Bmj Military Health最新文献

Bacteriophage (phage) is a virus that infects and kills bacteria but not human cells. As phages and bacteria have co-evolved over thousands of years, each phage is highly specific for its host bacteria. Phages were discovered over 100 years ago, with increasing antimicrobial resistance, there has been a resurgence of interest in phage therapy for antibiotic-resistant bacterial infections. Given their ubiquitous nature and high specificity, phages have many advantages as a potential therapy. However, their utility is not limited to treatment and phages can also be useful tools for diagnosis, decontamination and prophylaxis. This article reviews the potential uses for phage and explores the associated opportunities and challenges within a military medical context.

Introduction: Advancements in technology and intelligence, as well as deliberate targeting of medical personnel and vehicles, have made casualty extraction increasingly hazardous. The Russo-Ukrainian War has further demonstrated that the rapid development of unmanned technologies may also enable novel approaches. Although some of these systems have been deployed, reporting on their performance is scarce and understandably incomplete, which limits their evidence-based and effective integration with fighting forces. This paper addresses this gap by presenting preliminary findings on potential ranges of evacuation unmanned ground vehicles (UGVs) utilisation.

Methods: A virtual simulation experiment was conducted, where a platoon defended against a mechanised infantry company. The experiment was a repeated military exercise with different groups of participants. The defending force had evacuation UGVs, which were placed close behind the defensive line. The aim was to determine whether UGVs could survive long enough to support evacuation and whether evacuation could be carried out before the conflict ended. Furthermore, the availability of UGVs and the likelihood that an evacuation attempt could avoid enemy interference were assessed. The experiment involved 470 participants divided into 11 groups. Each participant completed four combat scenarios. Players of each group switched sides and environments. In total, 44 instances of skirmishes were fought in a virtual simulation environment.

Results: The simulation results indicated UGV loss rate of 53%. Evacuations were attempted in 45% of skirmishes. Furthermore, 81% of initiated evacuation attempts were successful.

Conclusions: The experiment provided estimates of evacuation UGV loss rates near the defence line amid active conflict. It also offered evidence on the feasibility of initiating evacuation before the active conflict had fully ceased, and the likelihood of the moving evacuation vehicle encountering enemy fire. These findings can guide decisions on whether the risk of losing small evacuation vehicles and their equipment is acceptable when deployed near front lines.

The number of in-water mass casualty incidents has increased in recent years and provides significant challenges to rescuers. Existing triage systems require the rescue of immersed (in water) casualties before triage is undertaken. A tool that enables triage to be undertaken before rescue, and therefore the prioritisation of that rescue, should improve the efficiency, efficacy and survival rate associated with the management of such incidents.In this paper, we describe the rationale and development of a proposed novel 'in-water mass casualty triage tool (IWMCTT)' to assist in the swift and effective triage of those in the water in mass casualty situations before they are rescued, based upon the likelihood of survival after immersion. The tool is based on a review of the literature related to the hazards associated with immersion, most notably drowning.The IWMCTT employs a sequential approach to streamline the identification and prioritisation for rescue of immersed individuals; it considers factors such as hazards, visibility constraints, purposeful swimming, moving or floating, airway position, availability of flotation assistance and flotation device effectiveness. It categorises casualties from W1 (high) to W4 (low) priority for rescue.The proposed IWMCTT offers a potential solution to some of the challenges faced during water-based mass casualty incidents; providing rescue assets (rigid-hulled, inflatable boats, ships and helicopters) with a rapid and effective approach to assess and prioritise individuals for rescue and medical attention, hopefully thereby reducing mortality and morbidity. The IWMCTT requires further evaluation and validation.

Background: Despite robust reports in the literature concerning the effect of exposure to combat on mental health, there is a paucity of studies in the Nigerian Air Force (NAF) using a longitudinal design. This study was designed to determine the incidence of mental disorders among a cohort of NAF personnel exposed to combat and highlight its association with psychosocio-religious variables.

