Military Medicine最新文献

Introduction: In 2023, the prevalence of overweight and obesity in the Czech Army was 56% out of 19% in men and 38% out of 5% in women according to the body mass index (BMI). This study monitors changes in body composition following a targeted intervention in the Czech military population with the aim of reducing body weight in overweight or obese individuals.

Materials and methods: A prospective clinical study was conducted between 2023 and 2025 in six military units. Anthropometric measurements (weight, height, BMI) and body composition analysis (body fat, muscle mass, visceral fat) were performed using the bioimpedance method. Subsequently, participants received a targeted education on the results of the analysis and dietary and exercise measures were recommended. Follow-up body composition examinations were performed at 6 and 12 months.

Results: In a sample of 200 individuals (139 men, 61 women), 56% of subjects had a normal body fat percentage (PBF), (men up to 20%, women up to 28% inclusive). There was no significant change in monitored parameters in individuals with a normal PBF, but individuals with an above-normal PBF experienced weight loss (-0.8 kg in men, -3.6 kg in women) without any reduction in muscle mass. A statistically significant decrease in PBF (0.8% in men, 2% in women) and visceral fat was found in the entire sample during the follow-up measurement after 6 months.

Conclusion: This study demonstrates that a structured, physician-led, individualized intervention effectively reduces body fat and visceral adiposity while preserving muscle mass and improving key health parameters in overweight and obese soldiers. The feasible model highlights the importance of personalized, education-based prevention and has potential for broader application beyond the military.

Clinical trial registration:

Introduction: Millions of United States (U.S.) veterans report exposures to a wide range of chemical, physical, radiological, and biological agents during their military service (i.e., military exposures). Given the negative implications of military exposures for veterans health, high quality research is needed to inform disability policy and healthcare strategies. Existing repositories may help streamline research efforts but have not been comparatively evaluated. We conducted a rapid review to identify repositories for streamlining primary and secondary research on long-term health effects of military exposures.

Materials and methods: Repositories were included for analysis if they contained data or biospecimens that were collected from current or former U.S. service members. Six criteria concerning inventory (i.e., measures of exposures, biospecimens, personally identifiable information) and research permissions (i.e., future use, future contact, and sharing) were used to make a collective assessment of utility for military exposures research. Repositories were also descriptively coded for specific types of exposure-related data (i.e., air pollutants, chemicals, metals, radiation, warfare agents) and the exposure assessment method (i.e., direct or indirect).

Results: Of 52 identified resources, 29 repositories were eligible for further analysis. The most frequently represented exposure-related data type was air pollutants (n = 13), followed by chemicals (n = 11), warfare agents (n = 8), radiation (n = 6), and metals (n = 5). Most repositories used indirect (n = 24) versus direct (n = 5) exposure assessment methods. Eight repositories met al. 6 assessment criteria.

Conclusions: We identified 8 repositories that are useful for streamlining research on the long-term health outcomes of military exposures. Future efforts that focus on evaluating their data and biospecimen quality will further distinguish these resources regarding readiness to produce high-quality research that informs disability policy and healthcare strategies.

Hepatic fascioliasis is a foodborne zoonosis that can mimic hepatobiliary malignancy and occasionally requires surgery when diagnosis is uncertain or when a focal complicated lesion is not amenable to endoscopic or medical management. We report 2 cases managed at a military-associated surgical center in Ukraine involving civilian employees of the Armed Forces of Ukraine working in rear-area, non-combat facilities. Case 1: a 38-year-old man with more than 1 year of right upper quadrant pain and a subcapsular tract-like lesion in hepatic segment VI. Eosinophils and cholestatic enzymes were not elevated. Laparoscopic segment VI resection was performed, and histopathology demonstrated necrotizing inflammation with degenerated Fasciola fragments. Case 2: a 51-year-old woman with nausea, vomiting, back pain, and a brief episode of jaundice; imaging showed a lesion in segment VII extending into segment VI. Preoperative leukocytosis with marked neutrophilia was present, but eosinophil count and full liver biochemistry were not available in the preoperative record. Laparoscopic segment VII resection was performed, and histopathology showed necrotizing inflammation compatible with fascioliasis-related tissue injury. Both patients recovered without postoperative complications and were discharged; triclabendazole was prescribed postoperatively as a precaution. These cases highlight diagnostic pitfalls, including absent or incomplete "classic" laboratory signs, and support laparoscopic resection as a safe option in selected patients when malignancy cannot be excluded and endoscopic therapy is unlikely to succeed, with particular relevance to military health systems.

