Military Medicine最新文献

Introduction: Measuring shoulder mobility is essential for assessing function, especially in occupational settings like the military, where movement tasks in the frontal and sagittal planes are involved. Markerless motion capture systems like the HumanTrak may provide an expedient field platform to quantify upper body kinematics in occupational settings because of their portability. Further validation of these systems against established methodologies, such as marker-based motion capture, is required before upscaling their use.

Materials and methods: Seventeen participants (7 males and 10 females; age, 25 ± 7 years; stature, 1.70 ± 0.08 m; mass, 72.26 ± 15.09 kg) completed standardized fixed-range shoulder flexion, extension, abduction, and adduction tasks with and without body armor for 3 systems: HumanTrak, 2D video capture, and 3D marker-based motion capture. Joint angles were calculated using planar and Euler algorithms. The HumanTrak's relative and absolute validity was compared against these established methodologies.

Results: Generally, valid relative and absolute results were found, with Pearson correlations (r) ranging from 0.56 to 0.93 and root mean square errors ranging from 2.51° to 7.35° for shoulder flexion, extension, and abduction with and without body armor. Shoulder adduction measures were generally invalid, as r values ranged from -0.24 to 0.77, and with root mean square errors ranging from 5.27° to 8.42°.

Conclusions: The HumanTrak's validity is comparable to that of existing field expedient markerless motion capture systems in estimating shoulder joint angles in abduction and the sagittal plane. When movements are standardized to a singular plane of motion and a neutral spine is assumed, valid results can be measured for shoulder flexion, extension, and abduction with and without body armor. Shoulder adduction was generally invalid for both body armor and no body armor conditions, likely because of its multi-planar nature and axial trunk rotation.

Introduction: The U.S. Department of Veterans Affairs (VA) is a leader in providing innovative wellness programming to its employees. However, like many organizations, VA faces ongoing challenges fostering employee engagement. This national, formative evaluation aimed to identify barriers and facilitators to the implementation of employee wellness programming at multiple sites.

Materials and methods: We used a novel quality improvement approach to uncover barriers and facilitators to employee engagement with employee wellness programs. We conducted qualitative, semi-structured interviews with key partners at 8 independent VA sites. Identified barriers and facilitators were coded and analyzed using a quality improvement framework for the cause-and-effect analysis.

Results: Based on the cause-and-effect analysis, we generated recommendations to enhance employee engagement. Recommendations included incorporating wellness into orientation, diversifying communication, hiring devoted leaders, developing whole health-oriented mission statements, constructing comprehensive whole person wellness measures, and promoting a holistic wellness culture.

Conclusions: This multisite evaluation generated collaborative insights from key partners with diverse perspectives of the employee wellness program implementation process. Organizations can adopt this evaluation model to assess and refine their own employee wellness initiatives, identifying both challenges and successes to drive engagement. VA has invested significant resources to support employees via the Employee Whole Health Program. To improve employee engagement with the wellness programming, we recommend promoting employee input, agency, and participation in shaping the programs mission.

Introduction: Phase II training, occurring between basic training and permanent duty assignment, occurs at units that provide specialty skills required by operational military units. Injuries and their subsequent treatment utilize potential training time, potentially delaying their transfer to operational units. Identification of when and where phase II trainees are injured is the first requirement to mitigate the effect of injury.

Materials and methods: All 81 Training Wing (TRW) Phase II trainees presenting for medical care for the first time and with a musculoskeletal injury between November 2024 and May 2025 were included. Trainees provided the location of injury (either before or after arrival to the 81 TRW), whether the injury occurred during physical fitness training, the cause of injury, and how many days after arrival to the 81 TRW they presented for medical care.

Results: 510 trainees were included. Most trainees at Phase II training at 81 TRW were injured after arrival at the installation (67.5%). Median time from arrival to injury presentation was significantly longer for injuries that occurred after arrival than for injuries that occurred before arrival (75 vs. 32 days, difference = 42 days, 95% CI 23 to 60 days, P < 0.001). Running accounted for most injuries (53.8%, 95% CI 48.6%-58.8%).

Conclusions: Most injuries during phase II are because of running. Interventions to lower running-related injuries are expected to yield the greatest reduction in musculoskeletal injuries in Phase II trainees.

Introduction: Cognitive training has arisen in the last several years as an approach to leveraging neuroplasticity toward the goals of improving cognitive performance and psychological well-being. The purpose of this review is to evaluate the potential for cognitive training to serve as a means of preventing maladaptive behaviors, particularly substance use disorder and suicidal thoughts and behaviors in a military population.

Materials and methods: We identified the outcomes of peer-reviewed, published randomized controlled trials (RCTs) using 2 common and well-validated approaches to cognitive training: SMART (and its online adaptation, SMART+) and BrainHQ. We also reviewed recent data from deploying SMART+ and BrainHQ within the National Guard, thus supplementing historical RCTs data with recent data collected in a military population. Finally, we conducted a literature review to determine whether there is evidence that the benefits of cognitive training have a documented relationship to risk of substance use and suicide.

Results: We observed 3 pathways by which cognitive training appears to reduce the risk of maladaptive behaviors: (1) improved higher order cognitive functions; (2) reduced symptoms of psychological distress; and (3) improved social connectedness.

