Beyond the Line

Beyond the Line: Military and Veteran Health Research

ALICE B. AIKEN
STÉPHANIE A. H. BÉLANGER
Copyright Date: 2013
Pages: 348
https://www.jstor.org/stable/j.ctt32b85v
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  • Book Info
    Beyond the Line
    Book Description:

    Caring for veterans returning from service is just as important as preparing troops for deployment. Beyond the Line is a collection of current research presented by the Canadian Institute for Military and Veteran Health Research, an organization committed to finding the best solutions to address the range of health issues arising from military service. Bringing together work by defence scientists and researchers and clinicians from several Canadian universities, contributors present their findings on topics such as mental, physical, social, rehabilitative, and occupational health, in addition to combat care. Diverse topics, ranging from technology to programs for children, add depth and dimension. Providing expert insight into healthcare for armed forces, veterans, and their families, Beyond the Line engages the research community towards the common goal of improved healthcare services for Canada's military population.

    eISBN: 978-0-7735-9021-2
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-viii)
  3. Acknowledgments
    (pp. ix-xii)
  4. Foreword
    (pp. xiii-xiv)
    PETER MACKAY

    It is an honour for me to introduce the report of the third Military and Veterans Health Research Forum organized by the Canadian Institute for Military and Veteran Health Research (cimvhr).Beyond the Line: Military and Veteran Health Researchis of great importance, not just in its content but in its demonstration of the academic research community’s support for the health of serving and retired Canadian Forces (cf) members and their families.

    Given the special and evolving conditions, hardships, and health hazards of service in the cf, research that is specific to military exposures and populations has long been recognized...

  5. Preface
    (pp. xv-xvi)
    MARC FORTIN
  6. Introduction
    (pp. xvii-xviii)
    ALICE B. AIKEN, STÉPHANIE A. H. BÉLANGER and MICHELLE U. DAIGLE

    The Canadian Institute for Military and Veteran Health Research (cimvhr) is a network of Canadian researchers from across the country who are strongly committed to working together to improve the health and well-being of military personnel, veterans, and their families. We are proud to say that our network includes over 300 researchers and clinicians from 26 universities and defence scientists across the country, and we are growing.

    The words of two of our eminent keynote speakers at the Third Annual Military and Veteran Health Research (mvhr) Forum (26–28 November 2012, Kingston, on), highlight the importance of the work being...

  7. PART ONE MILITARY AND FAMILY HEALTH
    • 1 Differentiation of Physiological Measures of Neck Myalgia by Principal Component Analysis
      (pp. 3-19)
      MICHAEL F. HARRISON, J. PATRICK NEARY, WAYNE J. ALBERT, VICTORIA L. CHESTER and JAMES C. CROLL

      Neck strain among military helicopter aircrew has been a focus topic, and a number of published papers have proposed different mechanisms of injury.¹ Some authors suggest that pain is a result of forces acting on the skeletal structures – in particular the vertebral bodies and the intervertebral discs.² We propose that the issue stems from a muscle physiology component, and our investigations have proceeded under that assumption. This hypothesis is based on other published works that indicate emg is useful in measuring in-flight stress related to neck pain in fast jet aircrew³ as well as fatigue in the musculature of...

    • 2 Novel Functional Magnetic Resonance Imaging to Quantify Neuronal Hemodynamic and Metabolic Underpinnings of Cognitive Impairment in Mild Traumatic Brain Injury and Amyotrophic Lateral Sclerosis
      (pp. 20-34)
      CLARISSE ILDIKO MARK and GILBERT BRUCE PIKE

      Mild tbi are diagnosed on the basis of symptoms. Although sometimes the signs are clear (acute headache, dizziness, confusion, and nausea), in many instances they are more covert, manifesting as mild cognitive deficits difficult to detect. Organizations generally use two types of assessment: Sport Concussion Assessment Tool version 2 (scat2) and/or a neurocognitive assessment such as Immediate Post-Concussion Assessment and Cognitive Testing (Impact). The scat2 is a symptom inventory and screening assessment for orientation, alertness, cognitive function, and balance. Impact is a very brief test designed to measure a variety of cognitive functions including processing speed, attention, and working memory....

