Margaret A K Ryan

• MD, MPH
• University of California, San Diego

Background The incidence of anaphylaxis after receipt of yellow fever (YF) vaccine is highly variable based upon previously published reports. Anaphylaxis after receiving the YF vaccine has been reported to range from 0 up to 22 per 1 000 000 doses. Our clinical experience suggested increased incidence, which prompted our investigation. We sought t...

This paper provides an update to the original cohort profile paper published a decade ago. The Millennium Cohort Study is the largest, longest-running, prospective study of current and former United States (US) military personnel and is sponsored by the US Departments of Defense (DoD) and Veterans Affairs (VA). While the original study aim, evalua...

Objectives (1) Characterize the initial clinical characteristics and long-term outcomes of smallpox vaccine-associated hypersensitivity myocarditis and pericarditis (MP) in United States service members. (2) Describe the process of case identification and adjudication using the 2003 CDC nationally defined myocarditis/pericarditis epidemiologic case...

Importance Myocarditis has been reported with COVID-19 but is not clearly recognized as a possible adverse event following COVID-19 vaccination. Objective To describe myocarditis presenting after COVID-19 vaccination within the Military Health System. Design, Setting, and Participants This retrospective case series studied patients within the US...

Objective: The purpose of this study was to identify the needs of military service members with chronic symptoms after mild traumatic brain injury (mTBI) that fall within the scope of occupational therapy practice. Method: In this qualitative descriptive study, service members with a history of mTBI (N = 12) participated in semistructured interv...

Serious adverse events after immunizations are rare. We review the case of a man who, 50 years earlier, experienced a serious adverse neurologic event 2 weeks after receiving influenza vaccine. He had received no subsequent seasonal influenza vaccinations, but after the risks and benefits were considered, he was vaccinated without adverse event tha...

Serious adverse events after immunizations are rare. We review the case of a man who, 50 years earlier, experienced a serious adverse neurologic event 2 weeks after receiving influenza vaccine. He had received no subsequent seasonal influenza vaccinations, but after the risks and benefits were considered, he was vaccinated without adverse event tha...

Date Presented 4/1/2017 The purpose of this study is to describe the occupational challenges in daily life faced by active duty military service members who experience persistent symptoms following mild traumatic brain injury. The findings establish needs that fall within each aspect of the occupational therapy domain of practice. Primary Author an...

Challenges of Military Service Members with Persistent Symptoms Following Mild Traumatic Brain Injury

Study design: A prospective cohort study. Objective: Activities performed during military operations vary in complexity and physical demand. The risk for mental illness following military combat deployment has been well documented. However, information regarding the possible contribution of back pain to decreased mental and functional health is...

Objective: To describe outpatient prescription treatment for active-duty military members with posttraumatic stress disorder (PTSD). Medical records were screened for drug-drug interactions with PTSD-related medications and for adverse drug events. Method: A retrospective chart review was conducted of the medical records of active-duty service m...

Posttraumatic stress disorder (PTSD) is a prevalent condition among military service members and civilians who have experienced traumatic events. Stimulant use has been postulated to increase the risk of incident PTSD; however, research in this area is lacking. In this study, the association between receipt of prescription stimulants and PTSD was e...

s: Healthcare workers use less tobacco than other working populations. In contrast, US military members use more tobacco than civilians. Military healthcare workers, therefore, represent a unique group with regard to occupational factors that may influence tobacco use. Aims/Methods: Records of workers at a military community hospital were reviewed...

Tobacco use among young adults is a major public health challenge. Near-term benefits of cessation may motivate active young people to quit or avoid smoking. Military basic training includes mandatory tobacco cessation, as well as uniform physical conditioning regimes, creating an opportunity to evaluate changes in physical performance metrics in d...

The objective of this study was to define the risk of hearing loss among US military members in relation to their deployment experiences. Data were drawn from the Millennium Cohort Study. Self-reported data and objective military service data were used to assess exposures and outcomes. Among all 48,540 participants, 7.5% self-reported new-onset hea...

