Bmj Military Health最新文献

Introduction: The Libyan Civil War (LCW) is an ongoing internal armed conflict that started as a peaceful protest in February 2011, resulting in a power vacuum after the regime collapsed and an uncontrolled spread of arms, which caused a significant increase in violence and trauma. Our review aims to investigate the war-related epidemiology and mortality in patients who have been injured during this conflict.

Methods: A systematic review was undertaken according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Embase, Web of Science and Cochrane Library databases were searched for studies published between February 2011 and May 2024. Studies were included if they involved patients with trauma during the LCW and outcomes of interest were type and anatomical distribution of injuries and mortality. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation.

Results: Thirteen studies met the eligibility criteria, with a total sample size of 4665 patients. There were seven studies (n=4378 patients) that reported mortality rate, with 438 (10%) who died. 13 out of the 14 studies documented the mechanism of injury of their participants with a total number of 4543 injuries, most commonly from firearm-related trauma (60.3%). 12 studies recorded the anatomical distribution of their sample of 4123 anatomical sites, with extremities being the most affected part, accounting for 54.5% of injuries.

Conclusion: The LCW has caused a high burden of morbidity and mortality among the Libyan population. This review provides an insight into the adverse health consequences of this active war and highlights the difficulties in collecting reliable information on the wounded during conflicts.PROSPERO registration numberCRD42024527289.

Achilles and patellar tendinopathy are common in military personnel due to the repetitive high loads and challenging extrinsic risk factors associated with the demands of their role. Sports medicine is rapidly evolving. Up-to-date evidence-based research is essential, alongside clinical reasoning, to deliver best-practice treatment to service personnel, underpinned by the duty of care to their long-term career.The aim of this research was to develop recommendations on conservative management of Achilles and patellar tendinopathy in relation to the military population. A systematic review was conducted by a multidisciplinary clinical panel from across Defence Rehabilitation. The panel was split into four subgroups (diagnosis and outcome measures, medical, exercise and adjuncts). Each subgroup proposed recommendations for voting across the wider authorship in a modified Delphi process. 28 recommendations achieved substantial agreement following a chaired meeting attended by all authors. A summary infographic was produced to highlight themes relevant to the military patient population.Diagnosis of Achilles and patellar tendinopathy remains clinical. The consensus panel strongly advocates exercise rehabilitation as the primary management of Achilles and patellar tendinopathy. Medical interventions should respect the long-term occupational needs of the military population. Education is advised, but further adjunctive interventions should only be considered on a case-by-case basis. This consensus agreement provides a framework for the development of local guidelines for the management of Achilles and patellar tendinopathy in the UK military population.

Introduction: Infantry is a physically demanding trade that is associated with elevated rates of musculoskeletal injury. A 17-week longitudinal intervention assessed the effect of a progressive increase in load carriage mass and sprint-intensity intervals on physical performance, physical complaints, medical encounters, physical activity and sleep in infantry trainees.

Methods: 91 infantry trainees from 2 separate platoons, randomly assigned as control (CON) or experimental (EXP), provided written voluntary consent. Both completed a 17-week training syllabus that included physical training and military education lessons. Compared with CON, EXP completed a modified regimen that included; a 25%-30% reduction in load carriage mass (weeks 1-4), sprint (weeks 1-7) and 3 min running intervals. Endurance, strength, power and functional performance were assessed (weeks 1, 6-8), physical activity and sleep were recorded using actigraphy (each day of training, weeks 1-17), with daily physical complaints tabulated (weeks 1-7) and frequency of medical encounters retrospectively extracted from defence health records (weeks 1-17).

Results: On-time completion of training was attained in 93% and 79% of CON and EXP, respectively. Total load carriage mass (weeks 1-4) was 27% lower in EXP (10.1 kg/hour) than CON (13.9 kg/hour). Push-up repetitions in CON (5 reps) improved compared with EXP, with functional performance improving markedly in both groups (71 m, 23%). All other fitness assessments were similar between groups. No difference in sleep quality and quantity was observed between groups, with 77% and 16% of trainees sleeping <7 hours (suboptimal) and <6 hours (sleep restricted) per night, respectively. Physical complaints in CON were higher (62), despite no difference observed in medical encounters.

Conclusions: The reduction in load carriage mass and inclusion of sprint interval training did not modify the adaptative or maladaptive responses to infantry training. Most trainees experienced chronic suboptimal sleep quantity and quality with over 15% classified as sleep restricted.

