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Parental Leave Impact and Experience: A Survey of the U.S. Graduate Medical Education System. 育婴假的影响与经验:美国研究生医学教育系统的调查。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-27 DOI: 10.1093/milmed/usaf653
Caitlin M Drumm, Elizabeth V Schulz, Paolo C Martin, Tasha R Wyatt, Theodora C Dworak, Sami A Abuhamdeh

Introduction: Prior work conducted within U.S. civilian graduate medical education (GME) programs has uncovered negative perceptions of parenthood related to trainee wellness and performance. However, this subject remains understudied within U.S. military GME which affords trainees 12-18 weeks of paid parental leave.

Materials and methods: We disseminated a web-based survey to trainees, faculty physicians and program directors (PDs) at U.S. military GME programs querying participants on the impact of parenthood and parental leave on trainee wellness and performance. Applicable statistical analyses were utilized to assess differences between groups. Content analysis was used to identify themes within participant open-ended responses.

Results: The survey was completed by 211 respondents from 24 different medical or surgical specialties across the Military Health System. A majority of participants reported that their program's parental leave policy either somewhat or significantly decreased the stress of trainee parents (trainee 50.5% vs. faculty 60.6% vs. PDs 61.9%). Participants reported no impact of parental leave on trainee dedication to patient care, clinical performance, scholarly activities or standardized test scores. Participants reported a somewhat negative impact of training interruptions on the training experience of peers, with no significant difference in how they rated birth and non-birth parents (birth parent 2.44 vs. non-birth parent 2.48, P = .10, d = -0.11). Technical skills and procedural volume were both rated lower for birth parents versus non-birth parents (technical skills: birth parent 2.50 vs. non-birth parent 2.60, P ≤ .001; d = -0.25, procedural volume: birth parent 2.32 vs. non-birth parent 2.41, P <. 001; d = -0.23). Content analysis uncovered themes consistent with the survey data but also revealed persistent stigma surrounding use of full parental leave benefits within certain GME programs.

Conclusions: The current parental leave policy within U.S. military GME is perceived to decrease parental stress and can have a positive impact on trainee wellness. While this policy has been effectively implemented with limited perceived impact on trainee performance, work remains to be done to promote full acceptance of parental leave within military GME.

导读:先前在美国民用研究生医学教育(GME)项目中进行的工作揭示了与培训生健康和表现相关的父母负面看法。然而,这一主题在美国军事GME中仍未得到充分研究,该GME为受训人员提供12-18周的带薪育儿假。材料和方法:我们向美国军事GME项目的学员、教员医师和项目主任(pd)分发了一份基于网络的调查,询问参与者为人父母和育儿假对学员健康和表现的影响。采用适用的统计分析来评估组间差异。内容分析用于确定参与者开放式回答中的主题。结果:该调查由211名受访者完成,他们来自军队卫生系统24个不同的医学或外科专业。大多数参与者报告说,他们项目的产假政策在一定程度上或显著地减轻了实习父母的压力(实习父母50.5%,教师60.6%,博士61.9%)。参与者报告说,育婴假对实习生对病人护理、临床表现、学术活动或标准化考试成绩的奉献精神没有影响。参与者报告说,培训中断对同伴的培训体验有一定的负面影响,他们对亲生父母和非亲生父母的评价没有显著差异(亲生父母2.44 vs.非亲生父母2.48,P =。10, d = -0.11)。与非亲生父母相比,亲生父母的技术技能和程序量都被评为较低(技术技能:亲生父母2.50 vs非亲生父母2.60,P≤0.001;d = -0.25,程序量:亲生父母2.32 vs非亲生父母2.41,P结论:美国军事GME目前的育儿假政策被认为可以减少父母的压力,并对受训人员的健康产生积极影响。虽然这一政策得到了有效实施,但对受训人员的表现影响有限,但要在军训中全面接受育婴假,还有很多工作要做。
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引用次数: 0
The Great Imitator: Syphilitic Hepatitis Presenting as a Mimic to Autoimmune Liver Disease. 伟大的模仿者:梅毒肝炎表现为自身免疫性肝病的模仿者
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-22 DOI: 10.1093/milmed/usaf631
John Stanavage, Jared S Magee, Adam M Tritsch

Syphilis is known to mimic other disease presentations, but is seldom documented as mimicking autoimmune hepatitis with positive autoantibodies. We present a case of a 34-year-old male on pre-exposure prophylaxis (PrEP) for HIV with prior negative syphilis screening presenting with epigastric pain and constitutional symptoms. He endorsed anal sex practices with a monogamous male partner. Laboratory testing revealed elevated aminotransferases, alkaline phosphatase, and bilirubin, along with positive smooth muscle antibodies. A rapid plasma reagin and treponemal antibodies were reactive. He was treated with benzathine penicillin G with resolution of liver function derangements and autoimmune titer elevations.