Background: Streptococcus pneumoniae infections have periodically caused significant morbidity and outbreaks among military personnel, especially trainees. This study evaluated the effectiveness of the 23-valent polysaccharide pneumococcal vaccine (PPV23) in reducing pneumonia in healthy military trainees. Methods: From 2000-2003, 152723 militar...

To evaluate the effect of clinical pharmacists embedded in primary care at a military facility by reviewing laboratory assessments following pharmacist management of referred patients with diabetes and hyperlipidemia. Electronic medical records of patients who were referred to clinical pharmacists for control of diabetes and/or hyperlipidemia were...

PurposeTo describe an intervention among overweight and obese hypertensive patients, encouraging Dietary Approaches to Stop Hypertension (DASH) diet and lifestyle changes, designed and led by a primary care nurse practitioner (NP).Data sourcesA pre- and postintervention quasi-experimental time-series design was implemented over 2 months. Interventi...

Objectives: Combat exposure is known to increase the risk for mental disorders; however, less is known about the temporal relationship between mental disorders and alcohol misuse or smoking. To better understand these interrelationships, this study investigated mental disorders in association with hazardous drinking and cigarette smoking. Methods...

Objective: Evaluate the rate of, and risk factors for, abusive head trauma (AHT) among infants born to military families and compare with civilian population rates. Methods: Electronic International Classification of Diseases data from the US Department of Defense (DoD) Birth and Infant Health Registry were used to identify infants born to milit...

We studied 25910 military members from a large prospective cohort that began enrollment prior to September 11th, 2001. Medication prescriptions were obtained from the military Pharmacy Data Transaction Service, and PTSD was based on a validated survey instrument (PTSD Checklist–Civilian Version) during the study period (2001–2008). The risk of inci...

Background Previous studies have examined the prevalence, risk factors, and health correlates of sexual stressors in the military, but have been limited to specific subpopulations. Furthermore, little is known about sexual stressors' occurrence and their correlates in relation to female troops deployed to the current operations in Iraq and Afghanis...

Background: Overuse injuries have a significant impact on United States military service members, but research to date has been limited in its ability to assess occupational and behavioral risk factors. Hypothesis/purpose: To prospectively identify risk factors for the development of lower extremity tendinopathy and plantar fasciitis in United S...

Objective: To determine if deployment to recent military operations or other health, demographic, or military-related characteristics were associated with employment after military service. Methods: Former US active duty military service members participating in the Millennium Cohort Study, a population-based sample of US military personnel that...

Empirically-based lifting criteria established by the National Institute for Occupational Safety and Health (NIOSH) to reduce risk of overexertion injuries in the general U.S. working population were evaluated for application to pregnant workers. This report proposes criteria to guide decisions by medical providers about permissible weights for lif...

Limited prospective studies exist that evaluate the mental health status of military health care professionals who have deployed. This study used prospective data from the Millennium Cohort Study with longitudinal analysis techniques to examine whether health care professionals deployed in support of the operations in Iraq and Afghanistan were more...

Background: Maternal depression is a common condition among new mothers that can be associated with poor maternal health and negative consequences on infant health. Little research has been conducted to examine maternal depression, especially among military mothers, where unique conditions often exist. Using data from a large military cohort, this...

Concerns about reproductive health persist among U.S. military members who served in the 1990-1991 Gulf War. This study explores the long-term impact of 1990-1991 Gulf War deployment on the prevalence of birth defects among infants of Gulf War veterans. Health care data from the Department of Defense Birth and Infant Health Registry and demographic...

Previous research has shown that military women often experience potentially severe health outcomes following deployment. Data from the Millennium Cohort Study, a 21-year longitudinal study examining the health effects of military service, were used to examine this issue. In longitudinal analyses (2001-2008) carried out among US military women (n =...