    • 3 Incidence and Risk Factors for Venous Gas Emboli Formation in Canadian Forces Experimental Divers
      (pp. 35-50)
      KAIGHLEY BRETT and PETER ZEINDLER

      Compressed gas divers are at risk for developing decompression sickness (dcs) – a syndrome caused by injury from circulating and tissue-borne inert gas bubbles that evolve in body tissues and the intravascular system as the result of inadequate decompression. The increased partial pressures of inert gases inhaled at depth results in increased tissue uptake of those gases (nitrogen for most diving, helium in mixed-gas diving). With ascent (decompression) the inhaled partial pressures decrease and inert gas flow is reversed from tissue to vasculature and then exhaled. If decompression is inadequate, inert gas bubbles may form either de novo or from...

    • 4 The Road to Joint Task Force Nijmegen 2012: The Soldier On Team Pilot Project
      (pp. 51-73)
      PAULINE GODSELL, MARKUS BESEMANN, ALEXANDRA HEBER and NICHOLAS HAZLEDINE

      The Nijmegen Marches date back to 1909, originally part of the Dutch military training to increase the long-distance marching and weight-carrying abilities of infantry soldiers. With over one million spectators and 45,000 marchers, this largest marching event in the world has evolved into a prestigious, international, four-day event that includes military and civilian divisions. Nijmegen activities provide important international exposure for Canada and the cf. They are reminders of our distinguished past, and our current and future security commitments in Europe. The cf contingent participates in a ceremony at Vimy Ridge and a second at Groesbeek Cemetery commemorating Canada’s honourable...

    • 5 Essential Task Identification for Military Occupations Using the TRIAGE Technique
      (pp. 74-83)
      PAIGE MATTIE, MIKE SPIVOCK and DANIEL THÉORET

      Research in the areas of health, fitness, and occupational requirements in the Canadian Forces (cf) often requires the researcher to draw on the experience and opinions of subject matter experts (smes). The Human Performance Research & Development (hp r&d) cell, within the Directorate of Fitness, has relied on expert opinion throughout several recent initiatives in the physical and occupational fitness standards. In order to draw on the expert advice of smes thoroughly and efficiently, hp r&d sought out a scientific methodology that would satisfy four requirements:

      1 The research method employed must be based on the achievement of group consensus to...

    • 6 Life Satisfaction among Canadian Forces Members
      (pp. 84-102)
      ALLA SKOMOROVSKY, AMANDA THOMPSON and KARLA EMENO

      Military jobs are more physically and psychologically demanding than most civilian jobs, involving high levels of fear, sensory overload, sensory deprivation, a constantly changing environment, and exposure to climatic changes, as well as stressors, such as deployment and prolonged periods of time away from home.¹ The stressors that military personnel encounter may lead to poorer well-being.² Moreover, low life-satisfaction was found to be associated with mental health problems, including suicide ideation³ and turnover intentions.⁴ For example, high occupational stress and work–family conflicts were predictive of poorer life satisfaction, which, in turn, were associated with turnover intentions.⁵ Some evidence suggests...

    • 7 Public Opinion and Soldier Identity: Tensions and Resolutions
      (pp. 103-113)
      STÉPHANIE A. H. BÉLANGER and MICHELLE MOORE

      The transformation of military culture² in modern warfare has affected how soldiers perceive their soldier identity and how this identity is constructed and reinforced throughout indoctrination, as well as during operations and post-deployment.³ The relationship between the military culture and the soldier identity and the impact of this relationship, often lived as a tension, on soldiers’ wellbeing, ⁴ can be explored through the discourse analysis of soldiers who have experienced these policy changes in combat. The sense of belonging to a social group, or social identity, is felt intensively in the everyday relationship of a soldier with the organizational culture...

    • 8 Health-Care Management in the Canadian Forces Health Services: A Comparative Study on Military and Civilian Health Leadership Skills
      (pp. 114-120)
      BRENDA GAMBLE, OLENA KAPRAL and PAUL YIELDER

      During the last fifteen years the concept of emotional intelligence (ei) has garnered much attention in leadership circles as an important interactive psychodynamic tool that contributes to successful leadership in the workplace.¹ ei is the capacity to recognize our own feelings and those of others, as a motivational complex, and also to recognize and manage emotions in both ourselves and in others.² ei is a combination of interpersonal (i.e., social awareness and relationship management) and intrapersonal (i.e., self-awareness and self-management) skills that are learnt and developed throughout one’s life in a maturational continuum that fundamentally supports intrinsic self-awareness and the...