梅毒是已知的模仿其他疾病的表现,但很少被记录为模仿自身免疫性肝炎阳性自身抗体。我们提出一个34岁的男性病例暴露前预防(PrEP)艾滋病毒与先前的梅毒筛查阴性呈现胃脘痛和体质症状。他支持与一夫一妻制的男性伴侣进行肛交。实验室检测显示转氨酶、碱性磷酸酶和胆红素升高,同时平滑肌抗体阳性。快速血浆reagin和密螺旋体抗体反应。患者给予苄星青霉素G治疗,肝功能紊乱和自身免疫滴度升高得到缓解。
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引用次数: 0
Outcomes following Medializing Tibial Tubercle Osteotomy for Lateral Patellar Instability in Patients with Patella Alta. 内侧胫结核截骨术治疗上髌骨外侧不稳的疗效。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-20 DOI: 10.1093/milmed/usaf636
Patrick C Mayolo, James Pruneski, Connor Zale, Andrew Cooper, Liang Zhou, Craig Bottoni

Introduction: Lateral patellar instability is characterized by patellar subluxation or dislocation secondary to traumatic injury, ligamentous laxity, or other pathoanatomy of the knee. Management often requires surgical stabilization via a tibial-tubercle osteotomy. The purpose of this study is to determine if patella alta is a risk factor for poor postoperative outcomes and return to activity following a medializing tibial-tubercle osteotomy in a young, active-duty military population.

Materials and methods: This is a retrospective review of 42 military patients who received a medializing tibial-tubercle osteotomy for recurrent lateral patellar with a minimum of 2-year follow-up. No other stabilization procedures (i.e., medial patellofemoral ligament reconstruction) were offered or performed during the study period. t-Test, Chi square, and univariate logistic regression were used to determine if patella alta was associated Single Assessment Numeric Evaluation (SANE) scores, postoperative pain, recurrent instability, need for revision surgery, or an adverse outcome resulting in military activity limitations or medical separation.

Results: Of the 42 subjects, 30 were found to have patella alta as defined by Insall-Salvati index, Caton-Deschamps index, or patellar tendon length to patella length ratios. No significant relationship was identified between patella alta and post-operative SANE score (P = .752), post-operative pain (P = .673), recurrent dislocation (P = .248), revision surgery (P = .868) or adverse outcomes requiring permanent activity modifications or medical separation from the military (P = .071). Male sex was found to be protective of adverse outcomes (P = .042).

Conclusion: These data suggest that patella alta is not an independent risk factor for poor outcomes following a medializing tibial-tubercle osteotomy for the management of lateral patella instability in a military population. Female sex is a significant predictor of adverse outcomes. A larger study is warranted to confirm these findings and further investigate the significance of patella alta in patients receiving stabilization procedures for lateral patella instability.

简介:外侧髌骨不稳定的特征是髌骨半脱位或脱位继发于外伤性损伤、韧带松弛或膝关节的其他病理解剖。治疗通常需要通过胫骨结节截骨术进行手术稳定。本研究的目的是确定在年轻现役军人中,髌骨高是否是胫骨结核中间化截骨术后不良预后和恢复活动的危险因素。材料和方法:本研究回顾性分析42例接受胫骨结核中间截骨术治疗复发性外侧髌骨的军人患者,随访至少2年。在研究期间,未提供或实施其他稳定手术(即髌股内侧韧带重建)。使用t检验、卡方检验和单变量logistic回归来确定髌骨是否与单一评估数值评估(SANE)评分、术后疼痛、复发性不稳定、需要进行修复手术或导致军事活动限制或医学分离的不良结果相关。结果:在42例受试者中,30例发现有髌骨上裂(以Insall-Salvati指数、Caton-Deschamps指数或髌骨肌腱长度与髌骨长度之比定义)。髌骨上缘与术后SANE评分无明显关系(P =。752),术后疼痛(P =。673),复发性脱位(P =。248)、翻修手术(P = .868)或不良后果(P = .071),需要永久性改变活动或因病离队。男性对不良结果有保护作用(P = 0.042)。结论:这些数据表明,髌骨上缘并不是军人行胫骨结核中间化截骨术治疗外侧髌骨不稳后预后不良的独立危险因素。女性是不良结果的重要预测因子。有必要进行更大规模的研究来证实这些发现,并进一步研究髌骨上缘在接受外侧髌骨不稳定稳定手术的患者中的意义。
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引用次数: 0
Mixing Energy Drinks with Alcohol is Related to Alcohol Problems Over Time Among Reserve and National Guard Soldiers. 将能量饮料与酒精混合与预备役和国民警卫队士兵长期饮酒问题有关。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-20 DOI: 10.1093/milmed/usaf632
Bonnie M Vest, Mala McCormick-Cisse, D Lynn Homish, Gregory G Homish

Introduction: The potential consequences of alcohol mixed with energy drinks (AMED) consumption are of concern, but research to date has yielded conflicting results on how this mixing relates to alcohol outcomes. How AMED might relate to particular at-risk populations, such as military personnel, and the longitudinal consequences are unknown. This research examines the relationship between AMED use with alcohol problems using 6 years of data, among Reserve and National Guard (R/NG) soldiers, a population at risk for both heavy use of caffeine and alcohol.