To investigate respiratory illnesses and potential open-air burn pit exposure among Millennium Cohort participants who deployed to Iraq or Afghanistan. Using multivariable logistic regression, newly reported chronic bronchitis or emphysema, newly reported asthma, and self-reported respiratory symptoms and possible burn pit exposure within 2, 3, or...

To assess the relationship between possible exposure to smoke from documented open-air burn pits and newly reported lupus and rheumatoid arthritis among Millennium Cohort participants who have deployed in support of operations in Iraq and Afghanistan. Prospectively assessed self-reported lupus and rheumatoid arthritis among deployers who completed...

To investigate the association between US Navy individual augmentee (IA) deployers, who may lack the protective effects of unit cohesion and social support, and newly reported mental health. Responses from the Millennium Cohort Study questionnaires were examined for 2086 Navy deployers in this prospective exploratory study. Multivariable logistic r...

Background: The US military provides many immunizations to its adult members to protect them from infectious disease threats. Ancillary healthcare staff members, including Navy hospital corpsmen, are the frontline for immunization delivery. Concerns have been raised about some military immunization practices, especially with the added complexity of...

The characteristics of U.S. military personnel who use dietary supplements have not been well described. This study aimed to determine whether deployment experience and physical activity were associated with the use of bodybuilding, energy, or weight-loss supplement among U.S. military personnel. Self-reported data from active-duty, Reserve, and Na...

It has been hypothesized that those who entered military service in the pre-September 11, 2001 era might have expectations incongruent with their subsequent experiences, increasing the risk for posttraumatic stress disorder (PTSD) or other mental disorders. A subset of Millennium Cohort Study participants who joined the military during 1995-1999 wa...

The Millennium Cohort Study is a longitudinal cohort study designed in the late 1990s to evaluate how military service may affect long-term health. The purpose of this investigation was to examine characteristics of Millennium Cohort Study participants who responded to the open-ended question, and to identify and investigate the most commonly repor...

: In the United Kingdom and United States, these two independent cohort studies have been instituted to prospectively study the health of service personnel and veterans. From comparisons with baseline information, these studies are designed to better inform the military and the public on how best to protect the health of their armed forces and bett...

Military professionals who deploy to combat operations may encounter hazards that could adversely affect reproductive health. Pregnant women are generally exempt from deployment to military operations; however, exposures to such environments may inadvertently occur. We investigated whether maternal deployment during pregnancy was associated with ad...

Combat-intense, lengthy, and multiple deployments in Iraq and Afghanistan have characterized the new millennium. The US military's all-volunteer force has never been better trained and technologically equipped to engage enemy combatants in multiple theaters of operations. Nonetheless, concerns over potential lasting effects of deployment on long-te...

The objective of this study was to prospectively assess the association between deployment in support of the operations in Iraq and Afghanistan and newly reported lupus and rheumatoid arthritis while also considering the effects of demographic, behavioral, and occupational characteristics. A total of 77,047 (2001-2003) and 31,110 (2004-2006) partic...

Few prospective data exist on the risk of diabetes in individuals serving in the U.S. military. The objectives of this study were to determine whether military deployment, combat exposures, and mental health conditions were related to the risk of newly reported diabetes over 3 years. Data were from Millennium Cohort Study participants who completed...

Posttraumatic stress disorder (PTSD) has been associated with combat intensity, lack of social support, and adverse childhood factors among military personnel in previous studies. It has not been well established if adverse childhood experiences reported predeployment are independently associated with postdeployment PTSD. Data were evaluated from 8...

Iodine deficiency is a global problem representing the most common preventable cause of mental retardation. Recently, the impact of subtle deficiencies in iodine intake on children and pregnant women has been questioned. This study was designed to compare hypothyroidism among infants born to US military families in countries of varied iodine nutrit...

Prostate cancer is the most common cancer among US men, however, the etiology remains unclear. Yet, one consistency is that black non-Hispanic men are at increased risk for prostate cancer compared to white, non-Hispanic men. The goal of this study was to assess relations between demographic and other potential prostate cancer risk factors in the c...

