Military Medicine最新文献

Introduction: Precision nutrition during military activities is an emerging concept aimed at enhancing physical performance. Energy balance is a fundamental aspect of precision nutrition. This study aims to quantify the relationship between body weight and energy expenditure during military activities.

Materials and methods: Multifrequency bioelectrical impedance analysis assessed baseline anthropometric measurements of 362 Belgian male soldiers. Triaxial accelerometers evaluated energy expenditure and step count during a cumulative total of 4,701 man-days. The Oxford equation evaluated resting metabolic rate.

Results: Body weight (kg) ranged from 75 to 83, and body fat percentage between 14.2 and 22.0. Mean step counts a day ranged from 11,592 for recruits to 19,241 for Special Forces. Total energy expenditure varied between 2,890 and 4,209 kcal.d-1. A multivariate linear regression analysis, with step count and body weight as independent variables, was conducted to assess their relationship with energy expenditure as the dependent variable. The modeled differences highlight the significant impact of body weight on energy expenditure. For instance, at a given step count, an increase in body weight from 70 to 90 kg resulted in a difference in total energy expenditure of approximately 1,800 kcal.d-1. Additionally, for every extra kilogram of body weight, total energy expenditure increased by 48 kcal.d-1.

Conclusions: Unlike the one-size-fits-all approach, precision nutrition seeks to optimize soldier performance by tailoring dietary strategies to individual metabolic profiles. As energy balance is a central principle of precision nutrition, our findings underscore the critical influence of body weight on the accurate estimation of energy requirements.

Introduction: Identifying common reasons for Suicidal Ideation (SI) is central to prevention. Military suicide research has typically focused on combat experiences or non-work challenges such as mental illness, romantic relationships, finance, and legal issues. Stressors of performing military jobs in garrison are either absent from most suicide research, are uninformative by being presented as a homogenous category, or are restricted to relatively uncommon situations such as being under investigation. However, there are a number of reasons related to methodology and military culture to question whether more common non-combat occupational stressors, such as simply disliking one's job, might be more impactful to suicide behavior and SI than is currently reflected in the literature.

Materials and methods: As part of a climate survey across seven U.S. Army installations, 15,496 soldiers completed anonymous surveys, which included items from the Columbia-Suicide Severity Rating Scale (C-SSRS). Where SIs were indicated, soldiers were asked to select from a list of 16 potential non-combat related reasons any they felt were "main causes" for their SI.

Results: In total, 1617 soldiers (10.4%) reported a wish to be dead or thoughts of suicide in the past month. The top four endorsed reasons were all common occupational stressors: "Disliking your job" (51.0%); "Feeling like a failure in your career" (50.5%); "Feeling like you don't fit in at work" (46.2%); and "Lack of support from leaders" (34.9%). In total, 76.3% of soldiers with SI endorsed at least one of these stressors as a main cause. Problems with romantic partners and finances were identified less frequently (30.4% and 28.9%, respectively). Legal issues were endorsed by 9.7% and 5.9% for Army and non-Army legal/administrative actions, respectively. Soldiers who had some intention of acting on their SI (2.7% of soldiers) had a similar distribution of responses.

Conclusions: Results show the importance of common non-combat occupational stressors as identified contributors to SI, and suggest that these factors have been underestimated for cultural and methodological reasons. Results suggest that suicide prevention efforts should include leader training to ensure that subordinates find satisfaction in their work, receive regular career-based counseling, form connections with their peers, and feel supported by their leaders.

Introduction: Toxic exposures have been linked to hormonal disruption and DNA damage, increasing risk for hormone-sensitive cancers, such as breast and gynecologic cancers. However, the effect of toxic exposure on women Veteran cancer risk is unknown, especially for Veterans who served in the recent Middle East conflict because of the latency with which cancer develops. This study assesses the prevalence of toxic exposures among women Veterans with diagnosed breast and gynecologic cancers.

