Military Medicine最新文献

Street medicine's mobile, patient-centered model reflects long-standing military doctrine rather than contemporary invention. Drawing parallels with Korean War MASH units, this column examines shared principles of forward deployment, adaptability, and care under constraint, emphasizing their relevance to unhoused populations and veterans for whom proximity to care determines access and outcomes.

Introduction: The aim of this study was to investigate whether physical fitness and body mass index (BMI) are associated with premature discharge from military service because of health reasons.

Materials and methods: The data was collected using a cross-sectional design and included the fitness test results and background information of Finnish conscripts (n = 228, 125) from 2012 to 2021. The physical fitness measures included a 12-minute running test, standing long jump, sit-up, and push-up tests. The BMI was calculated based on height and weight.

Results: Conscripts in any of the lowest quartile of physical fitness were more likely to be discharged from their service compared to those in the highest quartiles (12-minute running test odds ratio (OR) 1.99; 95% confidence interval (CI) 1.88-2.11; standing long jump OR 1.45; 95% CI 1.38-1.53; sit-up test OR 1.46; 95% CI 1.38-1.54; and push-up test OR 1.50; 95% CI 1.42-1.59). The likelihood of being discharged from military service was higher among underweight (OR 1.35; 95% CI 1.22-1.50) and obese conscripts (OR 1.32; 95% CI 1.23-1.42) compared to normal weight conscripts. The most significant predictors for being discharged from service, found using backward elimination regression, were the 12-minute running test performance and BMI. The highest risk of being discharged from service was found to be among underweight conscripts with poor fitness.

Discussion: Physical fitness and BMI were both associated with discharge from military service. Both under and overweight conscripts and those with poor physical fitness had a higher probability of being discharged from service. Therefore, the use of pre- and in service modifications to improve physical fitness and BMI could save resources for the Defence Forces and society as a whole.

An interventional radiology fellow recounts taking his febrile toddler to the ED for neck pain, fearing meningitis or abscess. Despite medical and military experience, he feels powerless as physician and parent roles collide. The episode deepens his humility and empathy for anxious families.

Introduction: As of 2022, 17.5% of active duty service members are female, a population vulnerable to delayed family building because of deployments, geographic relocations, occupational hazards, and career progression demands. Despite increasing access to leadership roles, systemic support for reproductive planning remains inconsistent. The objective of this study was to evaluate how fertility planning affects career progression and retention among active duty military women.

Materials and methods: From June 2020 to December 2023, we conducted an IRB-approved, cross-sectional, anonymous survey with embedded qualitative responses at a single tri-service military medical center. Eligible participants were women with current or prior military service. Survey domains included demographics, military career and deployment history, reproductive knowledge, fertility care access, and perceived impacts on career and family planning. Descriptive statistics summarized trends, t-tests, and chi-square tests were used for comparisons.

Results: Among 185 respondents (mean age 32.7 years), 98.9% were active duty; 48.1% had been deployed, with a mean of 2.1 deployments and 3.5 permanent change of station moves. Most participants (74.1%) were partnered; of these, 33.0% were actively trying to conceive. A majority delayed family building for career reasons (71.9%), and 30.3% reported being passed over for a position because of reproductive plans. Although 75.7% and 90.3% were aware of embryo and egg cryopreservation, respectively, 73.0% were unaware of whether the military offered these services.

Conclusions: Family-building decisions among military women are significantly impacted by career-related demands. Routine counseling and broader access to fertility preservation services are critical to support reproductive autonomy and long-term retention in the Armed Forces.

Introduction: Military pilots and aircrew frequently experience musculoskeletal injuries (MSKIs), particularly in the neck, shoulder, and back, because of the physical and environmental demands of flight. The prevalence of these injuries varies depending on the type of aircraft operated. Such injuries can significantly impact operational readiness and flight capabilities, especially in deployed settings where access to therapy may be limited. Interventions to prevent or mitigate MSKIs are critical to keeping pilots and aircrew flight ready. Non-pharmacological therapies provide accessible, autonomous care, and promote recovery and a more rapid return to duty, especially in remote settings. This review will evaluate the effectiveness of non-pharmacological interventions versus control/usual care therapy in improving strength and pain among military pilots/aircrew with MSKIs in the neck, shoulder and back.