    • 9 Canadian Forces Nursing Officer Pediatric Clinical Preparedness
      (pp. 121-138)
      STEPHANIE MARIE SMITH

      The research question “Are Canadian Forces nursing officers adequately prepared to treat pediatric patients in disasters?” emerged from my experiences on past deployments. The purpose of the research question is to evaluate current training and preparedness among Canadian Forces nursing officers (cfnos) and to provide recommendations to the cfhSvcs to ensure preparedness is achieved.

      Over the last ten years, the cf has continually deployed nursing officers to human-made and natural disasters across the globe. Many cfnos have deployed to Afghanistan and with the Disaster Assistance Response Team (dart). Over the last seven years, the dart has deployed three times. These...

    • 10 Group for Children and Families Having a Parent with an Operational Stress Injury
      (pp. 139-150)
      NADIA KOHLER and REBECCA WIGFIELD

      The idea for e = mc³ arose eight years ago when a group of partners noticed that several families were coping with an osi and that there were no services tailored for children and their parents as a unit. In order to meet that need they worked together to develop a project that would offer three parallel support groups: one for cf members who had sustained an osi, one for spouses, and one for children aged nine to eleven. Each group would address topics relevant to its participants and, on occasion, the groups would combine to discuss certain family aspects....

  8. PART TWO VETERAN AND TRANSITION HEALTH
    • 11 Veterans’ Health in Canada: A Scoping Review of the Literature
      (pp. 153-179)
      STEVEN ROSE, ALICE B. AIKEN, MARY ANN MCCOLL and ALLIE CAREW

      Over the last decade, Canada has seen more people affected by military service-related injuries and illnesses than any time since the Korean War, yet Canada still lags behind its allies in research on military, veteran, and family health. As our military returns from Afghanistan, the time has never been better for a renaissance in military and veteran health research.

      Worldwide interest in the unique health needs of military personnel, veterans, and their families increased following the 1991 Persian Gulf War, when military members from countries around the world returned home with health concerns. The Gulf War also marked the beginning...

    • 12 Exploring the Relationships between Untreated Adverse Childhood Events and Substance Abuse, and Their Impact on PTSD Relapse Rates among Canadian Military Veterans
      (pp. 180-195)
      JOHN WHELAN

      The impetus for this project came from clinical interviews with clients referred through Veterans Affairs Canada for reassessment and treatment of post traumatic stress disorder (ptsd). These veterans had completed exposure-based treatment previously, but during reassessments they continued to meet criteria for ptsd and disclosed developmental and substance abuse histories that were widely discrepant from the accounts described in baseline assessments conducted when they were still serving. This study investigates the impact of these undisclosed, potentially traumatizing events (ptes) and substance use disorders (suds) on reported post-treatment declines. Specifically, the study explores the extent to which adverse childhood events (ace)...

    • 13 Evidence-Based Treatments for Military-Related PTSD: A Review of Advances in Psychotherapy
      (pp. 196-209)
      MAYA ROTH, KATE ST CYR and ALEXANDRA MCINTYRE-SMITH

      Research suggests that participation in peacekeeping missions and exposure to combat are associated with increased risk of developing psychiatric conditions, such as post traumatic stress disorder (ptsd),¹ and that lifetime prevalence estimates of ptsd among military personnel and veterans range from 9% to 30%.² As such, ptsd continues to be a significant concern for the Canadian Forces (cf). Previous research indicates that there is a self-perceived need for mental health service utilization following deployment on combat or peacekeeping missions among cf personnel, and that a considerable proportion of military personnel who acknowledge a need for treatment will seek it.³

      Treatment...

    • 14 Service Use in an Outpatient Clinic for Current and Veteran Military and RCMP Members
      (pp. 210-230)
      JENNIFER C. LAFORCE, DEBBIE L. WHITNEY and KRISTEN N. KLASSEN

      The intense and sustained demands of both military and police service are associated with the development of mental health conditions such as post traumatic stress disorder (ptsd), depression, substance abuse, and other anxiety disorders.¹ Within the Canadian Forces (cf), a survey conducted in 2001 found the prevalence of mental health disorders in the past year to be 15%, with depression at 6.9% and ptsd at 2.3%.² The survey also found that the experiences of combat exposure and/or witnessing atrocities had the strongest association with mental health disorders. Since then, approximately 30,000 Canadian soldiers have been deployed in support of the...