Introduction: Tuberculosis (TB) causes significant morbidity and mortality worldwide. Diagnosing TB in service members can be a challenge given the overall low incidence but increased risk of exposure that accompanies military travel, training and activities. Here we describe clinical features, risk factors, and characteristics of initial diagnoses of TB at the largest Department of Defense hospital.

Materials and methods: Acid-fast bacilli cultures positive for Mycobacterium tuberculosis at Brooke Army Medical Center were reviewed identifying TB cases between 2010 and 2023. Epidemiologic, clinical, and microbiologic data were collected from medical records. Only patients with initial diagnosis at Brooke Army Medical Center (BAMC) were included.

Results: Twenty-nine patients (65% non-U.S. born) were diagnosed with TB, primarily pulmonary. Latent tuberculosis infection was the most common comorbidity (33%), followed by diabetes and lung disease (21% and 17%). Cough and sputum production were the most frequent symptoms (59%, 48%); 24% were asymptomatic at diagnosis. Acid fast bacilli (AFB) smear positive patients were older with higher rates of classic TB symptoms. Median number of sputum cultures was 4; 58% were collected at least 8 hours apart; 41% had one collected before 10 AM. Only 75% of samples included TB nucleic acid amplification testing (NAAT).

Conclusions: Acid fast bacilli smear negative patients tended to be younger, asymptomatic, have more chronic lung disease, extrapulmonary disease, prior latent tuberculosis infection (LTBI), and longer time from symptoms to treatment highlighting the diagnostic difficulty of these cases. Patients with sputum negative disease and extrapulmonary TB had more days between symptom onset and treatment than AFB sputum positive TB cases. Half of AFB smear negative active duty patients were also TB NAAT negative. Care should be taken when evaluating young, asymptomatic active duty patients with high-risk histories and features for tuberculosis. More research is needed to enhance initial diagnostic evaluation and testing and evaluation for TB in civilian and military population.

This case report describes a 46 year old female with complaints of dizziness and decreased ability to complete activities of daily living although aboard a U.S. Navy ship. She was unable to walk unsupported and her ability to work at a computer was severely limited because of the severity of her symptoms. She had a long history of motion sickness, predominantly seasickness (mal de mer), Eustachian tube dysfunction, and bilateral tympanic membrane perforations. Finding minimal benefit from pharmacological interventions, she was evaluated and diagnosed with seasickness by a physical therapist. The initial interventions focused on gaze stabilization exercises, but were limited in efficacy because of the continuous nature of shipboard motion resulting in needing extended times in a supine position with a foot grounding her on the floor for symptom resolution. Through the application of a sensory reweighting system improvised from available clinic supplies, the patient's symptoms reduced to the point of being able to walk unsupported and engage with VOR habituation exercises although on the ship. This case is unique in that the patient's seasickness did not resolve with typical pharmacologic or physical therapy interventions, so innovative strategies were used to modify her sensory weighting to mitigate her symptoms. This case report may provide other clinicians in austere settings (shipboard) with a non-pharmacological option for the treatment of unresolving seasickness.

Introduction: Chronic low back pain (cLBP) is the most prevalent chronic pain condition among veterans, contributing to disability, reduced quality of life, and opioid dependence. Complementary and integrative health (CIH) approaches offer evidence-based, non-pharmacological alternatives that may improve pain management, enhance patient satisfaction, lower healthcare costs, and reduce opioid dependence.

