Nov
2015

The term "Human Performance Optimization" (HPO) emerged across the Department of Defense (DoD) around 2006 when the importance of human performance for military success on the battlefield was acknowledged. Likewise, the term Total Force Fitness (TFF) arose as a conceptual framework within DoD in response to the need for a more holistic approach to the unparalleled operational demands with multiple deployments and strains on the United States Armed Forces. Both HPO and TFF are frameworks for enhancing and sustaining the health, well-being, and performance among our warriors and their families; they are fundamental to accomplishing our nation's mission.

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Nov
2015

Human performance optimization (HPO) is defined as "the process of applying knowledge, skills and emerging technologies to improve and preserve the capabilities of military members, and organizations to execute essential tasks." The lack of consensus for operationally relevant and standardized metrics that meet joint military requirements has been identified as the single most important gap for research and application of HPO. In 2013, the Consortium for Health and Military Performance hosted a meeting to develop a toolkit of standardized HPO metrics for use in military and civilian research, and potentially for field applications by commanders, units, and organizations.

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Aug
2016

It is legal tomarketmost naturally occurring substances as dietary supplements in the USA without manufacturers demonstrating they are safe or effective, and an endless variety of ingredients, from esoteric botanicals to unapproved pharmaceuticals, can be found in dietary supplements. Use of certain supplements can pose a risk, but since a robust reporting systemdoes not exist in the USA it is difficult to know which are problematic and the number of adverse events (AE) resulting from their use. Certain populations, includingmilitary personnel, aremore likely to use dietary supplements than the general population.

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Jul
2015

Tyrosine, a precursor of catecholamine neurotransmitters, may help alleviate physical/cognitive performance decrements in humans under conditions of high physical/psychological stress.
Determine whether supplemental tyrosine mitigates stress-induced decrements in cognitive and/or physical performance in healthy individuals using Samueli Institute's Rapid Evidence Assessment of the Literature methodology.
Key databases (PubMed/MEDLINE, CINAHL, Embase, PsycInfo, and Agricola) were searched for randomized controlled trials from inception to October 2012.

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Jul
2015

Although prior studies have examined the prevalence of dietary supplement use among various populations, data on single vitamins prescribed by health care providers are limited.
This study examined trends in single-vitamin supplement (A, C, D, E, K) prescriptions by providers from military treatment facilities from 2007 to 2011.
We examined prescription data from the Department of Defense Pharmacy Data Transaction Service to determine trends in the aforementioned single-vitamin supplement prescriptions.

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Jul
2015

Mineral supplements such as calcium and iron are readily available over the counter and are some of the most frequently consumed dietary supplements. Health care providers also prescribe mineral supplements for treatment of certain conditions and to maintain health.
This study examines trends in mineral-supplement prescriptions dispensed by military treatment facilities.

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Jul
2015

Third-party certification/verification of dietary supplements (DS), although not mainstream, is one way to help ensure high-quality products. In the medical setting, physicians may prescribe DS to correct a deficiency or improve a health care outcome, and they want products of a certain standard of quality, free of adulteration/contamination.
We reviewed DS dispensed from all Department of Defense military treatment facilities over a 5-year period to determine which products had been third-party reviewed and certified/verified.

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Jul
2015

The use of B-vitamin supplements has increased over the last decade. Although use is widespread in both military and civilian populations, data on patterns of B-vitamin prescription rates are lacking.
This study examines trends in B-vitamin prescriptions dispensed by military treatment facilities.

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Jul
2015

The role of testosterone in health and quality of life has become increasingly visible and overtly marketed to the public. Some evidence suggests that testosterone levels in men may be low because of a variety of reasons, including stress and environmental exposures.
This study examines trends in testosterone prescriptions dispensed by military treatment facilities (MTFs).

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Jun
2015

With the expanding role of women into previously closed combat military occupational specialties, women will likely be exposed more to challenging and extreme conditions. Physical work or exercise in extreme environments could increase the risk for exertional heat illness (EHI) and exertional heat stroke (EHS), the most severe type of EHI. Although men have higher rates of EHS than women, women have slightly higher rates of other EHI.