Little prospective data exist on the risk of diabetes among persons in active military service. We examined risk of newly-reported diabetes (DM) in members of the Millennium Cohort Study over a 3-yr follow-up period that included the initiation of military conflicts in Afghanistan and Iraq. Study subjects included a random sample of all persons on...

Introduction: Hypertension affects nearly one-third of the US adult population and may lead to other serious conditions such as cardiovascular disease, stroke or renal failure. Combat deployments present unique stressors to military members. Although stress is postulated to increase blood pressure, little is known regarding a potential role in the...

Combat exposure is known to increase the risk for mental health outcomes, however, little is known about the temporal relationship of mental health symptoms and coping mechanisms. The objective of this study was to prospectively investigate new and persistent mental health symptoms in association with newly reported alcohol misuse and cigarette smo...

We investigated relations between deployment and new-onset depression among US service members recently deployed to the wars in Iraq and Afghanistan. We included 40 219 Millennium Cohort Study participants who completed baseline and follow-up questionnaires and met inclusion criteria. Participants were identified with depression if they met the Pri...

High-stress situations, such as combat deployments, are a potential risk factor for hypertension. Although stress is postulated to increase blood pressure, the underlying role of stress on hypertension is not well established. We sought to determine the relations between combat deployment-induced stress and hypertension. The Millennium Cohort basel...

Infants in utero during the terrorist attacks of September 11, 2001 may have been negatively affected by maternal stress. Studies to date have produced contradictory results. Data for this retrospective cohort study were obtained from the Department of Defense Birth and Infant Health Registry and included up to 164,743 infants born to active-duty m...

There is significant public and veteran concerns over the impact of military deployments to Iraq and Afghanistan on veterans' health. This study investigates morbidity among deployers by uniquely comparing after-deployment hospitalizations to before-deployment hospitalizations and hospitalizations among nondeployers. To compare after-deployment wit...

Since the end of the 1991 Gulf War, there have been reports of unexplained, multisymptom illnesses afflicting veterans who consistently report more symptoms than do nondeployed veterans. One of the many possible exposures suspected of causing chronic multisymptom illnesses Gulf War veterans is squalene, thought to be present in anthrax vaccine. We...

: Participant retention is vital to the success of a longitudinal cohort study. Various approaches have been used for retaining participants in longitudinal studies, including maintaining up-to-date contact information. Postcards are sent to Millennium Cohort Study participants each Memorial and Veterans Day to honor their military service, thank t...

The effect of military deployments to combat environments on disordered eating and weight changes is unknown. Using longitudinal data from Millennium Cohort Study participants who completed baseline (2001-2003) and follow-up (2004-2006) questionnaires (n=48,378), the authors investigated new-onset disordered eating and weight changes in a large mil...

There are no data currently available on gender and racial variation in smallpox vaccine immune responses. We recruited 1076 healthy adults 18-40 years old who received one dose of the US-licensed smallpox vaccine (Dryvax). Vaccinia neutralizing antibody titers in each subject's serum were determined using a high throughput neutralization assay bas...

To determine if baseline functional health status, as measured by SF-36 (veterans), predicts new onset symptoms or diagnosis of post-traumatic stress disorder among deployed US military personnel with combat exposure. Prospective cohort analysis. Millennium Cohort. Combat deployed members who completed baseline (2001-3) and follow-up (2004-6) quest...

Posttraumatic stress disorder (PTSD) results from experiencing or witnessing traumatic, life-threatening events including combat-related experiences. The purpose of this study was to investigate the prevalence of PTSD symptoms and diagnosis, self-reported exposures, and functional health in a large cross-section of the U.S. military. This study use...

Haemangiomas are common, benign, vascular tumours, observed in 4–12% of infants during the first year of life. Most cases progress without complication, yet a small proportion experience life‐threatening complications. Concomitant congenital malformations have been reported in a small but significant proportion of haemangioma patients. This study a...