    • 15 Integration of Chiropractic Services into the United States Veterans Health Administration
      (pp. 231-248)
      STEVEN R. PASSMORE and ANTHONY J. LISI

      Every honourably discharged veteran of military service in the United States is entitled to chiropractic care through the Veterans Health Administration (vha). The Veterans Health Administration is the largest network of health-care facilities in the United States, employs more than 15,000 physicians, and has an operational size similar to the province of Ontario.¹ Services at Veterans Health Administration facilities include the spectrum of specialties from medicine, surgery, pharmacy, physical therapy, dentistry, optometry, podiatry, and most recently chiropractic care. The integration of the chiropractic profession occurred in response to patient demand and government legislation.

      In the United States, the federal Public...

    • 16 Overcoming Systemic Obstacles to Veteran Transition to Civilian Life
      (pp. 249-264)
      ALLAN ENGLISH and SYDNEY DALE-MCGRATH

      The transition from military to civilian life, especially for those who are injured, can be difficult. Lately, because of our almost ten-year involvement in combat operations in Afghanistan, this issue has become more pressing as “more than 8,000 Canadian Forces (cf) members were released for medical reasons” between 2006 and 2011. The financial cost for supporting them totalled about $500 million in the 2010–11 fiscal year alone.¹ The high cost of this support is, in part, caused by systemic obstacles to veteran transition to civilian life.²

      A number of disciplines study concrete obstacles to successful transition; however, relatively little...

    • 17 Literature Review on Rural–Urban Differences in Well-being after Transition to Civilian Life
      (pp. 265-280)
      KIMBERLEY WATKINS

      The Canadian population is becoming increasingly urbanized. In just five years (2001–06), metropolitan and urban areas experienced population growth rates of 6.9% and 4.0%, respectively, compared to just 1.0% in small towns and rural regions.¹ Furthermore, according to Statistics Canada’s 2006 census, the vast majority of Canadians live in urban areas. Nonetheless, a notable percentage (20%) of Canadians resides in rural areas, defined as locations outside areas of more than 1,000 residents and 400 residents per square kilometre.² The ratio of urban to rural residents varies greatly by province, with just 15% of Ontario and British Columbia residents inhabiting...

    • 18 Transition-Focused Treatment: An Uncontrolled Study of a Group Program for Veterans
      (pp. 281-290)
      DANIEL W. COX, TIMOTHY G. BLACK, MARVIN J. WESTWOOD and ERIC K. H. CHAN

      In a recent survey of Canadian veterans, approximately one-quarter reported a difficult adjustment to civilian life.¹ Further, the most difficult adjustment was reported by veterans released for medical reasons, followed by those who were widowed, separated, or divorced. While there are many barriers to successful transition, chief among them are the psychiatric disorders associated with veteran status.² In the Canadian Forces (cf), major depression is the most prevalent psychiatric disorder, with rates approximately three times greater than post traumatic stress disorder (ptsd).³ Depression’s relationship with suicidality further increases the importance of understanding and treating the disorder. In studies of cf...

    • 19 The Paradox of Military Training: Survival on the Streets among Homeless Veterans
      (pp. 291-306)
      SUSAN L. RAY, KAREN E. HAINES and MARIE S. S. LONGO

      Over the generations, young recruits have entered the military to serve their country, further educational goals, develop a promising career, or use it as a stepping stone to better prepare for adult responsibilities of civilian life.¹ The military offers promise to young recruits, but the challenges of training and serving at home and in wartime or on peacekeeping missions are intense, complex, and often violent and may result in long-lasting physical and psychological consequences.² Recent changes from peacekeeping to peace-making and deployment of cf troops have led to an increase in traumatic experiences.³ As a result, there is increased potential...

    • 20 Pilot Project on Incarcerated Former Military Personnel in Three Ontario Detention Centres, 2011–2012
      (pp. 307-318)
      ISABELLE COTE

      With the long and sustained missions in Iraq and Afghanistan, the media turned their attention to the consequences of the mental health of returning troops. They also reported on the issue of military personnel and veterans being involved in the criminal justice system. Such titles could be found in the written press: “The Number of Canadian Soldiers Jailed in Edmonton’s Military Prison Has Doubled since 2001.”¹ “Number of [U.K.] Military Veterans in Jail Has More Than Doubled in Six Years.”²

      The notion that military personnel or former military personnel are involved in committing crimes is not new. Gilles de Rais,...

  9. Abbreviations
    (pp. 319-322)
  10. Contributors
    (pp. 323-334)
  11. Index
    (pp. 335-337)