Materials and methods: The current analyses used 6 years of annual survey data, collected from soldiers (n = 485) participating in Operation: SAFETY, a longitudinal cohort study of U.S. Army R/NG soldiers and their spouses. Generalized estimating equation models were used to examine the relationship between past-year use of energy drinks mixed with alcohol (yes/no) on the likelihood of having an AUDIT score ≥8 (yes/no), indicative of problems with alcohol. Adjusted models controlled for age, sex, and symptoms of PTSD. The study was approved by the Institutional Review Board at the University at Buffalo, and vetted by the Army Human Research Protections Office, the Office of the Chief, the Army Reserve, and the Adjutant General of the National Guard. All participants provided informed consent to participate.

Results: At the first assessment, over half of the sample reported AMED in their lifetime, and 14.4% reported AMED in the past year. Reporting past-year mixing of energy drinks with alcohol was significantly related to higher odds of likely problems with alcohol (Odds Ratio (OR), 2.01; 95% CI, 1.51-2.66; P < .001) over time (Table 1). This remained true in adjusted models, after accounting for sex, age, and PTSD symptom levels (Adjusted Odds Ratio (AOR), 1.88; 95% Confidence Interval (CI), 1.39-2.54; P < .001).

Conclusions: Soldiers are already at greater risk for problems with alcohol compared to their civilian counterparts; the current analyses suggest that using energy drinks combined with alcohol may increase this risk for some individuals. Further research is needed to explore the context in which energy drinks and alcohol are used to inform future prevention messaging and interventions.

简介:酒精与能量饮料(AMED)混合饮用的潜在后果令人担忧,但迄今为止的研究在这种混合与酒精结果的关系上得出了相互矛盾的结果。AMED如何与特定的高危人群(如军事人员)相关,以及其纵向后果尚不清楚。这项研究利用6年的数据,在预备役和国民警卫队(R/NG)士兵中调查了阿米德胺的使用与酒精问题之间的关系,这两个群体都有大量使用咖啡因和酒精的风险。材料和方法:目前的分析使用了6年的年度调查数据,这些数据来自参加Operation: SAFETY的士兵(n = 485),这是一项对美国陆军R/NG士兵及其配偶的纵向队列研究。使用广义估计方程模型来检验过去一年使用能量饮料与酒精混合(是/否)与审计评分≥8(是/否)的可能性之间的关系,这表明存在酒精问题。调整后的模型控制了年龄、性别和PTSD症状。这项研究得到了布法罗大学机构审查委员会的批准,并由陆军人类研究保护办公室、参谋长办公室、陆军预备役部队和国民警卫队副官进行了审查。所有参与者均提供知情同意。结果:在第一次评估时,超过一半的样本报告其一生中有AMED, 14.4%的样本报告在过去一年中有AMED。报告称,过去一年将能量饮料与酒精混合与酒精可能出现问题的几率显著相关(优势比(OR), 2.01;95% ci, 1.51-2.66;P < 0.001)随时间变化(表1)。在考虑了性别、年龄和创伤后应激障碍症状水平后,调整后的模型仍然如此(调整优势比(AOR), 1.88;95%置信区间(CI), 1.39-2.54;P < 0.001)。结论:与平民相比,士兵已经面临更大的酒精问题风险;目前的分析表明,对某些人来说,混合饮用能量饮料可能会增加这种风险。需要进一步的研究来探索使用能量饮料和酒精来告知未来预防信息和干预措施的背景。
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引用次数: 0
Complex Elbow Fracture-Dislocation in the South Korean Military. 韩国军队复杂肘关节骨折脱位。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-20 DOI: 10.1093/milmed/usaf643
Yoo-Sun Won, Woo Kyoung Kwak, Sang Min Lee, Cheungsoo Ha

Introduction: This study aimed to analyze the surgical outcomes of complex elbow fracture-dislocations treated at a Korean military hospital and to present optimal approaches and fixation strategies according to injury subtype.

Materials and methods: A retrospective review was conducted on 10 patients who underwent surgical treatment for complex elbow fracture-dislocations between May 2023 and December 2024. Demographic data, injury mechanisms, fracture subtype, surgical approach, fixation methods, and clinical outcomes were reviewed. Functional outcomes were assessed using the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) score, and Mayo Elbow Performance Score (MEPS). Radiographic bone union and postoperative complications were also evaluated.

Results: The mean follow-up period was 14.5 months. All fractures achieved radiographic union at a mean of 9.1 weeks. At final follow-up, the mean VAS was 1.8, DASH 11.4, and MEPS 87.5, indicating generally good to excellent outcomes in most cases. The average range of motion was 8°-139° in flexion-extension and 74°-75° in pronation-supination. No cases of re-dislocation or nonunion were observed.