Materials and methods: This descriptive, cross-sectional study examines self-reported toxic exposures among Veterans diagnosed with breast or gynecologic cancers in the Veterans Health Administration and who participated in a clinical care survey with a nurse navigator. Data were obtained from Veteran Health Affairs (VA) electronic medical records and data from the Breast and Gynecologic Oncology System of Excellence (BGSoE) Program Dashboard. Exposure categories include air pollutants, occupational hazards, chemicals, physical agents, and biological risks. We compared demographic, health, and geographic factors between Veterans who reported hazardous exposure versus those who did not and described the characteristics of those hazards.

Results: Nearly 50% of women Veterans in the sample reported experiencing a hazardous exposure during military service. Over 80% reported feeling very or somewhat concerned about the exposure. Airborne exposures were the most frequently reported.

Conclusions: Women Veterans with breast and/or gynecologic cancer frequently report hazardous exposures during military service, which may impact their actual and perceived cancer risk and subsequent health care utilization. Future research is needed to assess the relationship between perceived/reported and actual hazardous exposures and inform any needed cancer interception.

Klebsiella pneumoniae Endogenous Endophthalmitis (KPEE) typically presents among those who are immunocompromised or have systemic diseases, leading to visual impairment and other fatal complications. The following case is an immunocompetent, healthy active duty (AD) male with no known risk factors who developed KPEE. A 47-year-old AD male with multiple deployments to Asia experienced fevers, chills, and fatigue and tested positive for COVID. He then began experiencing vision changes before presentation to the Emergency Department. He had a painful right eye and vision loss, specifically a deficit in the right temporal visual field. Orbital MRI revealed endophthalmitis concerning for infectious etiology. Blood cultures revealed K. pneumoniae. Elevated liver-associated enzymes and concern for an abdominal source of K. pneumoniae prompted abdomen CT showing complex hepatic hypodensities. Biopsy of these abscesses also grew K. pneumoniae. It is speculated that K. pneumoniae from these abscesses seeded to the blood, which then seeded to his right eye. K. pneumoniae liver abscesses are associated with a 3%-11% incidence of endogenous endophthalmitis with predominance in Asia. Risk factors include diabetes, alcoholism, and immunocompromise. With deployments to Asia, it is possible that this patient was exposed to a hypervirulent strain of K. pneumoniae. His COVID infection and subsequent immunocompromise may have predisposed him to systemic K. pneumoniae. Although KPEE typically occurs in patients from Asia, it is possible that our ADs who deploy to Asia may be exposed to strains of virulent K. pneumoniae. However, more studies need to be done as the evidence is limited.

Introduction: Military medical students train in austere, high-stress environments that simulate prolonged casualty care and the cognitive and emotional demands of combat medicine. These scenarios can heighten stress and cognitive load, yet few curricula explicitly equip learners with structured strategies for psychological self-regulation. Mindfulness training has shown promise in clinical and operational contexts, but its educational role in military medical training is underexplored.

Materials and methods: We developed the Mental Strength and Resilience Training (MSRT), a brief, theory-informed mindfulness curriculum incorporating three 1-hour sessions and asynchronous video materials. Mental Strength and Resilience Training emphasized 5 mindfulness strategies-breathing, mantra, movement, stretching, and body scan-framed for transfer to prehospital operational environments. Ninety-seven third- and fourth-year medical students at the Uniformed Services University participated across 2 high-fidelity military medical field exercises: Operation Gunpowder (36 hours) and Operation Bushmaster (5 days). Outcomes were assessed with the Mindful Attention Awareness Scale (MAAS), Brief Resilience Scale (BRS), and Perceived Stress Scale (PSS) at 4 time points. These 4 time point measures were then analyzed using a repeated measures Analysis of Variance (ANOVA) model, and the relationships between each scale score were analyzed using correlations. Faculty observers also evaluated clinical performance at Operations Gunpowder and Bushmaster for all students. Performance comparisons between students involved in the study and students not involved were compared via independent samples t-testing. The relationships between study participants' performance and their mindfulness, resilience, and stress were analyzed via correlations, with any significant correlations being entered into a regression model for further examination. This study was approved and deemed exempt by the Uniformed Services University Institutional Review Board (IRB) committee.

