Bmj Military Health最新文献

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.

Musculoskeletal injury (MSKI) is the most common reason for short-term occupational limitation and subsequent medically related early departure from the military. MSKI-related medical discharge/separation occurs when service personnel are unable to perform their roles due to pain or functional limitations associated with long-term conditions, including osteoarthritis (OA). There is a clear link between traumatic knee injuries, such as anterior cruciate ligament or meniscal, and the development of post-traumatic OA (PTOA). Notably, PTOA is the leading cause of disability following combat injury. Primary injury prevention strategies exist within the military, with interventions focused on conditioning, physical health and leadership. However, not every injury can be prevented, and there is a need to develop secondary prevention to mitigate or reduce the risk of PTOA following an MSKI. Two international collaborative groups, OPTIKNEE and OA Action Alliance, recently produced rigorous evidence-based consensus statements for the secondary prevention of OA following a traumatic knee injury, including consensus definitions and clinical and research recommendations. These recommendations focus on patient-centred lifespan interventions to optimise joint health and prevent lost decades of care. This article aims to describe their relevance and applicability to the military population and outline some of the challenges associated with service life that need to be considered for successful integration into military care pathways and research studies.

Introduction: Travel to resource-limited settings is a known risk for acquisition of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) and carbapenem-resistant Enterobacterales (CRE), which are both associated with increased morbidity and mortality. We investigated the ESBL-PE and CRE baseline prevalence in British service personnel (SP).

Methods: SP provided faecal samples for research projects in several different settings, between September 2021 and April 2022. Bacterial colonies from faecal isolates were recovered from incubated ChromID ESBL plates (bioMérieux, Marcy-l'Étoile, France) and DNA extracted using Qiagen DNeasy extraction kits (Qiagen, UK). PCR to identify β-lactamase and CRE encoding genes was performed using the Rotor-Gene Q (RGQ) (Qiagen, UK), with positivity detected by RGQ software. Phenotypic assessment of antimicrobial susceptibility was not performed.

Results: Out of 250 personnel approached, 239 (85.5% men, median (IQR) age 31 (26-37) years) provided faecal samples suitable for analysis. The ESBL prevalence was 40/239 (16.7%), with ESBL-producing Escherichia coli detected in 39 (16.3%) samples and ESBL-producing Klebsiella pneumoniae in 1 (0.4%) sample. Combinations including Temoniera, sulfhydryl reagent variable (SHV), cefotaxime hydrolysing β-lactamase (Munich) (CTX-M) 1 and CTX-M 9 genes were detected in 18 (7.5%), 33 (13.8%) 16 (6.7%) and 8 (3.3%) samples, respectively. E. coli samples had mixtures of all four genotypes with SHV predominating. One (0.4%) sample carried all four gene types and the only K. pneumoniae sample carried a single SHV gene. No CRE were detected.

Conclusions: The prevalence of ESBL-PE in cohorts of SP closely matches that of civilian populations in England; however, we noted differences in ESBL genotype distribution. Potential exposure risks for SP from international travel and occupational trauma emphasise the need for repeated surveillance to characterise and detect changes in acquisition epidemiology and carriage of ESBL. Such prospective data have important antimicrobial stewardship implications in optimising clinical outcomes, controlling resistance and guiding empirical antibiotic formulary policy recommendations.

The evolving landscape of battlefield medicine forces medical planners to prepare for large-scale combat operations (LSCO) against peer adversaries, requiring reassessment of recent medical strategies. Despite lacking medical backing, the term 'golden day' has been used by senior military leaders to link the resuscitative benefits of the 'golden hour' to prolonged medical care through similar nomenclature. Pseudomedical terminology can easily enter the lexicon of commanders as attractive soundbites. However, articulating the evidence-based factors influencing mortality on the battlefield is critical to effectively articulate risk to commanders. The challenges of LSCO will be significant with increased casualty numbers and treatment constraints. Realistic medical and operational planning is critical to maximising survival, with a clear understanding of what can and cannot be achieved. Recent improvements in trauma care, such as early haemorrhage control, advanced prehospital care and rapid evacuation to surgical care, have significantly reduced mortality rates. Given the predictability of when casualties die from significant injuries, the absence of timely clinical interventions will increase avoidable battlefield deaths. If evacuation to surgical care is extended to 24 hours, many more casualties will die from potentially survivable injuries. Medical planners must recognise the potential challenges associated with LSCO including contested, delayed evacuation which predicts a tripling of mortality rates from 10% to 30%. Leaders must appreciate the unchanging human physiologic response to injury and historical combat casualty statistics when preparing commanders and politicians for the excess in mortality during LSCO. Without candour, plans will be unrealistic, causing non-medical leaders and the public to be unprepared.