Conclusions: Complex elbow fracture-dislocations remain rare but challenging injuries. Proper selection of surgical approach and fixation method according to injury subtype can lead to favorable clinical outcomes. This study, the first from a Korean military hospital, provides practical insight into individualized surgical management.

本研究旨在分析韩国一家军队医院治疗复杂肘关节骨折脱位的手术效果,并根据损伤亚型提出最佳入路和固定策略。材料与方法:回顾性分析2023年5月至2024年12月10例接受手术治疗的复杂肘关节骨折脱位患者。回顾了人口统计资料、损伤机制、骨折亚型、手术入路、固定方法和临床结果。使用视觉模拟量表(VAS)、手臂、肩膀和手的残疾(DASH)评分和Mayo肘部功能评分(MEPS)评估功能结局。x线骨愈合和术后并发症也进行了评估。结果:平均随访14.5个月。所有骨折均在平均9.1周内实现x线愈合。在最终随访时,平均VAS为1.8,DASH为11.4,MEPS为87.5,表明大多数病例的预后一般为良好至优异。屈伸关节的平均活动范围为8°-139°,旋前关节的平均活动范围为74°-75°。没有观察到再脱位或不愈合的病例。结论:复杂肘关节骨折脱位仍然是罕见但具有挑战性的损伤。根据损伤亚型选择合适的手术入路和固定方法可获得良好的临床效果。这项研究首次在韩国军队医院进行,为个体化手术管理提供了实用的见解。
{"title":"Complex Elbow Fracture-Dislocation in the South Korean Military.","authors":"Yoo-Sun Won, Woo Kyoung Kwak, Sang Min Lee, Cheungsoo Ha","doi":"10.1093/milmed/usaf643","DOIUrl":"https://doi.org/10.1093/milmed/usaf643","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to analyze the surgical outcomes of complex elbow fracture-dislocations treated at a Korean military hospital and to present optimal approaches and fixation strategies according to injury subtype.</p><p><strong>Materials and methods: </strong>A retrospective review was conducted on 10 patients who underwent surgical treatment for complex elbow fracture-dislocations between May 2023 and December 2024. Demographic data, injury mechanisms, fracture subtype, surgical approach, fixation methods, and clinical outcomes were reviewed. Functional outcomes were assessed using the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) score, and Mayo Elbow Performance Score (MEPS). Radiographic bone union and postoperative complications were also evaluated.</p><p><strong>Results: </strong>The mean follow-up period was 14.5 months. All fractures achieved radiographic union at a mean of 9.1 weeks. At final follow-up, the mean VAS was 1.8, DASH 11.4, and MEPS 87.5, indicating generally good to excellent outcomes in most cases. The average range of motion was 8°-139° in flexion-extension and 74°-75° in pronation-supination. No cases of re-dislocation or nonunion were observed.</p><p><strong>Conclusions: </strong>Complex elbow fracture-dislocations remain rare but challenging injuries. Proper selection of surgical approach and fixation method according to injury subtype can lead to favorable clinical outcomes. This study, the first from a Korean military hospital, provides practical insight into individualized surgical management.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Military Health System in Transition: Revisiting Avoidable Hospitalizations (Fiscal Years 2021-2024). 转型中的军事卫生系统:重新审视可避免的住院治疗(2021-2024财政年度)。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-20 DOI: 10.1093/milmed/usaf637
Mark J Meuer, Wendy Vaughan, Amanda Banaag, Christian L Coles, Tracey Pérez Koehlmoos

Introduction: The Military Health System (MHS) has faced multiple changes and challenges over the last decade including the Defense Health Agency (DHA) merger, deployment of MHS GENESIS, military treatment facility (MTF) realignment, and the COVID-19 pandemic. We sought to understand the impact of these events on MHS beneficiary care by comparing Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs) for avoidable hospitalizations between beneficiaries with a designated direct care primary care manager (PCM) and those with a designated private sector PCM.

Materials and methods: We used the MHS Data Repository to conduct a cross-sectional study of TRICARE Prime beneficiaries aged 18 to 64 years during fiscal years 2021-2024. Crude and adjusted risk ratios were used to determine risk by PCM type for each AHRQ PQI. Logistic regression models were used to estimate unadjusted and adjusted odds ratios for admissions for any of the PQIs. This study was found exempt by the Institutional Review Board of the Uniformed Services University of the Health Sciences.

Results: We identified a total of 490,236 hospital admissions by patients in the MHS with a designated primary care manager (PCM) during the study period. Of the total admissions, 2.85% were associated with PQIs, 2.70% by direct care PCM at a military treatment facility, and 3.75% by a private sector PCM. Rate of admission for several of these conditions on a scale per 1,000 hospitalizations showed lower rates of avoidable hospitalizations in patients with a direct care PCM, but adjusted analysis showed lower overall risk of avoidable hospitalizations for patients with a private sector PCM. Additionally, several individual characteristics, including Black race and comorbidities had higher odds of avoidable hospitalization.

