Military Medicine最新文献

Introduction: The U.S. military launched various combat operations following the September 11, 2001 terrorist attack on America. This included Operation Enduring Freedom (OEF) in and around Afghanistan and Operation Iraqi Freedom (OIF) in and around Iraq. These operations occurred in different locations and timeframes and had a significantly different number of casualties. Little is known about the psychological impact of these operations among service members. This study evaluated differences in mental health diagnoses and suicide risk among individuals evacuated for psychiatric conditions from these 2 theaters of combat.

Materials and methods: Data was retrieved from U.S. Transportation Command Regulating and Command and Control Evacuation System and Defense Manpower Data Center records of services members who were aeromedically evacuated for psychiatric conditions during OEF (n = 2,920) and OIF (n = 4,832) between 2001 and 2013 (N = 7,752). We computed Pearson chi-squares to identify differences between service members who had a psychiatric aeromedical evacuation from OEF versus OIF. We evaluated differences in (1) demographic and military characteristics, (2) the prevalence of psychiatric conditions, (3) the 5 most common primary diagnoses, (4) indicators of suicide risk, and (5) the relationship of suicide risk with separation from military service.

Results: There were significant differences in those who had a psychiatric aeromedical evacuation from OEF and OIF related to marital status (χ2(2) = 10.99, P = .004) and education (χ2(3) = 21.29, P < .001). The prevalence of diagnosed psychiatric conditions also differed between OEF and OIF (χ2(10) = 263.49, P < .001). There were no differences in the distribution of suicide attempts, but there was a significant difference in the number of aeromedical evacuations attributed to suicidal ideation (χ2(1) = 182.705, P < .001).

Conclusion: Significant differences were identified in service members who had a psychiatric aeromedical evacuations from OEF and OIF regarding demographic factors and military characteristics. Even though fewer services members were evacuated for suicidal ideations during OIF, a higher number of services members were evacuated for suicide attempts. This inverse trend may be attributable to deployment stressors or healthcare services differences delivered in theater. Similarly, this may explain the difference in the prevalence of diagnosed conditions.

Introduction: The physical fitness and body composition of soldiers are critical for operational readiness and overall health. Military service demands optimal levels of muscle strength, endurance, and cardiorespiratory fitness, alongside a healthy body fat percentage (%BF). However, unlike in the U.S. Armed Forces, Czech Soldiers are not required to meet specific %BF standards, and the prevalence of excessive fat remains unknown. Dual-energy X-ray absorptiometry (DXA) offers a precise and reliable assessment of body composition, yet its use in European military research remains limited. This study evaluates the body composition of Czech Artillery Soldiers using DXA, focusing on %BF, fat-free mass, visceral adipose tissue (VAT), and bone mineral density (BMD), compares %BF values with U.S. Army and civilian norms, and evaluates the practical implications of these findings for military health policy.

Materials and methods: A randomized cross-sectional study was conducted on 209 healthy adult active-duty Czech Artillery Soldiers (189 men, 20 women). Participants underwent a DXA scan to assess body composition using a Hologic Horizon system. Statistical analyses included the Mann-Whitney and Kruskal-Wallis tests, 1-way ANOVA, and generalized linear models (GLM) with age as a covariate. Health classifications were derived using BMI, %BF, and VAT thresholds for cardiometabolic risk and BMD T-scores for osteopenia and osteoporosis. The protocol adhered to the approval granted by the relevant institutional ethics committee (No. 246/2021).

Results: Czech Artillery Soldiers and U.S. Soldiers had nearly identical %BF, 24.3% in Czech men vs. 24.3% in U.S. men; 33.8% vs. 33.3% in women, respectively. Overall, excessive %BF (≥25%) was observed in 41.2% of participants. Age group was a significant predictor of VAT (ω2 = 0.20, df = 6, H = 42.51, P < .001) and %BF (ω2 = 0.07, df = 6, H = 18.73, P < .005), with older participants exhibiting higher levels. High prevalence of osteopenia was found, reaching 20% in both sexes. Contrary to expectations, the GLM revealed that there are no significant differences among units of the Czech Artillery Brigade in any measured variable when age is considered.