Conclusions: Maladaptive behaviors arise in response to a complex, highly individuated set of psychosocial and situational conditions. Prevention of maladaptive behaviors is, therefore, likely to require a wide variety of interventions. Based upon this literature review, there is a compelling case for cognitive training to be among these interventions. Not only does cognitive training bolster protective factors such as emotional regulation, problem-solving, and psychological well-being, but it reduces risk factors such as social isolation and impaired social skills. Furthermore, because cognitive training is beneficial to healthy (ie, nonclinical) populations, it can be appropriately framed as a tool to improve brain fitness, rather as a "mental health" intervention, the latter of which may be met with some resistance in military populations. Based upon this literature review, we recommend prospective research be conducted to further quantify the relationship between cognitive training and primary prevention of maladaptive behaviors in a military population.

Introduction: Carrying external loads is a fundamental aspect of military training and operational readiness. Added weight and its distribution on the body significantly alters biomechanics and may increase the risk of physical injury. The vertical jump test, a widely accepted measure of lower-body strength and explosiveness, offers a reliable, low-fatigue method for assessing physical readiness in military populations. Despite its utility, researchers have not examined how varying percentages of body weight carried in the MOLLE 4000, a standard military load carriage system, affects biomechanics and movement patterns. Therefore, the primary aim of this study is to determine the effects of various relative external loads on vertical jump height in a cadet sample.

Materials and methods: This study was conducted utilizing a cross-sectional design at a senior military college in the southeastern United States. Cadets were recruited with convenience sampling (N = 41; female [F]=20). Each participant completed three unloaded jumps (control) and three jumps although holding a rubber rifle. Loaded conditions included weights equivalent to 0.00%, 22.0%, 44.0%, and 66.0% of body weight added to the MOLLE 4000 rucksack. Dependent variables analyzed included jump height, flight time, reactive strength index modified (RSI-mod), concentric duration, and eccentric duration.

Results: Male (M) cadets demonstrated significantly greater jump height and flight time compared to F cadets. The most notable decline in performance was observed between the control condition (with and without rifle) and the 22% body weight load condition (control mean: females = 21.60 ± 6.46 cm; males = 34.79 ± 6.80 cm).

Conclusion: Findings highlight that increasing external load from 0% to 22% of body weight significantly reduces vertical jump height in both sexes.

Introduction: An aberrant tympanic segment of the internal carotid artery is a rare vascular anomaly. Clinical manifestations are variable and nonspecific, including hearing loss, tinnitus, vertigo, headache, and aural fullness. In military settings, it may remain undiagnosed, particularly when candidates are asymptomatic or do not report minor symptoms. This condition can render a candidate unfit for enlistment because of the risk of ear trauma during training or procedures. The French Armed Forces require comprehensive medical evaluations before enlistment, including audiometric testing and otoscopic examination. Detecting rare anomalies such as an aberrant carotid artery is critical to ensure candidates' safety.

Materials and methods: We present the case of a 23-year-old female candidate who attended a military medical selection center for army enlistment. Audiometric testing revealed unilateral conductive hearing loss, otoscopic examination demonstrated a pale red pulsatile mass in the middle ear anterior to the umbo, and computed tomography (CT) and magnetic resonance imaging (MRI) of the temporal bone confirmed an aberrant internal carotid artery.

Results: The medical team recommended conservative management with regular follow-up. Because military duty increases the risk of ear trauma, the candidate was classified as unfit for service.

Conclusion: This case illustrates a rare vascular cause of military unfitness and underscores the importance of systematic otoscopic examination and audiometric testing during initial medical screening. Beyond military qualification considerations, early recognition of an aberrant internal carotid artery is critical to prevent catastrophic iatrogenic complications, including massive hemorrhage during otologic procedures or head trauma. Raising awareness of this entity among military clinicians enhances patient safety and helps prevent future complications.

Introduction: The ongoing war between Russia and Ukraine represents the return of large-scale combat operations to Europe for the first time since 1945 and the largest sustained conventional armed conflict in Europe of the 21st century. The current war has led to the rapid escalation of a mental health crisis with predictions of between 10 and 15 million Ukrainians ultimately needing professional psychological assistance as a result of the current hostilities.

Materials and methods: We conducted qualitative key informant interviews (KII) during the ongoing conflict using a Ukraine Trauma System Assessment Tool (TSAT) to understand the experiences of the health and trauma system in Ukraine with respect to mental health disorders and care delivery for these conditions in the time period following the Russian Federation invasion.

Results: Between September 2023 and February 2024, 36 civilian and military healthcare or healthcare-adjacent participants were interviewed, including 22 (61%) males and 13 (36%) females. Mental health conditions are seen as having a detrimental impact on service members in Ukraine. Respondents reported frequent presentations of post-traumatic stress disorder (PTSD), anxiety, depression, sleep disturbance, and traumatic brain injury, described varied treatment practices including psychotherapy, pharmacologic support, and telemedicine, and highlighted persistent gaps in access to care. Participants also emphasized the importance of rehabilitation and noted that untreated mental health conditions adversely affected readiness and return-to-duty rates.

Conclusions: The ongoing conflict in Ukraine has precipitated a significant mental health crisis, impacting both civilians and military personnel. Comprehensive mental health services for PTSD, anxiety, depression, traumatic brain injury (TBI), and other related disorders among Ukrainians are needed. Integration of mental health care into rehabilitation settings, development of expanded community mental health service, and the embedding of psychiatrists and psychologists within military units are necessary to effectively address these needs.