Conclusions: Our findings show that beneficiaries with a private sector PCM had lower odds of an avoidable hospitalization, supporting existing concerns that current staffing shortages have impacted direct care capabilities. With the push to increase force lethality, MHS stabilization is needed to rebuild a ready medical force that can support a medically ready force.

简介:在过去十年中,军事卫生系统(MHS)面临着多种变化和挑战,包括国防卫生机构(DHA)合并、MHS GENESIS的部署、军事治疗设施(MTF)重组以及COVID-19大流行。我们试图通过比较医疗保健研究和质量机构(AHRQ)预防质量指标(PQIs)在指定直接护理初级保健经理(PCM)和指定私营部门PCM的受益人之间可避免住院治疗的影响,来了解这些事件对MHS受益人护理的影响。材料和方法:我们使用MHS数据库在2021-2024财政年度对18至64岁的TRICARE主要受益人进行了横断面研究。采用粗风险比和调整风险比来确定每个AHRQ PQI的PCM类型的风险。使用逻辑回归模型来估计任何pqi患者入院的未调整和调整的优势比。这项研究被健康科学统一服务大学机构审查委员会认定为豁免。结果:在研究期间,我们确定了共有490,236名患者在指定的初级保健经理(PCM)的MHS住院。在总入院人数中,2.85%与PQIs有关,2.70%与军事治疗设施的直接护理PCM有关,3.75%与私营部门PCM有关。在每1,000名住院患者中,其中几种疾病的住院率显示,直接护理的PCM患者可避免住院的比例较低,但调整后的分析显示,私营部门PCM患者可避免住院的总体风险较低。此外,包括黑人种族和合并症在内的一些个体特征有更高的可避免住院的几率。结论:我们的研究结果表明,私营部门PCM的受益人可避免住院的几率较低,这支持了现有的担忧,即目前的人员短缺已经影响了直接护理能力。在努力提高部队杀伤力的情况下,需要稳定MHS,以重建一支随时待命的医疗部队,支持一支随时待命的医疗部队。
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引用次数: 0
Risk Factors for Musculoskeletal Injuries in Military Recruits: The Impact of Sex, Body Fat Percentage, and Physical Fitness. 新兵肌肉骨骼损伤的危险因素:性别、体脂率和体能的影响。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-13 DOI: 10.1093/milmed/usaf614
Gilberto de Carvalho Junior, Leonardo Mendes Leal de Souza, Guillermo Brito Portugal, Valéria Cristina de Faria, Bruno Ferreira Viana, Priscila Dos Santos Bunn

Introduction: Basic military training is crucial for preparing civilians for military life. This period prepares them with physical and cognitive skills required for military service. However, basic military training is marked by a high incidence of musculoskeletal injuries. In addition, female sex has been identified as a risk factor in military training courses, contributing to higher medical treatment costs and reduced operational readiness.

Objective: To investigate the incidence of musculoskeletal symptoms and injuries in male and female recruits during sixteen weeks of Brazilian Marine Basic Military Training, as well as to assess their potential risk factors.

Methods: A total of 626 military recruits were enrolled in the training period. The study was divided into two phases. Firstly, a cross-sectional analysis included body composition assessment and physical fitness tests. Secondly, a retrospective analysis included the application of the Nordic Musculoskeletal Symptoms Questionnaire (NMQ) at the end of the course to assess the musculoskeletal complaints experienced by the recruits. A logistic regression analysis investigated factors associated with injuries, adjusting for physical fitness variables. Data analysis was performed using Jamovi software, with a significance level set at 0.05.

Results: The NMQ revealed that women had a higher risk in the following categories: any symptom, symptoms that resulted in time loss from duties, symptoms that required medical attention, symptoms in the 7 days preceding the baseline evaluation, trunk injuries, upper and lower limbs injuries. However, after adjusting for physical fitness variables, the fitness-related factors associated with the incidence of musculoskeletal symptoms were body fat percentage and running performance only for symptoms that led to medical consultation or duty restriction. Sex was associated only with the week in which the NMQ was administered. The activities associated with a higher risk of injuries in women were drill and ceremonies, load carriage marching, and obstacle courses.

Conclusions: The present study identified that sex, body fat percentage, and running performance were risk factors for musculoskeletal symptoms in recruits. Additionally, physical training, loaded marching, and running were the activities most associated with injuries during the training course.

