Military Medicine最新文献

Introduction: Aeromedical evacuation continues to grow and push altitude boundaries as unmanned aerial vehicle feasibility is explored. The inherent hypobaric, hypoxic environment that comes with aeromedical evacuation is known to be deleterious in various injury models, but no studies have investigated the effects of post-injury flight after polytrauma. This study hypothesized that hypobaric hypoxia inherent to the aeromedical evacuation environment potentiates the proinflammatory milieu of murine polytrauma, worsens systemic and organ-level endotheliopathy, and modulates coagulability.

Materials and methods: Mice underwent a polytrauma model consisting of midline laparotomy, rectus muscle crush, splenectomy, and hemorrhagic shock, followed by simulated flight for one hour at 12,000 feet. Cohorts included untouched, flight alone, polytrauma, and polytrauma with flight. Whole blood and lungs were collected. Serum inflammatory markers, serum endotheliopathy markers, lung immunohistochemistry, and coagulation profiles were analyzed.

Results: Flight combined with polytrauma was found to elevate systemic proinflammatory cytokines, including IL-1β, MCP-1, MIP-1α, and TNFα, from control levels (P < .05). Notably, IL-1α was uniquely increased from polytrauma to polytrauma with flight (P < .05). The endotheliopathy biomarker, syndecan, was increased by polytrauma and polytrauma with flight compared to controls, but without a difference between polytrauma and polytrauma with flight. Lung histological markers of endothelial disruption and rotational thromboelastometry parameters were unchanged by flight after polytrauma.

Conclusions: In this murine model of polytrauma and post-injury flight, early altitude exposure after polytrauma had an additive effect on the proinflammatory state, with the potential to differentiate flight exposure utilizing IL-1α. Early altitude exposure did not, however, exacerbate trauma-induced coagulopathy or endotheliopathy. Future studies should continue to address the physiologic basis of worsened clinical outcomes after early post-injury aeromedical evacuation.

Introduction: Military service involves potential exposure to a range of physical, chemical, and biological hazards that could impact reproductive health. Females represent 20% of Australian Defence Force (ADF) members and, like many military services, the ADF is prioritizing their recruitment and retention. However, given that females have different physiology and anthropometry, specific female occupational research is essential. This systematic review aimed to retrieve and summarize the findings of research involving currently serving ADF personnel with outcomes relevant to male or female reproductive health or any aspect of female health.

Materials and methods: Reproductive and female health studies between January 2002 and April 2023 that included serving ADF members were identified through a systematic search of 5 scientific databases. Data were extracted and synthesized, alongside a risk of bias assessment following PRISMA-ScR guidelines.

Results: Overall, 8 studies relating to reproductive health and 14 studies related to female health were identified. Studies were methodologically heterogeneous: few studies were at low risk of bias and few covered the same health outcome, preventing pooling of data. Four studies of males concluded that deployment to the Middle East was not associated with risk of infertility or birth defects. Female reproductive health studies provided very limited data. Other female health research primarily covered musculoskeletal disorders and injuries from basic training.

Conclusions: Studies of reproductive and female health in ADF members do not currently provide a cohesive or comprehensive body of evidence in either area. This review serves as a systematic map of the existing evidence to identify gaps and set future strategic research agendas. More high-quality longitudinal studies with sex-stratified analyses are urgently needed, as is a strategic focus on health outcomes that may affect military preparedness and fitness for deployment.

Background: A secure pharmaceutical supply chain is essential for the U.S. Department of Defense (DoD). An inability to obtain high-quality essential medicines for our nation's warfighters constitutes a significant national security concern. Access to safe, high-quality essential medicines is vital for both military operational readiness and ensuring that the Military Health System (MHS) is able to support its 9.5 million beneficiaries. This study aims to identify recommendations regarding the DoD pharmaceutical supply chain and categorize them according to the Doctrine, Organization, Training, Materiel, Leadership, Personnel, Facilities, and Policy (DOTMLPF-P) framework to identify potential areas within the framework that are critical to the success of the supply chain to facilitate actionable discussion to address pharmaceutical supply chain concerns that impact national security.

Materials and methods: We performed a narrative literature review of all recently published government publications relating to the DoD pharmaceutical supply chain. Selected publications identified challenges with the potential to impact or currently impacting the DoD pharmaceutical supply chain and documented recommendations for improvement. To categorize recommendations, we used the DOTMLPF-P framework developed by the DoD as part of the Joint Capabilities Integration Development System to identify and address capability shortfalls or gaps.

Results: We identified 11 publications and reports and 36 recommendations, for inclusion in this assessment that were published between 2021 and 2024. Twenty-three recommendations were categorized into 2 or more categories. Key recommendations included increased transparency, specifically sourced manufacturers and suppliers, avoidance of suppliers and manufacturers from adversarial nations, increased domestic supply capacity, and interagency collaboration.