Background: Genetics play a pivotal role in the host immune response variation to vaccination within a population. Since cytokines and their receptors modulate both innate and adaptive immunity, we hypothesized that SNPs that influence phenotype (cytokine level or function) may be associated with immunologic heterogeneity to smallpox vaccination. M...

The stress of military deployment may compound occupational stress experienced in the military and manifest in maladaptive coping behaviors such as cigarette smoking. The current study describes new smoking among never-smokers, smoking recidivism among past smokers, and change in daily smoking among smokers in relation to military deployment. The M...

High rates of alcohol misuse after deployment have been reported among personnel returning from past conflicts, yet investigations of alcohol misuse after return from the current wars in Iraq and Afghanistan are lacking. To determine whether deployment with combat exposures was associated with new-onset or continued alcohol consumption, binge drink...

In response to bioterrorism threats, anthrax vaccine has been used by the US military and considered for civilian use. Concerns exist about the potential for adverse reproductive health effects among vaccine recipients. This retrospective cohort evaluated birth defects, in relation to maternal anthrax vaccination, among all infants born to US milit...

This study explores adverse events severe enough to warrant hospitalization that may have been associated with receiving the smallpox vaccine in conjunction with military service. Cox proportional hazards modeling was used to identify the risk of hospitalization among US active-duty military personnel during a 1-year period following receipt of the...

Women serving in the US military have some unique occupational exposures, including exposure to vaccinations that are rarely required in civilian professions. When vaccinations are inadvertently given during pregnancy, such exposures raise special concerns. These analyses address health outcomes, particularly preterm births and birth defects, among...

Self-reported medical history data are frequently used in epidemiological studies. Self-reported diagnoses may differ from medical record diagnoses due to poor patient-clinician communication, self-diagnosis in the absence of a satisfactory explanation for symptoms, or the "health literacy" of the patient. The US Department of Defense military heal...

Factors that make people vulnerable to or resilient against posttraumatic stress disorder (PTSD) following overwhelming stress are not well understood. The objective of this study was to prospectively examine the relation between prior assault and new-onset PTSD symptoms in a large US military cohort deployed in the wars in Iraq and Afghanistan. Da...

The DoD Birth and Infant Registry provides systematic surveillance of DoD beneficiary births evaluates reproductive outcomes and conducts research to identify military-or deployment-specific risk factors that might significantly effect infant health. The Registry monitors the 45 major birth defects diagnoses outlined in the National Birth Defects P...

Concerns exist regarding reproductive health, including potential infertility, among young adults with military-related occupational exposures. This study evaluated infertility diagnoses in a large population of healthy young adults in relation to prior smallpox vaccination. Using a retrospective cohort design, the population consisted of United St...

Evaluating the incidence of inflicted traumatic brain injuries (inflicted TBI) in young children, and encompassing shaken baby syndrome (SBS) and related injuries, is an epidemiologic challenge. Data available regarding military families in the U.S. may complement other national surveillance efforts. A protocol was developed to assess the epidemiol...

When the United States implemented civilian and military smallpox vaccination programs in 2003, the National Smallpox Vaccine in Pregnancy Registry was established to better evaluate outcomes after the inadvertent vaccination of pregnant women. Women were referred to the registry by vaccine administrators, health care providers, or state health dep...

In December 2002, the Department of Defense re-instituted smallpox vaccination for US military forces following growing concerns that smallpox might be employed as a bioterrorist weapon. More than one million service members have been given the smallpox vaccine since 2002, although there have been concerns about the safety of the vaccine. Using a l...

To describe new onset and persistence of self reported post-traumatic stress disorder symptoms in a large population based military cohort, many of whom were deployed in support of the wars in Iraq and Afghanistan. Prospective cohort analysis. Survey enrolment data from the millennium cohort (July 2001 to June 2003) obtained before the wars in Iraq...