基础军事训练是为平民准备军事生活的关键。这段时间使他们具备服兵役所需的身体和认知技能。然而,基础军事训练的特点是肌肉骨骼损伤的发生率很高。此外,女性已被确定为军事训练课程中的一个风险因素,导致医疗费用增加和行动准备程度降低。目的:调查巴西海军陆战队新兵在16周的基础军事训练中肌肉骨骼症状和损伤的发生率,并评估其潜在的危险因素。方法:对626名新兵进行训练。研究分为两个阶段。首先,横断面分析包括身体成分评估和体能测试。其次,回顾性分析包括在课程结束时应用北欧肌肉骨骼症状问卷(NMQ)来评估新兵经历的肌肉骨骼投诉。逻辑回归分析调查了与损伤相关的因素,调整了身体健康变量。数据分析采用Jamovi软件,显著性水平设为0.05。结果:NMQ显示,妇女在以下类别中具有较高的风险:任何症状、导致工作时间损失的症状、需要就医的症状、基线评估前7天内的症状、躯干损伤、上肢和下肢损伤。然而,在调整身体健康变量后,与肌肉骨骼症状发生率相关的健康相关因素是体脂率,只有在导致医疗咨询或限制工作的症状时才会出现跑步表现。性行为只与进行NMQ测试的那一周有关。与女性受伤风险较高的活动是训练和仪式、载重马车行进和障碍训练。结论:本研究发现,性别、体脂率和跑步表现是新兵肌肉骨骼症状的危险因素。此外,体能训练、负重行军和跑步是训练过程中最容易受伤的活动。
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引用次数: 0
Oxylipin Responses during the Yukon Arctic Ultra: The Longest and Coldest Ultramarathon in the World. 育空北极超级马拉松:世界上最长、最冷的超级马拉松。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-12 DOI: 10.1093/milmed/usaf622
Robert H Coker, Tadataka Tsuji, Reed J Thomas, Melynda S Coker, Juan J Aristizabal-Henao, Michael A Kiebish, Camilla Kienest, Adriane Schalt, Yu-Hua Tseng, Mathias Steinach

Introduction: Aerobic exercise and cold exposure modulate lipid mediator production, which may optimize physiological resilience. The Yukon Arctic Ultra (YAU), a 692-km self-provisioned multiday endurance event, offers a unique opportunity to examine lipidomic adaptations to nutrients and environmental and physical stress. This study aimed to identify lipid mediators responsive in YAU athletes compared to control participants.

Methods: Nine athletes and six controls were recruited from the 2017 and 2019 YAU events. Targeted liquid chromatography-tandem mass spectrometry/mass spectrometry-based signaling lipidomic analysis was conducted on serum samples collected from participants at pre-event, during the event, and post-event time points.

Results: Athletes and controls did not differ significantly in age, body mass index (BMI), fat mass index (FMI), or fat-free mass index. During the event, athletes exhibited significant reductions in BMI, fat mass, and FMI, whereas no changes were observed in controls. Athletes showed higher baseline levels of anti-inflammatory oxylipins, including resolvin D2 and lipoxin A4 (LXA4), and lower levels of the pro-inflammatory leukotriene E4 compared to controls. Linoleic acid- and α-linolenic acid-derived oxylipins were also elevated in athletes. Notably, these anti-inflammatory lipids remained elevated throughout the event. Certain hydroxy-eicosapentaenoic acids demonstrated a declining trend during the event in athletes.

Discussion: YAU athletes exhibit a distinct lipidomic signature marked by persistently elevated anti-inflammatory oxylipins, likely reflecting a complex interplay between adipose tissue and skeletal muscle. Overall, the oxylipin shifts point to anti-inflammatory and thermogenic adaptations that support physiological resilience during physical, nutrient, and environmental stress in austere circumstances.