Materials and methods: The objective of the study was to synthesize current evidence on CIH approaches for veterans with cLBP, evaluate their impact on pain, function, and well-being, and identify implications for policy, health system implementation, and future research. The key questions of the study included: what is the effectiveness of CIH modalities in reducing cLBP intensity among veterans, what are their broader effects on health outcomes, opioid use, and quality of life, what barriers exist to implementation within the VA, and what research and policy priorities are needed to optimize veteran-centered CIH care? A narrative synthesis of peer-reviewed literature published between 2010 and 2025 was conducted, prioritizing studies specific to veterans and incorporating systematic reviews, randomized controlled trials, observational studies, and evidence maps. A patient-centered, biopsychosocial, and whole-health framework guided the analysis.

Results: Evidence for CIH in veterans remains limited compared to that in civilian populations, but it demonstrates promise. Battlefield acupuncture demonstrated clinically meaningful reductions in pain, although yoga, Tai Chi, Qigong, and mindfulness offered modest improvements in pain and functional outcomes. Cognitive-behavioral therapy, Chiropractic care, and massage showed mixed results, with low to moderate certainty and limited durability. Multimodal approaches integrating CIH with conventional care have demonstrated the strongest outcomes, including reduced opioid prescriptions, improved coping, and potential cost savings. Barriers to care include provider shortages, administrative challenges, and uneven access across facilities.

Conclusions: CIH approaches represent patient-centered and holistic strategies with the potential to reduce pain, enhance function, and mitigate opioid reliance among veterans with cLBP. Broader, standardized implementation and veteran-specific trials are necessary to strengthen the evidence base and guide the sustainable integration of this approach into the VA health system.

Introduction: Although the incidence rate of exertional heat stroke (EHS) in the U.S. military decreased from 2018 to 2022, a resurgence in 2024 highlights the importance of continued refinement of effective preventive measures. This study aimed to describe the burden of exertional heat illness (EHI) in the U.S. Air Force Special Warfare Training Wing (SWTW) from FY19 to FY24 and assess changes in annual external heat exhaustion (EHE) and EHS risk following implementation of mitigation strategies in 2019.

Materials and methods: This descriptive epidemiology study analyzed 195 EHI cases among SWTW trainees from FY19 to FY24. Data on EHE and EHS were extracted from Military Health System records. Cumulative incidence (proportion of affected trainees per year) was calculated using the annual trainee population as the denominator. Mitigation strategies implemented in 2019 were assessed. Chi-square testing indicated that the distribution of EHS and EHE differed by fiscal year (χ2 = 12.92, P = .0241), reflecting year-to-year variation in case proportions. Historical weather data were reviewed to descriptively contextualize seasonal environmental conditions during periods of elevated EHI proportions.

Results: During FY19 to FY24, there were 195 reported cases of EHI: 135 EHE and 60 EHS. EHE exceeded EHS annually from FY19 to FY23, with EHI peaking in FY22 (n = 45), declining in FY23 (n = 19), and resurging in FY24 (n = 36), driven by increased EHS (n = 19). EHE cumulative incidence (0.91%-1.90%) outpaced EHS (0.28%-0.79%) until FY24, when EHS rose to 1.80%, surpassing EHE (1.61%). A significant association was identified between EHI type and fiscal year (χ2 = 12.92, P = .0241) with an increased EHS rate in FY24 versus FY20 (P = .012) and FY23 (P = .045); FY22 versus FY20 (P = .039). No significant year-over-year variation in EHE was observed. The SWTW implemented various measures to mitigate heat injury.

Conclusions: Despite interventions at the SWTW, EHI remained prevalent to include an EHS proportion surge (1.80%) in FY24, indicating potential limitations and need for improved training adaptations, early detection, and risk management in high-intensity environments. Achieving zero EHI may not be feasible, thus, leadership must make decisions that acknowledge risk and apply evidence-based strategies to meet mission objectives. Seasonal patterns suggest tailored interventions may be necessary. Future studies should assess morbidity metrics, trainee fitness, and acclimatization to further evaluate and refine prevention strategies.