Military Medicine最新文献

Introduction: This study aimed to identify content-valid occupational tasks performed by Brazilian Air Force (BAF) firefighters to support the development of Physical Employment Standards (PES).

Materials and methods: A 3-step validation process was applied: (1) scenario development, (2) subject matter expert (SME) judgment, and (3) task quantification. Seven SMEs identified 5 operational scenarios and 33 critical tasks, which were rated based on importance, frequency, and physical demand. Tasks with a Content Validity Index above 0.86 were retained. In the final step, 164 active duty firefighters rated 27 tasks using a Likert scale.

Results: Tasks involving victim removal and load carriage were rated among the most important and physically demanding, and forest firefighting tasks were the most frequently performed. Inter-rater reliability was high across all domains.

Conclusion: This systematic approach provides a foundation for future PES development, contributing to improved readiness, safety, and targeted physical training programs for BAF firefighters.

Introduction: Aircraft piloting is a complex task that requires high cognitive load and emotional pressure, increasing the risk of human error. The mental workload (MWL) experienced by pilots is influenced by the dynamic environments in which they operate, their skills, training, and individual perceptions. Mental workload varies across individuals because of differences in personality, cognition, and situational awareness, making its evaluation a vital aspect of flight safety. This study evaluated the MWL of Brazilian military pilots during graduate flight instruction and identified the factors that contribute the most to this workload.

Materials and methods: We conducted a cross-sectional observational study of 22 pilots of the T-27 "Tucano" aircraft were divided into 2 groups based on their assigned role. Group 1 (G1) was composed of 11 instructors responsible for providing instruction to a cadet, whereas Group 2 (G2) consisted of 11 instructor pilots tasked with piloting the lead aircraft. The MWL was assessed using the National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire and heart rate variability (HRV) analysis. The data were collected during training flights in a real operational environment.

Results: We found an average MWL of 69.82 points, with G1s reporting 74.2 and G2s reporting 65.5, which were higher than the averages reported in previous studies. The dimensions that contributed most to MWL were Performance, Mental Demand, and Effort. Heart rate variability analysis showed an increased heart rate and decreased RR intervals, indicating greater flight-induced sympathetic activity, with significant differences between the groups, suggesting that G2s experienced greater mental demands during flight.

Conclusions: We confirmed that MWL is high during formation training for both groups of pilots. The NASA-TLX and HRV tools were effective in analyzing MWL, and the combination of these metrics provided a comprehensive view of psychophysio-logical stress.

Perilunate disassociation injuries are rare and may be missed in the acute setting. Prompt identification and management are critical to prevent late complications such as arthritis and instability. These injuries can present several patterns with soft tissue disruption, fracture, or a combination of both. In this report, we present a unique pattern of a periscaphoid, perilunte injury with an intact scapholunate interosseous ligament and describe our treatment strategy and outcome.

Drug-induced liver injury ranges from asymptomatic to liver failure with supplements becoming an increasingly recognized cause. This case highlights the unique supplement, AlbutarexV2, and the severe cholestatic liver injury it induced with resolution occurring in six months. With steadily increasing obesity rates and supplement use, weight-loss supplements are gaining popularity with various claims of increasing energy expenditure or metabolic rate. Recognition of adverse effects from these therapies is critical to aid in identification and cessation of the agent and helping ban harmful supplements. This case demonstrates the danger of "fat-burners" and delineates the protracted and prolonged liver injury of AlbutarexV2.

Introduction: Pectoralis major (PM) tendon ruptures are common injuries in the active duty military population. Despite strong evidence supporting operative management, there is a dearth of literature regarding the management of medial PM tear patterns requiring intramuscular fixation. The present study was conducted to describe surgical techniques and outcomes of acellular dermal allograft reconstruction for irreparable junctional and intrasubstance PM tears.

Materials and methods: This study comprises a consecutive series of patients with full-thickness junctional or intrasubstance PM tears who underwent reconstruction with acellular dermal allograft. A single fellowship-trained shoulder and elbow surgeon performed the procedures, utilizing Decellularized Dermal Allograft (ArthroFLEX, Arthrex Inc., Naples, FL, United States). Each patient underwent both pre and postoperative chest magnetic resonance imaging (MRIs), the latter occurring at least 6 months after surgery to assess for graft incorporation. Clinical and functional outcome measures included the following: Single Assessment Numeric Evaluation (SANE) scores, range of motion, return to push-ups/bench press, workout modifications, and differences in self-reported preoperative and postoperative bench press 1-repetition maximums.