有氧运动和冷暴露可调节脂质介质的产生,从而优化生理弹性。育空北极超长赛(Yukon Arctic Ultra, YAU)是一项长达692公里的自选多日耐力赛,为研究脂质组学对营养、环境和身体压力的适应提供了一个独特的机会。本研究旨在确定与对照组相比,YAU运动员的脂质介质反应。方法:从2017年和2019年的YAU赛事中招募9名运动员和6名对照组。在活动前、活动中和活动后时间点采集的参与者血清样本进行了靶向液相色谱-串联质谱/基于质谱的信号脂质组学分析。结果:运动员和对照组在年龄、身体质量指数(BMI)、脂肪质量指数(FMI)或无脂质量指数方面没有显著差异。在比赛期间,运动员表现出BMI、脂肪量和FMI的显著降低,而对照组没有观察到变化。与对照组相比,运动员显示出更高的抗炎氧脂素基线水平,包括resolvin D2和lipoxin A4 (LXA4),以及更低的促炎白三烯E4水平。亚油酸和α-亚麻酸衍生的氧磷脂在运动员中也升高。值得注意的是,这些抗炎脂质在整个事件中保持升高。某些羟基二十碳五烯酸在运动员的比赛中表现出下降的趋势。讨论:YAU运动员表现出明显的脂质组学特征,其特征是抗炎氧脂素持续升高,可能反映了脂肪组织和骨骼肌之间复杂的相互作用。总的来说,在严峻的环境下,氧化脂素的变化指向抗炎和产热适应,支持身体、营养和环境压力下的生理弹性。
{"title":"Oxylipin Responses during the Yukon Arctic Ultra: The Longest and Coldest Ultramarathon in the World.","authors":"Robert H Coker, Tadataka Tsuji, Reed J Thomas, Melynda S Coker, Juan J Aristizabal-Henao, Michael A Kiebish, Camilla Kienest, Adriane Schalt, Yu-Hua Tseng, Mathias Steinach","doi":"10.1093/milmed/usaf622","DOIUrl":"https://doi.org/10.1093/milmed/usaf622","url":null,"abstract":"<p><strong>Introduction: </strong>Aerobic exercise and cold exposure modulate lipid mediator production, which may optimize physiological resilience. The Yukon Arctic Ultra (YAU), a 692-km self-provisioned multiday endurance event, offers a unique opportunity to examine lipidomic adaptations to nutrients and environmental and physical stress. This study aimed to identify lipid mediators responsive in YAU athletes compared to control participants.</p><p><strong>Methods: </strong>Nine athletes and six controls were recruited from the 2017 and 2019 YAU events. Targeted liquid chromatography-tandem mass spectrometry/mass spectrometry-based signaling lipidomic analysis was conducted on serum samples collected from participants at pre-event, during the event, and post-event time points.</p><p><strong>Results: </strong>Athletes and controls did not differ significantly in age, body mass index (BMI), fat mass index (FMI), or fat-free mass index. During the event, athletes exhibited significant reductions in BMI, fat mass, and FMI, whereas no changes were observed in controls. Athletes showed higher baseline levels of anti-inflammatory oxylipins, including resolvin D2 and lipoxin A4 (LXA4), and lower levels of the pro-inflammatory leukotriene E4 compared to controls. Linoleic acid- and α-linolenic acid-derived oxylipins were also elevated in athletes. Notably, these anti-inflammatory lipids remained elevated throughout the event. Certain hydroxy-eicosapentaenoic acids demonstrated a declining trend during the event in athletes.</p><p><strong>Discussion: </strong>YAU athletes exhibit a distinct lipidomic signature marked by persistently elevated anti-inflammatory oxylipins, likely reflecting a complex interplay between adipose tissue and skeletal muscle. Overall, the oxylipin shifts point to anti-inflammatory and thermogenic adaptations that support physiological resilience during physical, nutrient, and environmental stress in austere circumstances.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quality Improvement Project to Assess the Safety of Dietary Supplements Sold on Two United States Army Installations, 2024. 质量改进项目评估在两个美国陆军基地销售的膳食补充剂的安全性,2024年。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-12 DOI: 10.1093/milmed/usaf591
Kyala E Clegg, Kimberly M Whitbeck, Joseph D Brennan, Matthew R Beymer

Introduction: Approximately 50% of the United States (U.S.) adult population uses at least one dietary supplement (DS). Higher DS use is reported among occupations with high physical fitness demands. As of 2021, roughly 75% of U.S. military service members (SMs) used at least one DS weekly. The primary objective of this quality improvement project was to characterize the DS environment on two U.S. military installations.

Materials and methods: Fort Drum in the United States and Camp Buehring in Kuwait were surveyed from March to August 2024. A team of 12 health professionals (Registered Dietitian Nutritionists, Health Educators, and Certified Strength and Conditioning Specialists) analyzed 1,209 unique DS sold on Fort Drum and/or Camp Buehring. By analyzing the DS labels, our team assessed DS for dosage of vitamins and minerals, caffeine content, presence of stimulants and prohibited substances, as well as for the Operation Supplement Safety (OPSS)-vetted third-party certification organization seals.

Results: Of the 1,209 unique DS examined, 250 (21%) contained a proprietary blend, matrix, or complex. Additionally, 461 (38%) had more than 200% of the established Daily Value for at least one vitamin or mineral, 63 (5%) contained more than 200 mg of caffeine per serving, and 87 (7%) were found to contain multiple stimulants. Only 120 (10%) of the DS were certified by an OPSS-vetted third-party certifying agency. No prohibited substances were identified on the labels of the evaluated DS.

Conclusions: Given the significant risk to medical readiness, it behooves the Department of Defense (DoD) to more closely monitor DS sold on installations. As the lead organization for supplement education and mandatory safety training, OPSS should play a central role in reassessing the vetting process of DS sold on military installations. Integrating OPSS into this process would help mitigate the risk of SMs inadvertently consuming prohibited substances.