Conclusions: DXA-measured body composition in Czech Artillery Soldiers closely matches contemporary U.S. Army values. The high prevalence of overweight and osteopenia underscores the need for preventive and educational strategies addressing both metabolic and skeletal health risks. Future research should determine the prevalence of osteopenia and osteoporosis across the Czech Armed Forces to inform appropriate screening practices and targeted interventions.

Introduction: Musculoskeletal injuries are prevalent during military training, with overuse knee injuries representing a major source of medical attention and time-loss. The early transition into military academy life is marked by considerable physical and psychological stressors, creating a high-risk window for injury development-particularly among individuals with an injury history. Thus, the aim of this study was to develop and internally validate a multivariable prediction model for overuse knee injuries among first-year military cadets with a history of knee injury.

Materials and methods: This was a prospective cohort study, which included 1,265 newly matriculated cadets and midshipmen with a recent history of knee injury from the U.S. Air Force, Army, and Naval Academies. Participants completed standardized baseline testing, including sport and physical training history, lower-extremity isometric strength, and jump-landing biomechanical assessments. Incident overuse knee injuries were prospectively tracked over a 9-month period using medical record review. A multivariable logistic regression was used to develop a prediction model and dynamic nomogram for real-world use. Decision curve analysis was completed to evaluate clinical utility.

Results: Among our sample, 389 (30.8%) trainees sustained at least 1 overuse knee injury within their first academic year. The internally validated prediction model demonstrated moderate discrimination (area under the receiver operator characteristic [AUC] = 0.66; 95% CI, 0.65, 0.67) and stable calibration (0.79; 95% CI, 0.77, 0.81). Decision curve analysis indicated that our final prediction model would correctly identify 29 additional participants out of every 100 as high risk for injury compared with not using a model at all.

Conclusion: This study presents a novel, internally validated prediction model for overuse knee injuries in a high-risk trainee population with prior knee injury. Subgrouping by prior injury status performed better than applying the model to the entire cohort, highlighting the potential efficiency of anatomically specific injury history as a first-level filter for development of injury prediction models. Although this specific study's model performance was moderate, the decision curve analysis supports its potential clinical utility for guiding targeted prevention efforts in military trainees.

Necrotizing soft tissue infections (NSTI) are serious infections that are typically treated with aggressive debridements. Coverage of those extensive full-thickness integumentary defects requires complex reconstructions of both the dermal and epidermal layers with the goal of achieving close to normal pliability. A key determinant factor in the development of scar tissue is the time to create a graftable surface and curtail inflammatory reactions. A second limiting factor is the extent of donor skin needed for coverage. Kerecis, a fish skin-derived regenerative tissue matrix, is a novel product that has shown good promise in the rapid generation of a graftable, pliable dermal matrix in burn patients. Additionally, it decreases the inflammatory reaction through its Omega-3 polyunsaturated fatty acids content. The ReCell system produces a regenerative skin cell suspension of a patient's own skin, with a reduction in the size of the skin graft needed for coverage. The combined use of Kerecis and ReCell provides a promising reconstructive approach that may speed up definitive coverage while reducing donor-site morbidity and pain.

Introduction: Oftentimes, special operations forces (SOF) function in near-extreme physical and psychological conditions demanding exceptional physiological resistance. Strength and aerobic fitness are well-established predictors of SOF performance, but the role of lean muscle mass (LM) within military tests and training paradigms is under-researched. The purpose of this narrative review is to synthesize evidence on the role of LM for SOF selection success, physical performance, and injury prevention.

Materials and methods: A comprehensive literature search was conducted across six databases (PubMed/MEDLINE, Scopus, Web of Science, EBSCO, Military Medicine archives, DTIC) from January 2001 to July 2025. Studies were included if they examined LM in SOF populations and reported on performance, selection, or injury outcomes.