Results: Five male active duty service members (27-45 years) underwent PM reconstruction with acellular dermal allograft during the study period, with a mean follow-up of 31.9 (±9.5) months. There were 4 patients with intrasubstance tears and 1 patient with a tear at the musculotendinous junction which occurred while bench pressing. After reconstruction, there were no re-ruptures and postoperative MRIs universally demonstrated allograft incorporation. All patients regained full range of motion, and the mean SANE score was 83 (±14). Three patients modified chest workouts after injury, most commonly with dumbbell bench press. Two patients returned to a flat bench press, and of these 2, 1 regained 86% of his preoperative 1-repetition maximum.

Conclusion: Reconstruction of "irreparable" PM injuries with acellular dermal allograft is efficacious for the management of junctional or intrasubstance tears requiring intramuscular fixation. Postoperative outcome measures indicate this procedure is well-tolerated and reliably restores function after medial PM tendon ruptures. The novel surgical techniques described in the present study expand the armamentarium of shoulder surgeons to address PM injuries.

Background: Although women serving in the Korean military are steadily increasing, little is known on the status and related factors of their urogenital health behaviors (UHB), especially during field training. This study aims to identify UHB status and its affecting factors among female military personnel in South Korea.

Materials and methods: An exploratory sequential mixed methods design was used. First, the experiences of UHB were explored through interviews (n = 17), followed by a cross-sectional survey to identify its affecting factors (n = 719). The integration phase was done via joint display of findings.

Results: The experiences of UHB centered on 4 categories: 'holding it to avoid restroom use'; 'Walking on eggshells (noonchi) in unavoidable situations'; 'seeking solutions independently'; and 'hoping for an improved work environment.' The majority of participants reported problems in changing feminine hygiene products in the field (344 out of 377, 91.2%) Among those who had experienced duty or training in the field in the past 6 months (n = 520) 90% (n = 469) reported having reduced water intake in the field and 91.0% (n = 473) delayed urination during field training. Branch, position, length of service, confidence in performing UHB, job stress, supervisor support, military health provider support, unit type, presence of female supervisor had significant influences on UHB. Thus, quantitative findings corroborated with and further built up the qualitative findings.

Conclusions: Interventions for improving female military personnel's UHB are needed, especially for those whose branches are combat or combat support, who work in battalion level units, and who are in staff positions.

Introduction: To assess whether abnormal body mass index (BMI) among Israeli Defense Force (IDF) recruits is associated with increased risk for post-traumatic stress disorder (PTSD).

Materials and methods: This retrospective cohort study included 1,430,118 Israeli late adolescents aged 16-20 who were physically and mentally evaluated before IDF enlistment from January 1, 1998, to December 31, 2019. Body mass index was measured before enlistment, and PTSD diagnoses were based on the DSM-5 criteria as recorded by the IDF or the Ministry of Defense for combat-related PTSD. Individuals with PTSD diagnosis before recruitment were excluded.

Results: Of the 1,430,118 late adolescents in this study, 839,200 (58.7%) were male, 1,329,796 (93.1%) were Jewish, and 392,418 (27.5%) served in combat roles. Post-traumatic stress disorder was diagnosed in 7,157 (0.5%) individuals. No significant association was found between BMI and PTSD risk in combat setting. However, late adolescents with prior psychiatric diagnoses exhibited an elevated PTSD risk: 40% higher in combatants (odds ratio [OR] = 1.366) and 30% higher in non-combatants (OR = 1.296). Furthermore, extreme BMI values (below 17 or above 35) in non-combat roles were associated with a lower PTSD risk.

Conclusions: In the largest cohort study to date on the association between BMI and PTSD because of combat, BMI did not significantly predict PTSD risk in combat-exposed soldiers, while psychiatric history emerged as a stronger predictor across all military roles. These findings suggest prioritizing mental health history over BMI in PTSD risk assessment and prevention efforts.