Bmj Military Health最新文献

Since the unanimous passing of United Nations Security Council Resolution 1325, which calls on member states to address gender inequality, many countries and the wider North Atlantic Treaty Organisation community have championed the Women Peace and Security agenda to empower women and reduce violence within fragile states. When women are empowered and actively involved in decision-making, there is less violence, and more peace and stability in that society, which benefits all members.Defence Medical Services are uniquely positioned to progress this agenda, particularly through its Defence Engagement activities. The UK's military medical community has more women in leadership than the wider military community. Our personnel can and should be used to model and empower military healthcare workers in partner nations. This paper forms part of a special issue of BMJ Military Health dedicated to Defence Engagement.

Defence Engagement (DE) has grown to become one of the key operational outputs of UK Defence. Defence Engagement (Health) (DE(H)) is a subcategory of DE, in which Defence Medical Services (DMS) personnel and assets are used to achieve influence and promote the UK's national interests. For most DMS personnel, their involvement in DE(H) will be as part of a Short-Term Training Team (STTT). STTTs are deployed to Host Nations (HNs) to work alongside a Partner Force, training, mentoring and supporting them to enhance their own capabilities. This article aims to guide junior members of the DMS in how they might approach an STTT from a DE(H) perspective. The article will draw primarily on the recent operational experiences of the authors across multiple STTTs in a variety of HNs.

Future warfare will likely involve near-peer or peer-peer conflict in which there is a great risk of mass casualty scenarios. Because of anti-access and area denial, air superiority will not be guaranteed, which will hamper rapid evacuation of casualties as well as resupply. Under such circumstances, military medical personnel may be forced, due to the constraints of the battlefield and tactical necessity to return servicemembers to duty, to implement reverse triage in which servicemembers with less severe injuries are treated first. However, reverse triage is potentially incongruent with international humanitarian law. Furthermore, should reverse triage need to be implemented, from the extant military doctrine it is not certain when this would be appropriate or the steps that might be followed, which highlight the gaps that exist before reverse triage should be considered as military doctrine on the battlefield. Lastly, we question the psychological impact that reverse triage could portend on military medical personnel, unit morale and unit cohesion. While there have been recent recommendations that reverse triage might need to be implemented in a near-term future conflict, these issues linger. It is time for Western militaries to assess the merits of reverse triage and the potential drawbacks.

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: The present study determined the (1) day-to-day reliability of basal heart rate (HR) and HR variability (HRV) measured by the Equivital eq02+ LifeMonitor and (2) agreement of ultra short-term HRV compared with short-term HRV.

Methods: Twenty-three active-duty US Army Soldiers (5 females, 18 males) completed two experimental visits separated by >48 hours with restrictions consistent with basal monitoring (eg, exercise, dietary), with measurements after supine rest at minutes 20-21 (ultra short-term) and minutes 20-25 (short-term). HRV was assessed as the SD of R-R intervals (SDNN) and the square root of the mean squared differences between consecutive R-R intervals (RMSSD).

Results: The day-to-day reliability (intraclass correlation coefficient (ICC)) using linear-mixed model approach was good for HR (0.849, 95% CI: 0.689 to 0.933) and RMSSD (ICC: 0.823, 95% CI: 0.623 to 0.920). SDNN had moderate day-to-day reliability with greater variation (ICC: 0.689, 95% CI: 0.428 to 0.858). The reliability of RMSSD was slightly improved when considering the effect of respiration (ICC: 0.821, 95% CI: 0.672 to 0.944). There was no bias for HR measured for 1 min versus 5 min (p=0.511). For 1 min measurements versus 5 min, there was a very modest mean bias of -4 ms for SDNN and -1 ms for RMSSD (p≤0.023).

Conclusion: When preceded by a 20 min stabilisation period using restrictions consistent with basal monitoring and measuring respiration, military personnel can rely on the eq02+ for basal HR and RMSSD monitoring but should be more cautious using SDNN. These data also support using ultra short-term measurements when following these procedures.

Introduction: The Western lifestyle challenges national defence. Inactivity, obesity, high BP and elevated lipid and glucose levels as well as tobacco use all increase cardiometabolic risk. The present study was thus aimed at investigating the health and physical activity of employees in a military environment, concentrating on comparisons between soldiers and civilians.

Methods and design: A total of 260 employees from 6 brigades were included in the present study. Health status was evaluated with body composition, cardiometabolic risk markers from laboratory samples and a questionnaire concerning lifestyle habits. Body composition was assessed by means of body mass, body mass index, fat percentage and waist circumference. Furthermore, physical activity was examined by the aid of accelerometer recordings for a 2-week period, and physical fitness via aerobic and muscle fitness tests. Finally, upper-quartile active and lower-quartile passive participants were compared, by incorporating mean daily step counts.

Results: When standardised by gender, there were no differences between the soldiers and civilians except for the muscle fitness test, in which soldiers performed better. The mean (±SD) moderate to vigorous activity was 0.9±0.3 hours/day in male soldiers and 1.0±0.4 hours/day in male civilians, and respectively sedentary behaviour was 9.5±1.4 hours/day in male soldiers and 8.9±1.7 hours/day in male civilians. The mean (±SD) low-density lipoprotein values were 3.28±0.84 mmol/L in male soldiers and 3.36±0.86 mmol/L in male civilians. In comparing soldiers and civilians, statistically significant differences were observed in body composition, physical fitness, insulin, fasting glucose, triglycerides and high-density lipoprotein values between the upper-quartile active and lower-quartile passive participants, but no difference in low-density lipoprotein values was noticed.

Conclusions: Sedentary behaviour and elevated low-density lipoprotein values seem to increase cardiometabolic disease risk among participants, even if they meet the weekly physical activity demands.

Introduction: Harmful gambling negatively impacts individuals, families and communities. Growing international evidence indicates that the Armed Forces (AF) community may be at a comparatively higher risk of experiencing harm from gambling than the general population. The current study sought to identify general predictors of harmful gambling and gambling engagement among UK AF serving personnel (AFSP).

Methods: We conducted a cross-sectional, exploratory survey to identify associations between demographic factors, mental health, gambling engagement and gambling type in a sample (N=608) of AFSP.

Results: Most of the sample reported past-year gambling, with 23% having experienced harm. Male gender, younger age and lower educational attainment all predicted harmful gambling, as did mental health variables of prior generalised anxiety and post-traumatic stress symptomatology. Strategy-based gambling and online sports betting were also predictive of experiencing harm from gambling.

Conclusions: The risk of harm from gambling is associated with demographic, mental health and gambling engagement variables among AFSP. Better understanding of these predictors is important for the development of individualised treatment approaches for harmful gambling.