Results: Twenty-eight studies examining 2,239 SOF operators and candidates met the inclusion criteria. LM emerged as a significant predictor of operational performance, with strong correlations to load carrying capacity (r = 0.68) and military-specific tasks. Selected SFAS candidates possessed higher LM than nonselected peers (67.2 ± 7.3 kg vs. 61.9 ± 7.6 kg; d = 0.71, large effect). Each kilogram increase in arm lean mass increased the odds of casualty drag completion by nearly 12-fold (OR = 11.69; 95% CI: 3.84-35.60). Higher LM was associated with reduced musculoskeletal injury (MSKI) risk when coupled with movement symmetry; however, operators with >25% movement asymmetry and body mass >81.8 kg showed 100% injury rates. Operational deployments resulted in substantial LM degradation (4.6% loss) with disproportionate strength decline (11.7%), driven by energy deficits averaging 2,200 kcal/day and hormonal disruption.

Conclusions: Higher LM was associated with favorable outcomes across performance, selection, and injury domains in observational studies, though causal relationships remain unestablished. Despite the limited number of studies that directly assess SOF populations, large effect sizes are shown in SFAS selection, but are susceptible to confounding variables. Contradictory evidence exists regarding optimal body mass and injury interactions. Randomized controlled trials comparing LM-focused versus alternative preparation strategies are needed to establish causality before operational implementation. Current evidence identifies LM as worthy of experimental investigation but insufficient to support definitive recommendations for selection preparation or operational preservation protocols.

Introduction: Explosive Ordnance Disposal (EOD) technicians' roles and responsibilities place them in dangerous and morally challenging situations, and they also experience disproportionately high suicide rates compared to both the general population and other military personnel. Although previous research has identified several risk factors for suicide among military personnel, the extent to which these factors apply to EOD technicians remains unclear.

Materials and methods: This exploratory study examined the role of previously validated risk factors, such as those comprising the Interpersonal Theory of Suicide (IPTS), in differentiating low- and high-risk EOD technicians. We gathered survey data from 698 EOD technicians using validated measures. We employed chi-squared analyses to identify demographic variables that significantly varied between low and high suicide risk EOD technicians.

Results: Logistic regression analyses revealed that 2 factors of IPTS, acquired capability (adjusted odds ratio [aOR] = 1.14, P < .01) and perceived burdensomeness (aOR = 1.07, P < .001), increased the odds of high suicide risk, even after controlling for demographic covariates. Moral injury similarly had a statistically significant effect on increased suicide risk (aOR = 1.05, P < .01). Additional demographic risk factors included being between the ages of 45-49 (aOR = 2.73, P < .01) and being legally separated (aOR = 2.63, P < .05).

Conclusions: Our preliminary findings highlight the necessity of targeted suicide prevention efforts that actively integrate both psychological variables as well as high-risk demographic characteristics. By identifying key differentiators of suicide risk among EOD technicians, this study contributes to the refinement of intervention strategies aimed at reducing military personnel suicide rates.

Introduction: Maintaining optimal body composition and sleep quality (SQ) is essential for preserving combat fitness in military personnel. However, whether body composition independently influences combat fitness components and whether SQ moderates the relationship between body composition and combat fitness remain unclear. Therefore, we examined these relationships to identify the main determinants of combat fitness.

Materials and methods: This study recruited 92 elite army personnel, including company-grade officers and noncommissioned officers, who achieved the "Special Class" standard on the officially authorized army physical fitness test. Body composition was assessed by bioelectrical impedance analysis (BIA), and SQ was evaluated using the Pittsburgh sleep quality index (PSQI). Combat fitness was measured through 3 operationally relevant tasks: leg tuck (LT), 240-m shuttle run (SR), and combat performance test (CPT). Partial correlation was used to analyze the independent effects of body composition, although hierarchical regression examined the moderating role of SQ.

Results: Body fat percentage (BFP) showed significant correlations with LT (r = -0.58), SR (r = 0.51), and CPT (r = 0.44), whereas skeletal muscle mass (SMM) correlated with LT (r = 0.60), SR (r = -0.50), and CPT (r = -0.46). Moderation analysis revealed that lower SQ strengthened the negative effects of BFP on LT (R2 = 0.41) and SR (R2 = 0.39). In contrast, higher SQ enhanced the positive effect of SMM on CPT (R2 = 0.29).

Conclusions: These findings suggest that SQ can function as a moderating factor that either amplifies or mitigates the effect of body composition on combat fitness. Enhancing body composition-by reducing BFP and increasing SMM-and SQ should be considered concurrently to improve military combat performance.