Bmj Military Health最新文献

Introduction: Military operations place high demands on many cognitive functions, and stressful events characterise the military work environment. The study aimed to examine the relationship between cardiorespiratory fitness, stress response, cognitive function and military performance during prolonged military exercise.

Methods: 66 army cadets were included in the study. The subjects participated in a 4.5-day military winter training in northern Sweden. Maximal oxygen uptake (VO₂max) was estimated from a cycle test. Cognitive tests (design fluency, DF test) and measurements of heart rate variability (HRV) were conducted before and after the exercise. Assessment of military performance as an individual soldier (P-ind) and performance as a team leader (P-lead) was carried out during the final day of the exercise. Pearson's coefficient of correlation (r) and Spearman's rho were used to evaluate correlations, and linear regressions were used to examine the relationships between VO₂max, HRV, DF test scores and military performance. Simple mediation analyses were performed with DF test scores and military performance (P-ind, P-lead) as dependent variables, VO₂max as a predictor and HRV as a mediator.

Results: Post-exercise HRV was related to military performance (P-ind: r=0.40, p<0.01; P-lead: r=0.32, p<0.05). Absolute VO₂max was positively correlated with P-ind (r=0.28, p<0.05), and the effect of VO₂max on military performance was mediated by HRV. Post-test DF scores were negatively correlated with post-exercise HRV (total correct designs: r=-0.26, p<0.05; total incorrect designs: r=-0.27, p<0.05).

Conclusions: Results suggest that high absolute VO₂max predicts military performance by reducing the stress response to prolonged military exercise. Aerobic capacity may provide a meaningful effect on the ability to preserve military performance. Future studies need to identify thresholds for this capacity.

Pre-registration: The protocol was retrospectively registered at OSF (https://osf.io/), registration DOI 10.17605/OSF.IO/ND6XM.

Introduction: Emergency resuscitative thoracotomy (ERT) is a resource-intensive procedure that can deplete a combat surgical team's supply and divert attention from casualties with more survivable injuries. An understanding of survival after ERT in the combat trauma population will inform surgical decision-making.

Methods: We requested all encounters from 2007 to 2023 from the Department of Defense Trauma Registry (DoDTR). We analysed any documented thoracotomy in the emergency department and excluded any case for which it was not possible to distinguish ERT from operating room thoracotomy. The primary outcome was 24-hour mortality.

Results: There were 48 301 casualties within the original dataset. Of those, 154 (0.3%) received ERT, with 114 non-survivors and 40 survivors at 24 hours. There were 26 (17%) survivors at 30 days. The majority were performed in role 3. The US military made up the largest proportion among the non-survivors and survivors. Explosives predominated in both groups (61% and 65%). Median Composite Injury Severity Scores were lower among the non-survivors (19 vs 33). Non-survivors had a lower proportion of serious head injuries (13% vs 40%) and thorax injuries (32% vs 58%). Median RBC consumption was lower among non-survivors (10 units vs 19 units), as was plasma (6 vs 16) and platelets (0 vs 3). The most frequent interventions and surgical procedures were exploratory thoracotomy (n=140), chest thoracostomy (n=137), open cardiac massage (n=131) and closed cardiac massage (n=121).

Conclusion: ERT in this group of combat casualties resulted in 26% survival at 24 hours. Although this proportion is higher than that reported in civilian data, more rigorous prospective studies would need to be conducted or improvement in the DoDTR data capture methods would need to be implemented to determine the utility of ERT in combat populations.

Musculoskeletal injuries (MSKI) are one of the biggest challenges for military services globally, contributing to substantial financial burdens and lost training and working days. Effective evidence-based intervention strategies are essential to reduce MSKI incidence, and research has shown the positive effect of both nutritional interventions and physical training (PT) interventions on reducing MSKI incidence. Levels of vitamin D metabolites have been associated with MSKI and bone stress fracture risk, while calcium and vitamin D supplementation has been shown to reduce the incidence of stress fractures during military training. Protein and carbohydrate supplementation during arduous military training (high volume, high intensity) has also been shown to reduce MSKI risk and the number of limited/missed duty days. PT has played a key role in soldier development to meet the occupational demands of serving in the armed forces. Paradoxically, while PT is fundamental to enhancing soldier readiness, PT can also be a major contributor to MSKI; emerging evidence suggests that the nature of the PT being performed is a risk factor for MSKI. However, strategies like reducing training load and implementing PT programmes using evidence-based training principles can reduce MSKI incidence among military service members by 33-62%, and reduce the financial burdens for military services. This review provides a summary of effective MSKI reduction interventions and provides strategies to enhance the success and adoption of such interventions.

The development of inclusive equipment and clothing is a priority across national defence departments that are part of The Technical Cooperation Programme. As such, a collaborative effort has been established to inform the development of clothing and equipment for women. This invited review provides an overview of an ongoing collaborative project presented at the sixth International Congress on Soldiers Physical Performance. The purpose of this review was to summarise the outputs of scoping work conducted to inform the direction of future research programmes. The scoping work has recommended a framework, which includes improved objective metrics for assessment, standardised methods to characterise study participants and improved methods for characterising the system being evaluated. The longer-term research project aims to implement the framework so that the design of future equipment and clothing is optimised for all end users.