The prevalence of complementary and alternative medicine (CAM) use has been estimated to be as high as 65% in some populations. However, there has been little objective research into the possible risks or benefits of unmanaged CAM therapies. In this prospective study of active duty US Navy and Marine Corps personnel, the association between self-re...

Results obtained from self-reported health data may be biased if those being surveyed respond differently based on health status. This study was conducted to investigate if health, as measured by health care use preceding invitation, influenced response to invitation to a 21-year prospective study, the Millennium Cohort Study. Inpatient and outpati...

Studies researching service members' health after deployment have relied on self-reported deployment history, although validity of these data remains unknown. This study compared self-reported and electronic deployment data and explored differences in functional health. Self-reported and military deployment data were compared for more than 51,000 p...

Almost 60% of American households were connected to the Internet in 2001, when the Millennium Cohort Study, the largest longitudinal study ever undertaken by the Department of Defense, was launched. To facilitate survey completion, increase data integrity, and encourage cohort retention while maintaining the highest standards of participant privacy...

In December 2002, the US Government implemented policy to immunize health workers, first responders and military personnel against smallpox in preparation for a possible bioterrorist attack. Self-reported vaccination data are commonly used in epidemiologic research and may be used to determine vaccination status in a public health emergency. To est...

In December 2002, the US Government implemented policy to immunize health workers, first responders, and military personnel against smallpox in preparation for a possible bioterrorist attack. Self-reported vaccination data are commonly used in epidemiologic research and may be used to determine vaccination status in a public health emergency. To es...

Previous studies indicate that smokers attrite from military service at significantly higher rates than nonsmokers. The purpose of the current effort is twofold: (a) to examine the implications of treating smoking status as a third military accession quality indicator along with educational credential and mental ability, and (b) to explore preservi...

To better understand the US military's global peacekeeping and combat operations, which may expose a growing population of American service women to challenging occupations and environments. Concordance between self-reported and electronic occupation codes for female participants in the Millennium Cohort was measured using kappa statistics. Multiva...

Military recruits are at a higher risk of respiratory infection than their civilian counterparts. Continuous outbreaks of adenovirus (Ad)-associated acute respiratory disease were documented among US trainees before the implementation of serotype 4 (Ad4) and serotype 7 vaccines in 1971. The discontinuation of Ad vaccination programs in 1999 precipi...

The Millennium Cohort Study began in 2001 using mail and Internet questionnaires to gather occupational and environmental exposure, behavioral risk factor, and health outcome data from a large, population-based US military cohort. Standardized instruments, including the Patient Health Questionnaire, the Medical Outcomes Study Short Form-36 for Vete...

Virtually all US military basic trainees receive seasonal influenza vaccine. Surveillance data collected from December 2005 through March 2006 were evaluated to estimate effectiveness of the influenza vaccine at 6 US military basic training centers. Vaccine effectiveness against laboratory-confirmed influenza was 92% (95% confidence interval 85%-96...

In 1998, the United States Department of Defense initiated the Anthrax Vaccine Immunization Program. Concerns about vaccine-related adverse health effects followed, prompting several studies. Although some studies used self-reported vaccination data, the reliability of such data has not been established. The purpose of this study was to compare sel...

In response to health concerns of military members about deployment and other service-related exposures, the Department of Defense (DoD) initiated the largest prospective study ever undertaken in the U.S. military. The Millennium Cohort uses a phased enrollment strategy to eventually include more than 100,000 U.S. service members who will be follow...

Recently, numerous studies have revealed an increase in complementary and alternative medicine (CAM) use in US civilian populations. In contrast, few studies have examined CAM use within military populations, which have ready access to conventional medicine. Currently, the prevalence and impact of CAM use in US military populations remains unknown....

Acute asthma attacks strike unpredictably and may lead to hospitalization in otherwise healthy individuals. The burden of asthma hospitalization on the US health care system has greatly interested health care workers, many of whom see the incidence of asthma as increasing. To examine the annual incidence of hospitalization and the frequency of subs...