Materials and methods: We searched English publications in Ovid MEDLINE ALL, Embase, CENTRAL, Scopus, ClinicalTrials.gov, National Technical Reports Library, CINAHL Complete, and Google Scholar from their inception to June 2024. Two evaluators independently conducted title and abstract screening and reviewed eligible studies. Full-text articles were screened against eligibility criteria by 2 independent reviewers, with any lack of reviewer consensus being resolved by a third reviewer. The systematic review identified 22 reports from 20 studies of military pilots and/or aircrew, including 14 randomized controlled trials (RCT), 5 non-randomized trials, and 3 observational studies, all of which were included in the analyses. A meta-analysis was performed to address the level of improvement in strength and pain with the indicated treatments. Data were converted to standard mean differences (SMD) between treatment and control groups. A 3-level mixed effects model was used for the meta-analysis.

Results: While 126 reports were considered for full-text review, 22 met the eligibility criteria and were included in the systematic review. The analyses demonstrated modest improvements in strength and pain with rehabilitative therapies directed to neck, shoulder or back as compared to control/usual care.

Conclusions: Rehabilitative therapies potentially provided by embedded healthcare teams show promise in improving physical strength, reducing pain, and addressing the high prevalence of MSKI among military pilots and aircrew. However, further research is needed to refine intervention strategies, evaluate the long-term impact of embedded teams, and enhance recovery, resilience, and physical health outcomes tailored to their demanding operational needs.

Introduction: Effective contraception is essential for U.S. Army Women (USAW), most of whom are of reproductive age and at risk for unintended pregnancy. In this study, we use the Periodic Health Assessment (PHA) to identify contraception needs and electronic health records (EHR) to identify pregnancy events within the Military Health System (MHS).

Materials and methods: This was retrospective cohort from August 31, 2021, to August 31, 2023 of PHAs, electronic health records, and pharmacy records obtained from the Armed Forces Surveillance division. The population was USAW who completed 2 PHAs during the study period (n = 23,015). Inclusion criteria were being female sex, 18-45 years, and need for contraception (n = 10,679). Need for contraception was defined as sexually active women with a uterus, who do not plan to conceive over the following 12 months. This was further divided into a "met" or "unmet" need. A met need was defined as use of sterilization, long and short-acting reversible contraceptives, or barrier methods. An unmet need was defined as those not desiring pregnancy and not using contraception. The prevalence of reproductive-aged USAW with need for contraception who are on (needs meet) or not on (needs unmet) contraception along with rate of pregnancy was obtained.

Results: Overall prevalence of unmet need for contraception was 18.3%. Junior Officers were 2.24 times (95% CI, 1.89-2.64) more likely than junior enlisted to have contraception needs met after adjusting for other factors. Black/African U.S. U.S. Army Women had significantly lower odds (0.57; 95% CI, 0.50-0.65) of having their needs met compared to their non-Hispanic White counterparts. An unmet need was associated with increased risk of unintended pregnancy (adjusted OR = 2.46, 95% CI, 2.10-2.88).

Conclusions: Twenty percent of USAW with a need for contraception potentially had that need unmet over 12 months, which resulted in twice the rate unintended pregnancy compared to those with a met need. The military may consider using the PHA and other proactive strategies to address this issue.

Sleep disruption has been identified by the Department of Defense as one of the primary threats to service member health and mission readiness. Notwithstanding the clear need to address this threat, service members continue to endorse significant rates of sleep disruption, short sleep duration, and formal sleep disorders. Using the socio-ecological model, this commentary illustrates how factors at the individual, interpersonal, organizational, community, and policy level may interact to determine whether an individual service member or particular military unit gets sufficient sleep to accomplish the assigned mission. Several areas are highlighted in which a public health approach to addressing sleep disruption throughout the military can move beyond an individual focus and facilitate system-wide improvements in service member sleep. In particular, caffeine use, physical activity, and sleep scheduling could be addressed through systematic prevention efforts across the Department of Defense.