Conclusions: Challenges identified by this study are highly complex and require interagency collaboration, thus a whole-of-government approach is needed to strengthen the DoD pharmaceutical supply chain.

Background: Warfighters perform highly complex and dangerous combat missions are both physically and cognitively challenging. Meeting these physiological demands are regulated by the autonomic nervous system (ANS). Thus, continuously monitoring ANS activity during combat and training may critically inform military leadership of the current physiological state and ability of their warfighters to effectively execute mission tasks. The purpose of this study was to quantify ANS response throughout 540 minutes (9 hours) of aviation-related combat training drills performed in the UH-60 helicopter.

Materials and methods: Aircrew members recruited from the United States Army Aeromedical Research Laboratory participated in the current study. ANS function was measured using the Warfighter Monitor (WFM, Tiger Tech Solutions, Inc., Miami, FL, United States), an armband monitor equipped with electrocardiographic capabilities. Subjects wore the WFM on the upper arm throughout their 540-minute combat training which consisted of aviation-related tasks. The WFM continuously monitored heart rate (HR), HR variability (HRV), and respiration rate (RR). Two HRV time-domain metrics were calculated: SD of the NN interval (SDNN) and the root mean square of successive differences of NN intervals (rMSSD). Studentized t-tests were performed to evaluate within- and between-group differences in ANS activity.

Results: Thirty-four healthy, aircrew members aged between 18 and 45 years and mostly male, participated in the current study. For pre-flight events, average HRs ranged between 76.1 and 91.2 bpm. On average, HRs increased between +10.2 and +12.9 bpm. HRV metrics were between 72.4 and 91.3 milliseconds for rMSSD and from 101.8-139.9 ms for SDNN. RRs for aircrew members ranged between 12.4 and 13.5 breaths/min and increased by +1.4 to +1.7 breaths/min. For in-flight operations, significantly higher HRs (88.2-100.2 bpm) were observed. Similarly, significantly different increases were reported (+14.7 to +26.4 bpm). HRV metrics were significantly lower (rMSSD: 62.8-83.7 milliseconds; SDNN: 93.8-116.7 milliseconds). The average and increases in RRs were significantly higher, 12.8-17.3 breaths/min and +1.5 to +4.2 breaths/min.

Conclusions: Significant increases in sympathetic drive were observed in U.S. warfighter aircrew during combat mission training, reflected by higher HRs, RRs, and lower HRV. The magnitudes in the ANS response, however, differed between pre- and in-flight operations with the latter inducing a larger response, possibly attributed to greater physical and cognitive workloads. These observations may aid warfighters and military leadership in designing effective preparedness training and implementing immediate intervention for managing the heightened sympathetic drive while preventing negative outcomes.

Introduction: High body mass index (BMI) and depression are significant chronic health concerns in adult populations, including in the U.S. Military. This systematic review examines the published literature on the relationship between high BMI and depressive symptoms among U. S. service members (SMs) and veterans from the most recent wars.

Materials and methods: A structured literature review published from 2012 to 2022 used established systematic review guidelines. Sixteen primary research studies from the last 10 years were examined using healthcare and social sciences databases. The studies included BMI and depressive symptoms as variables. Studies measured the relationship between BMI and depressive symptoms among those with military service during the Gulf War or Post-9/11 eras.

Results: Four studies used SMs alone, 11 used veterans, and 1 used both. Nine studies found a relationship between high BMI and depressive symptoms, with 3 reporting the relationship only in specific sub-groups (e.g., specific BMI categories). Seven studies found no relationship. Mixed findings and varied study quality indicate a nuanced relationship. SMs and veterans have high BMIs and depressive symptoms at rates comparable to their civilian counterparts.

Conclusion: High BMI and depressive symptoms among SM and veterans could have consequences for personal health, healthcare systems, and national security. Little is understood about the complexity of relationship between high BMIs and depressive symptoms among military and veteran populations. Delivering evidence-based tailored care for SMs and veterans experiencing these conditions requires more research, especially intervention-based studies. Effective policies to ensure the holistic health of SMs and veterans are needed to secure the health and fitness of the warfighters in the U.S. Military.

Introduction: The purpose of this study was to examine the clinical outcomes and efficacy of the U.S. Army's Holistic Health and Fitness (H2F) program compared to standard physical therapy practices across the U.S. Military Health System. The H2F initiative aims to improve access to care and rehabilitation outcomes through a multidisciplinary approach, offering a potential advantage over traditional methods used in military hospital settings.