Methods: It was a follow-up study using a total population sampling in which all the 290 deployed personnel participated. Data was collected at two intervals: Baseline and 6 months after with sociodemographic questionnaire, Brief Coping Orientation to Problems Experienced Inventory, the Brief Religious Coping, the Oslo Social Support Scale and the Big Five Inventory, General Health Questionnaire (GHQ-12) and the Mini-International Neuropsychiatric Interview (MINI-Plus). A two-staged process involving screening with the GHQ and a further diagnostic interview using MINI-Plus for participants with a GHQ score of 2 and above.

Results: The incidence of any mental disorder was 243.1 per 1000 person-years. The top three priority conditions were: Substance use disorder (94.1 per 1000 person-years), major depressive disorder (43.8 per 1000 person-years) and post-traumatic stress disorder (PTSD) (41.6 per 1000 person-years). Being deployed in early adulthood was a risk factor for developing a mental illness (adjusted OR (AOR), (95% CI): 2.89, (1.28, 6.50), p=0.01) while longer duration in the military service was a protective factor (AOR, (95% CI): 0.95, (0.91, 0.99), p=0.03). Social support, personality traits, religious coping and other coping strategies did not significantly predict mental disorders in this population (p>0.05).

Conclusion: The incidence of any mental disorder among NAF personnel exposed to combat was huge. The three top priority conditions were substance use disorder, major depressive disorder and PTSD. These findings are useful in identifying priority conditions for interventions in the NAF population.

Introduction: Medial tibial stress syndrome (MTSS) is common in the Armed Forces due to the physical demands placed on service personnel (SP). There are no large studies reporting the extent to which MTSS affects the Armed Forces. A retrospective cross-sectional study design was used to report the annual prevalence of MTSS in the British Armed Forces and in training units and healthcare utilisation.

Methods: Secondary data were sourced from the electronic medical records for all SP with MTSS (20 257) between 1 January 2010 and 31 December 2018. Prevalence was calculated annually across the Armed Forces and in recruits. Healthcare utilisation (number of contacts and days under the care of a healthcare professional) was reported according to characteristics of SP (sex, age, ethnicity, service branch, body composition measurement and medical discharge).

Results: Over 9 years, 20 257 SP were seen for MTSS. Prevalence of MTSS decreased across the Armed Forces, from 2.19% (95% CI 2.12 to 2.26) in 2013 to 1.61% (95% CI 1.55 to 1.68) in 2018. The prevalence of MTSS was 2.7 times higher in recruits, affecting 4.34% (95% CI 4.00 to 4.69) in 2018. In 2018, the prevalence in female recruits was over four times higher (7.03%, 95% CI 5.74 to 8.32) than trained female SP (1.60%, 95% CI 1.39 to 1.81) and higher than male recruits (4%, 95% CI 3.65 to 4.35). Comparing service branches, royal marines had the least healthcare input (median contacts (IQR): 3 (1-7.5)) over the least number of days (median days (IQR): 17 (0-154)), with the royal air force receiving the most (median contacts (IQR): 5 (2-13)) over the greatest number of days (median days (IQR): 76 (4-349)).

Conclusion: The prevalence of MTSS has reduced; however, it remains high in subsections of the Armed Forces, particularly in female recruits. There is a large variation in the amount and duration of healthcare input SP received for MTSS.

Introduction: Combat readiness assessments through simulated tasks (STs) have been developed for the Brazilian Air Force (BAF) to establish physical employment standards. Previous research has established BAF critical combat tasks with STs developed based on the physical demands of these tasks. Before implementing these STs, the standards required of BAF personnel must be established. The aim of this study was to determine the cut-off scores for five previously established STs.

Methods: Eighty-eight cadets attended three different testing batteries in order to complete the five STs, being: Battery 1 (foot march), Battery 2 (plane crash on water and water survival skills) and Battery 3 (plane crash on land, obstacle course) with their times recorded. Cut-off scores were set at the 85th percentile of the data distribution with these values and then analysed by four subject matter experts (SMEs) using subjective criteria through criterion analysis.