大约50%的美国成年人至少使用一种膳食补充剂(DS)。据报道,在对身体健康要求较高的职业中,DS的使用率较高。截至2021年,大约75%的美国军人每周至少使用一次DS。这个质量改进项目的主要目标是描述两个美国军事设施的DS环境。材料和方法:于2024年3月至8月对美国的Fort Drum和科威特的Camp Buehring进行了调查。一个由12名健康专家组成的团队(注册营养师、营养学家、健康教育者和认证力量和调节专家)分析了在Fort Drum和/或Camp Buehring销售的1209种独特的DS。通过分析DS标签,我们的团队评估了DS的维生素和矿物质的剂量,咖啡因含量,兴奋剂和违禁物质的存在,以及OPSS审核的第三方认证机构印章。结果:在检查的1209种独特的DS中,250种(21%)含有专有的混合物、基质或复合物。此外,461种(38%)至少含有一种维生素或矿物质超过每日摄入量的200%,63种(5%)每份含有超过200毫克的咖啡因,87种(7%)被发现含有多种兴奋剂。只有120个(10%)DS通过了opss审查的第三方认证机构的认证。经评估的DS标签上未发现禁用物质。结论:鉴于对医疗准备的重大风险,国防部(DoD)有必要更密切地监测在设备上销售的DS。作为补充教育和强制性安全培训的牵头机构,安全保障司应在重新评估军事设施出售的DS的审查过程中发挥核心作用。将OPSS纳入这一过程将有助于减轻SMs无意中摄入违禁物质的风险。
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引用次数: 0
In Vitro Analysis of Flow Rates in Peripheral Catheter Devices: Implications for Emergency Fluid Resuscitation. 外周导管装置的体外流速分析:对紧急液体复苏的意义。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-09 DOI: 10.1093/milmed/usaf615
Dominique M Ferguson, Matthew A Tovar, Mariah A Jensen-Wachspress, Daniel T Weinberg, Alison M Colao, Lorie M Gower, Christopher D Treager, Brittany L Dellinger, Eric F Sulava

Introduction: Rapid, intravenous (IV) infusion is critical for resuscitation in emergency medicine. Needleless connectors improve safety by reducing the risk of bloodstream infection transmission and air embolism; however, needleless connectors also significantly limit flow rates. Although prior studies demonstrated that 3-way and 4-way "high-flow" stopcocks have flow rates noninferior to uninterrupted catheter tubing, the performance of 1- and 2-way high-flow stopcocks remains poorly understood. This study evaluated flow rates across various catheter connection adjuncts to identify optimal devices for resuscitation efficacy.

Materials and methods: A 500-mL infusion circuit of 0.9% normal saline was tested with needleless connectors, standard and high-flow stopcocks under gravity (0 mm Hg) and pressurized (300 mm Hg) conditions. A 16-gauge IV catheter connected directly to IV tubing served as the control. Fluid volume was measured gravimetrically over 120 seconds, and flow rate was calculated. Each condition was repeated in quadruplicate. Data were analyzed via 2-way analysis of variance and follow-on Tukey's post hoc testing, with multiplicity-adjusted statistical significance defined as P < .05.

Results: The use of needleless connectors significantly decreased flow compared to control in both the gravity cohort (0.95 ± 0.018 mL/second vs. 1.19 ± 0.05 mL/second, P < .0001) and the pressurized cohort (3.10 ± 0.048 mL/second vs. 3.46 ± 0.072 mL/second, P < .0001). The use of high-flow 2-way stopcocks did not significantly reduce flow in either gravity (1.21 ± 0.05 mL/second, P = .932) or pressurized cohorts (3.42 ± 0.048 mL/second, P = .957) compared to control. In addition, the use of high-flow 3-way stopcocks did not significantly reduce flow in gravity (1.240 ± 0.02 mL/second, P = .368) or pressurized cohorts (3.43 ± 0.064 mL/second, P = .986) compared to control.

Conclusion: In an idealized system, the use of high-flow stopcocks allows for an 8%-10% increase in flow rate compared to needleless connectors, correlating to an additional 400 mL of fluid delivered over a 20-minute period. The 2-way high-flow stopcock could provide a significant advantage by delivering increased flow rates while offering a compact design that maintains a low operational footprint. Given the impact of rapid fluid administration in trauma and resuscitation, high-flow stopcocks may enhance emergency care efficiency in austere combat environments.

简介:快速静脉(IV)输注是急救医学复苏的关键。无针连接器通过降低血液感染传播和空气栓塞的风险来提高安全性;然而,无针连接器也严重限制了流量。虽然先前的研究表明,3路和4路“高流量”旋塞的流量不低于不间断导管,但1路和2路高流量旋塞的性能仍然知之甚少。本研究评估了各种导管连接辅助装置的流量,以确定复苏效果的最佳装置。材料与方法:在重力(0 mm Hg)和加压(300 mm Hg)条件下,用无针接头、标准和高流量旋塞对500 ml 0.9%生理盐水输注回路进行测试。16号静脉导管直接连接到静脉管作为对照。在120秒内用重力法测量流体体积,并计算流速。每种情况重复四次。通过双向方差分析和后续的Tukey事后检验对数据进行分析,多重校正统计学显著性定义为P结果:与重力组相比,使用无针连接器显著降低了流量(0.95±0.018 mL/秒vs. 1.19±0.05 mL/秒,P在理想的系统中,与无针接头相比,使用高流量旋塞可以使流量增加8%-10%,相当于在20分钟内额外输送400ml流体。双向高流量截止阀具有显著的优势,可以提供更高的流量,同时提供紧凑的设计,保持低的运行占地面积。考虑到在创伤和复苏中快速给液的影响,高流量的堵头可以提高严峻战斗环境下的急救护理效率。
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引用次数: 0
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Military Medicine
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