Results: Learners demonstrated significant increases in mindfulness (η2p = 0.32, P < .001) and resilience (η2p = 0.06, P = .002), alongside reductions in perceived stress (η2p = 0.28, P < .001). Correlation analyses showed stress was consistently negatively associated with mindfulness and resilience. Faculty-rated performance scores did not differ significantly between the students involved in the study and non-participating students regularly enrolled at Operations Gunpowder and Bushmaster. However, pre-Bushmaster resilience predicted performance outcomes (P = .02) in the participating student sample.

Conclusions: Brief, theory-informed mindfulness training enhanced learners' self-regulation and reduced stress during high-fidelity military medical exercises. Although performance gains were not statistically significant, the findings

Introduction: Military forces have long supported epidemic and pandemic response, offering rapid mobilization, logistics, and operational capacity in challenging environments. Their roles-from building treatment centers and transporting supplies to enforcing quarantines-were especially visible during the 2014-2016 Ebola outbreak and the COVID-19 pandemic. Despite abundant case-specific literature, no broad synthesis has examined operational contributions, ethical dilemmas, coordination mechanisms, and long-term effects on health systems.

Methods: Following Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we conducted a scoping review across PubMed, Scopus, Journal Storage (JSTOR), the WHO Library (WHOLIS), Military Health System publications and Google Scholar, including studies up to December 2024. Eligible sources described military involvement in epidemic or pandemic responses and included peer-reviewed articles, reports, and case studies. Two reviewers independently screened and selected studies, extracting data on context, epidemic type, military role, coordination, and outcomes. Thematic analysis grouped findings into 4 domains: logistics and rapid deployment, ethical considerations and human rights, civil-military coordination, and long-term implications for health systems and governance.

Results: Of 5,000 records identified, 100 met inclusion criteria. Most addressed Ebola or COVID-19, with geographic coverage spanning West Africa, Southeast Asia, and high-income countries. Militaries excelled in logistics-airlifting supplies, building facilities, and restoring disrupted supply chains. Ethical tensions arose in enforcement roles, where measures sometimes undermined public trust. Coordination quality varied, with integrated command structures improving efficiency. Long-term impacts were inconsistently reported, with benefits such as infrastructure transfer alongside risks of civilian dependency.

Discussion and recommendations: Pre-established civil-military frameworks, ethical safeguards and community engagement are key to maximizing benefits and mitigating risks. Military roles should be framed as surge capacity with planned transition to civilian control.

Conclusions: Military forces are valuable epidemic partners but require strategic integration, ethical oversight and focus on strengthening civilian systems. Standardized evaluation frameworks are needed to measure short- and long-term impacts.

Objective: To evaluate the validity of the Wireless Automated Hearing Test System (WAHTS) in comparison to clinically acquired unmasked air conduction thresholds.

Design: A cross-sectional study comparing WAHTS and manual audiometry thresholds, with participants at Clinic 1 completing WAHTS followed by manual audiometry, and those at Clinic 2 completed manual audiometry first, followed by WAHTS, both on the same day.

Study sample: Ninety-three thresholds from 28 participants at Clinic 1 and 112 thresholds from 24 participants at Clinic 2 were analyzed. Participants were U.S. Service Members and represented a range of ages and hearing difficulties.

Results: The mean absolute difference between repeated WAHTS measurements was 2.21 dB (SD = 2.52 dB). Correlation coefficients for WAHTS and clinical thresholds were 0.95 (R2 = 0.91) at Clinic 1 and 0.94 (R2 = 0.94) at Clinic 2. Kappa agreement within ±10 dB was 90% at Clinic 1 and 87% at Clinic 2. Bland-Altman analysis indicated a slight bias, with WAHTS thresholds averaging 2-3 dB better than clinical thresholds.

Conclusions: Wireless Automated Hearing Test System demonstrated strong agreement with clinical audiometry, supporting its use for unmasked threshold evaluations. Its portability and accuracy suggest potential for expanding access to hearing health care, particularly in remote or resource-limited environments.