Results: All 88 cadets were submitted to the five assessments. After analysing the performance results on the STs, the SMEs discussed and agreed on the following cut-off scores: obstacle course (3:21 min:s), foot march (31:00 min:s), plane crash on land (1:25 min:s), plane crash on water (1:12 min:s) and water survival skills (4:03 min:s).

Conclusion: The outcomes of this research allow for the five STs to be implemented in BAF cadets and qualified BAF personnel with the established cut-off scores used to monitor the operational capability of these personnel (be it for cadet training outcomes or unit preparedness assessments) and to guide conditioning practices if personnel are below standards.

Introduction: Military forces receive training in various high-altitude warfare techniques to safeguard border regions and lives. Skiing is one of such practices where research evidences are limited. Therefore, a study was conducted to continuously monitor the physiological status of soldiers during military skiing practice to quantify the actual demands.

Methods: 11 Indian soldiers skied a distance of 8 km while carrying 18 kg of military equipment. Physiological status and heart rate variability (HRV) were continuously recorded throughout the exercise. The participants completed the event in about 3 hours. The icy track consisted of about 50% upward slopes, 40% downward slopes and only 10% of flat surface. The full data set was divided into four phases (45 min each), to understand the degree of changes in physiological, and autonomic responses with progress in time and intensity. Repeated measures analysis of variance was used to examine the degree of significance between the phases.

Results: Physiological factors including HR rose consistently from the first to the fourth phase, increasing from 116 to 150 beats/min. The peak acceleration was maintained within 0.4-0.6 g and ground speed varied from 0 to 14.8 km/hour, respectively. The time domain parameters decreased steadily from pre-exercise to the first half of the event, then slightly increased at the beginning of the second half before decreasing again during the final part. The low frequency increased during the first half and remained low until the end of the second half, while the high frequency exhibited an exactly opposite pattern.

Conclusion: The HRV data indicated parasympathetic withdrawal and sympathetic activation in first half, primarily due to the uphill climb. The third phase featured with the flatter surface, which increased the speed and led to partial parasympathetic activation. The final incline caused a rise in physiological responses and sympathetic dominance. Persistent cold, exposure to hypoxia and job requirements ensured that the physiological variables remained at a 'moderately' high level.

Introduction: Primary healthcare (PHC) patient medical records contain Systematised Nomenclature of Medicine-Clinical Terms (SNOMED-CT) that include information regarding diagnosis, demographics and veterans' status. This study intended to identify, analyse and compare the prevalence of type 2 diabetes, hypertension, dementia and smoking tobacco in veterans and non-veterans, including stratification by age and gender.

Methods: The authors partnered with 13 PHC practices with a population of 137 410 patients. Staff extracted matched veteran and non-veteran SNOMED-CT data from patient medical records; then sent the authors anonymised data in an amalgamated format between October 2023 and January 2024. Patients were from a local community and therefore social and environmental factors would be similar. Submitted information was inputted into an SPSS database 28 for analysis which included descriptive and inferential statistics to indicate statistical significance.

Results: In total, 5458 PHC electronic records were examined comprising 2729 veterans and 2729 demographically matched for age and gender non-veterans. Each group contained 86.4% (N=2359) men and 13.6% (N=370) women. The mean age was 63.8 years (SD 17.7). Rates of hypertension were 20.9% in veterans compared with 17.6% in non-veterans (p=0.002). Type 2 diabetes mellitus was 8.3% in veterans compared with 6.4% in non-veterans (p=0.007). Dementia was 2.1% of veterans compared with 2.5% of non-veterans (p=0.32). Smoking was 11.8% of veterans compared with 10.6% of non-veterans (p=0.16).

Conclusion: These results reveal that veterans were statistically more likely to be diagnosed with hypertension and diabetes. This study should assist in a better understanding of the healthcare needs of the veteran population to potentially inform better patient-centred care. However, the effectiveness of using PHC patient medical records requires increased efforts to improve data quality which needs improved PHC staff knowledge, consistency in SNOMED-CT coding, better veteran medical e-record registration and coding and better data transmission between the Defence Medical Services and PHC.