Introduction: Special operation diving is becoming increasingly prevalent but has received less attention. The anxiety profile in special operation divers and its influencing factors remain unclear, posing great challenges to medical and psychological security of this unique population. The current study aimed to investigate the anxiety profile and to analyse the correlations between anxiety with demographic and personality traits data among special operation divers.

Methods: From July to October 2023, 650 special operation divers participated this analytical cross-sectional study. The Spielberg's State-Trait Anxiety Inventory and the Neuroticism Extraversion Openness Five-Factor Inventory were used to evaluate anxiety and personality traits of special operation divers.

Results: 27.2% and 30.3% special operation divers showed high scores on state anxiety and trait anxiety, respectively. Special operation divers who are 30 years or older and who have dived for 15 years or more are prone to higher level of trait anxiety and state anxiety (all p<0.001). Neuroticism showed a significantly positive correlation with both trait anxiety (r=0.675, p<0.001) and state anxiety (r=0.674, p<0.001). Extraversion, openness, agreeableness and conscientiousness are all negatively correlated with both trait anxiety and state anxiety (r=-0.670 to -0.400, all p<0.001). Additionally, significant differences in neuroticism, extraversion, openness, agreeableness and conscientiousness were observed between the high anxiety group and the low anxiety group (all p<0.001).

Conclusion: The prevalence of trait anxiety and state anxiety are both relatively high among special operation divers. Individuals with older age and longer diving years are more prone to be anxious. Higher neuroticism, lower extraversion, lower openness, lower agreeableness and lower conscientiousness may be predictors of higher trait anxiety and higher state anxiety.

Introduction: Historically, diseases and non-battle injuries (DNBI) typically stand for 70%‒95% of all medical events during military missions. There is, however, no comprehensive compilation of medical statistics for Swedish soldiers during deployment.

Method: During United Nations Multidimensional Integrated Stabilization Mission in Mali, climate data and medical outpatient health surveillance data were compiled for Swedish soldiers deployed to Timbuctoo, between 2015 and 2019. Correlations between climate data and medical outpatient health surveillance data were analysed.

Results: Battle injuries accounted for 0.4% of the visits to healthcare, while diseases accounted for 53.6%, and non-battle injuries for 46%, the majority being musculoskeletal injuries. The combination of high temperature, humidity, sun radiation and good visibility, during summer rotation weeks, caused more events of injuries and heat stress than any other period.

Conclusion: Musculoskeletal injuries were the major cause for visits to the Swedish camp hospital. Injuries and heat stress increased during periods of high temperature, humidity, sun radiation and good visibility. Lack of medical data, i.e. unknown number of unique patients seeking healthcare, cause codes not always connected to a primary diagnosis, and revisits not being connected to a diagnose, complicated interpretation of health risk factors.

Proteins control individual patient's response to pharmaceutical medication, be they receptors, transporters or enzymes. These proteins are under the control of genes. The study of these genes and the interplay between multiple genes is pharmacogenomics, with individual genes being termed pharmacogenes. The greatest understanding of pharmacogenetics is of the drug metabolising enzymes, the cytochrome P450s. Almost the entire UK population is likely to have at least one genetic variant that controls these P450s and thus the phenotype for metabolic competence. This means two patients receiving the same medication and dose may have very different responses, from adverse reaction to being ineffective. An individual military person's response to medications can be predicted from their pharmacogenetics, as an example; the response to the commonly prescribed 'pain killers', codeine, tramadol, hydrocodone or oxycodone. These opioids are metabolised into their active forms by the cytochrome 2D6. Four phenotypes classify an individual's metabolic competency: ultra-rapid, extensive, intermediate or poor. A poor metaboliser is at risk of ineffective pain relief from one of the opioids listed, whereas an ultra-rapid metaboliser is at risk of overexposure and subsequent dependency or abuse. In white European populations, the prevalence of the phenotypes is well known and may be used to guide prescribing; however, in other populations such as Nepalese or Pacific Islander the distribution of these phenotypes is unknown. Genotyping provides a framework for the precise treatment of patients and cost-effective use of medication for the UK Armed Forces, as well as potentially providing equity for minority groups.

Introduction: Women make up almost 14% of the UK's veteran population; however, little is known about female veterans' physical health and experiences of accessing healthcare after military service. As part of a qualitative study to understand female veterans' experiences of statutory and charitable support, participants were asked if they felt anything about their military service had impacted their physical health as civilians. They were also asked about their experiences with accessing healthcare and any associated challenges. The aim of this paper is to outline participants' responses to inform the development of further research.

Methods: 85 women who had served in the British Armed Forces took part in semistructured interviews conducted via Microsoft Teams between June and December 2022. Reflexive thematic analysis of interview transcripts was conducted to identify, analyse and report repeated patterns in responses to questions.

Results: Participants reported a range of physical health consequences that they attributed to military service. These included injuries sustained during training and deployment, 'wear and tear' through training and the impact of sometimes unsuitable clothing. They reported chronic pain, tendonitis, arthritis, slipped discs, broken bones and hearing loss. Some described their lives as severely restricted as a result. Challenges to accessing healthcare included perceived stigma associated with help-seeking, inconsistency around the transfer of medical records and a widespread lack of veteran awareness among civilian healthcare professionals.

Conclusions: There is a distinct lack of research in the UK against which to compare these findings; thus, further research is required in all areas of female veterans' physical health and experiences of accessing healthcare. Research should begin by establishing the nature and prevalence of health conditions among female and male veterans to identify the unique needs of both and tailor support accordingly.