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Jun
2015

As more women enter the military, it is important to understand how different risks and lifestyle factors influence physical fitness and injury among women in both active duty (AD) and National Guard/Reserve (NG/R). Women in military service are less fit and more likely to suffer musculoskeletal injuries during physical training than men. They also use more medical care during deployment than men.

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Mar
2016

Certain dietary supplements (DSs) used by military populations pose a threat to overall readiness. This study assessed members of the American Medical Society for Sports Medicine (AMSSM) regarding their knowledge of DS use among their patients and reporting of suspected adverse events.
A thirteen-question retrospective, cross-sectional, Web-based survey sought data on practices regarding DSs and adverse event reporting.

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Mar
2015

The term "mindfulness" has become very fashionable within the military and across multiple sectors of civilian and first responder populations. Overall, the key concept of mindfulness is intentionally being acutely aware of what is going on internally as well as externally, without reacting. Mindfulness and the awareness that underlies it are inherent capabilities that can be honed through training.

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Nov
2014

The degree of psychological fitness will ultimately impact mission outcomes, so approaches to enhancing it are critical. Performance psychology is one important aspect of psychological fitness that fits into the holistic model of human performance optimization. This article delves into one component of performance psychology: how mental skill training can be applied to improve performance on mission-related tasks.

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Nov
2014

A systematic review was conducted using Samueli Institute's Rapid Evidence Assessment of the Literature (REAL) process to determine the evidence base for melatonin as an agent to optimize sleep or improve sleep quality, and generalize the results to a military, civilian, or other healthy, active, adult population. Multiple databases were searched yielding 35 randomized controlled trials (RCTs) meeting the review's inclusion criteria, which were assessed for methodological quality as well as for melatonin effectiveness. The majority of included studies were high quality (83.

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Nov
2014

This study investigated associations between heat intolerance, as determined by performance on a heat tolerance test (HTT), and anthropometric measurements (body surface-to-mass ratio, percent body fat, body mass index, and waist circumference) and cardiorespiratory fitness (maximal oxygen uptake [VO2max]). Relationships between predictive variables and specific physiological measurements recorded during the HTT were examined. A total of 34 male and 12 female participants, recruited from the military community, underwent anthropometric measurements, a maximal aerobic exercise test, and a standardized HTT, which consisted of walking on a treadmill at 5 km/h at 2% grade for 120 minutes at 40°C and 40% relative humidity.

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Oct
2014

The US Special Operations Command requires sound recommendations on nutrition to ensure optimal performance of Special Operations personnel. New information continues to emerge, and previous recommendations need to be modified as the evidence base continues to grow. The first 10 Commandments of Nutrition were published in the SEAL professional journal Full Mission Profile in 1992, published for the second time in this journal in 2005, and now revised a second time to reflect the newest science.

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Oct
2014

Use of energy drinks and energy shots among military personnel is controversial. High amounts of caffeine (the primary active ingredient in these products) may impact performance of military duties. The impact of caffeine overconsumption and potential subsequent side effects that might be experienced by service members with unique roles and responsibilities is a concern.

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Oct
2014

Sales of energy drinks in the United States reached $12.5 billion in 2012. Emergency department visits related to consumption of these products have increased sharply, and while these numbers remain small relative to product sales, they raise important questions regarding biological and behavioral effects.

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Oct
2014

Physical fitness, achieved through regular exercise and/or spontaneous physical activity, confers resilience by inducing positive psychological and physiological benefits, blunting stress reactivity, protecting against potentially adverse behavioural and metabolic consequences of stressful events and preventing many chronic diseases. In this review, we discuss the biological mechanisms underlying the beneficial effects of physical fitness on mental and physical health. Physical fitness appears to buffer against stress-related disease owing to its blunting/optimizing effects on hormonal stress responsive systems, such as the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system.

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