Materials and methods: This study utilized a retrospective cohort design, analyzing archived medical records of active duty U.S. Military personnel treated for musculoskeletal injuries. The records spanned from physical therapy, outpatient hospital clinics, and H2F outpatient services at Fort Liberty, NC. A total of 24,143 records were screened (23,324 from hospital clinics and 819 from H2F clinics), with 4,555 records (4,279 from hospital clinics and 276 from H2F clinics) ultimately included for analysis. The study compared holistic rehabilitative care provided by H2F with standard physical therapy care. Key outcome measures included days from injury to initial evaluation and changes in clinical outcome scores using the Numeric Pain Rating Scale (NPRS), Global Rating of Change (GROC), Modified Oswestry Disability Index (MODI), Lower Extremity Functional Scale (LEFS), Neck Disability Index (NDI), and Shoulder Pain and Disability Index (SPADI). Institutional Review Board (IRB) approval was obtained for the study.

Results: Patients treated through the H2F program were evaluated an average of 33.8 days sooner than those treated in hospital clinics (P < .001). Holistic Health and Fitness patients also demonstrated significant improvements in clinical outcome measures, including reduced disability scores on the NDI (P = .037), ODI (P < .001), SPADI (P < .045), and increased functional scores on the LEFS (P < .001). Additionally, patients in the H2F group reported lower NPRS scores (P < .001) and higher GROC scores (P < .001), indicating less pain and greater perceived improvements compared to those receiving traditional care.

Conclusions: Embedding physical therapists within H2F units is a safe and effective strategy for enhancing access to physical therapy services among soldiers, resulting in earlier intervention and improved rehabilitation outcomes. The study's findings suggest that the multidisciplinary care model offered by H2F can significantly reduce time to care and enhance recovery, providing a potential framework for optimizing soldier readiness. Limitations include differences in sample sizes between the groups, which may affect generalizability. Future research should explore the broader implementation of H2F and its impact on other military installations.

Introduction: Cold-water immersion (CWI) is a threat to warfighters operating in the cold. Even after removal from the cold, core temperature continues to decrease because of the afterdrop effect. The purpose of this study is to evaluate the effect of exercise-intensity on rewarming from CWI.

Materials and methods: Following a randomized match-paired design, 28 military personnel (27 Male, 1 Female; mean ± SD age: 29 ± 7year; ht: 175 ± 11 cm; wt: 86.9 ± 12.5 kg; body fat: 22 ± 9%) were immersed in an outdoor pond (air: -4.2 °C; water: 1.3 °C) for 10 minutes and subsequently rewarmed for 40 minutes by following a low-intensity [LI (n = 14); 30% VO2R] or moderate-intensity [MI (n = 14); 45% VO2R] exercise protocol. Core temperature, hand temperature, foot temperature, and heart rate were recorded throughout. Physiological responses were analyzed in 5-minute increments using a 2 (condition) by 11 (time) repeated measures analysis of variance (ANOVA) with significance set to P < .05.

Results: After 20 minutes of exercise, heart rate was significantly higher in the MI group relative to the LI group (P < .05). Core temperature (F = 34.0, P < .001, ηp2 = 0.630), hand temperature (F = 114.9, P < .001, ηp2 = 0.839), and foot temperature (F = 128.8, P < .001, ηp2 = 0.896) were all significantly different across time points; however, there was no main effect of group or group by time interaction effects.

Conclusions: Results suggest that rewarming of the core, hands, and feet following CWI were similar between LI and MI groups. Moderate-intensity exercise did not exacerbate the afterdrop effect. When rewarming after CWI, the Warfighter can select a low-to-moderate exercise intensity that best fits their comfort and mission requirements.

Introduction: To optimize reproductive outcomes for pregnant Veterans, more information is needed about their unique risk profile. The purpose of this study was to describe rates of (1) mental health diagnoses, (2) military-related trauma, (3) lifestyle behaviors, and (4) pregnancy risks among Pregnant Veterans (PVs); and to test whether these risks were associated with adverse pregnancy outcomes.

Materials and methods: A retrospective review of electronic medical records was conducted for all PVs who used Veterans Administration (VA) maternity care benefits at a large, urban VA medical center between January 1, 2018 and January 1, 2020 (n = 519). Data were extracted, coded, and analyzed based on national guidelines for adverse risk and maternal/fetal outcomes. Rates of pregnancy risk factors among civilians were extracted from published literature.

Results: Pregnant Veterans with complete data on study variables (n = 281) had a mean age of 31.9 (SD = 5.02) and were from diverse racial and ethnic groups (45% African American, 15% Latinex). Pregnant Veterans compared to the general population, were more likely to be unemployed (17% vs. 5%) and homeless (2% vs. <1%), and to have higher rates of mental health (MH) diagnoses (77% vs. 16%). Pregnant Veterans also had higher rates than civilians for miscarriage (18% vs. 10%) and preterm births (13% vs. 10%), but military sexual trauma (MST), combat exposure, unemployment, mental health, pre-pregnancy tobacco use, and pre-pregnancy substance use were not predictors of adverse outcomes among PVs.

Conclusions: Pregnant Veterans experience adverse pregnancy outcomes and pregnancy risks at higher rates than the general population. Maternal morbidity and mortality are indicators of healthcare quality for women. The VA should address pregnancy disparities if they are to remain a national healthcare leader.