Background: Gastrointestinal illnesses are common during military training and operational deployments. We compared the incidence and burden of travellers' diarrhoea (TD) reported by British service personnel (SP) during recent training exercises in Kenya and Oman.

Methods: SP completed a validated anonymous questionnaire regarding clinical features of any diarrhoeal illness, associated risk factors and impact on work capability after 6-week training exercises in 2018 in Kenya and 2018-2019 in Oman. Responses were tabulated for descriptive comparisons.

Results: Questionnaires were received from 388 (32%) SP in Kenya and 627 (52%) in Oman. The cumulative incidence of reported diarrhoea over 6-weeks was 14.2% (95% CI 8.02% to 22.61%) in Kenya compared with 3.9% (95% CI 1.10% to 9.91%) in Oman (OR 3.56, 95% CI 2.18 to 5.8; p<0.0001). Attack rates were 9.45 SP/100 exposure-months in Kenya and 2.66/100 in Oman. The number of workdays lost was greater in Kenya (6.26 per 1000 days) compared with Oman (4.13 per 1000 days) (p<0.01). In Kenya, 52.3% of those experiencing diarrhoea became ill during the first 14 days of deployment, but in Oman, 50% were ill in the last deployment week. The strongest risk factor associated with TD at both locations was contact with a colleague experiencing diarrhoea, followed in Kenya by eating locally sourced food and swimming in local water, which had weaker protective associations in Oman.

Conclusions: The epidemiology, risk factors and burden of TD in Kenya were similar to previous descriptions, where overall incidence continues to decline. Incidence and burden were significantly lower in Oman, where both were much lower than historical descriptions. Peak timing of illness and associated risk factors differed between Kenya and Oman. Continued documentation and review of TD during training exercises at different geographical locations is essential to inform the chain of command about risks to operational effectiveness.

Introduction: Tendinopathy is a common condition affecting physically active populations, such as the military. Diagnosis is clinical, with no gold-standard tests. The role of imaging and functional assessment in subdiagnosis is an active area of research with the hope of delivering more nuanced and clinically effective management. A vast array of injectable and adjunctive therapies have been proposed with varying, and at times, conflicting evidence. Multiple methods for exercise therapy exist, but increasingly tendinopathy is recognised as a heterogeneous condition not suited to a one-size-fits-all approach. The aim was to complete a systematic review, to appraise the recent evidence for conservative management of Achilles and patellar tendinopathy.

Methods: A multidisciplinary team from across defence rehabilitation searched PubMed for literature dating from May 2017 to July 2023. Four key areas were searched: diagnosis and outcome measures, medical, exercise and adjuncts.

Results: A total of 840 articles were identified. Articles were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Following screening and abstract review, a total of 143 were included for full review. Due to the breadth of literature and large heterogeneity of studies, meta-analysis of results was not feasible. Articles were assessed against the Oxford Centre for Evidence Based Medicine criteria.

Conclusions: The literature review found the strongest evidence for exercise-based rehabilitation as first-line treatment, with limited evidence for medical interventions and adjuncts. The primacy of stand-alone loading modalities is challenged by developing literature supporting a progressive tendon loading exercise protocol (PTLE). PTLE represents a framework where various exercise modalities are prescribed based on the individual's capacity and function. Novel interventions should be practised with caution and not conducted as monotherapy.

Introduction: French paratroopers have been deployed during airborne operations for nearly a century. Parachute operations have increased since the start of Operations Serval and Barkhane in the Sahelo-Saharan strip. These military operations allow paratroopers to be dropped behind enemy lines. Our primary objective was to compare injuries sustained during airborne operations and training. Our secondary objective was to compare serious injuries sustained during airborne operations and training.

Methods: We conducted a multicentric comparative retrospective study of military parachuting injuries sustained during training and airborne operations from 1 January 2013 to 31 December 2020. Parachuting injuries included in our study came from the French Army Injury Register.

Results: During the study period, 91 injuries (among 90 wounded), including one death, were recorded during airborne operations and 2744 injuries (among 2516 wounded), including one death, were recorded during training. Proportionally, injuries were more common during airborne operations (3.3%) than training (0.3%), especially during military freefall operations. Operational static-line jumps are more associated with serious injuries than training ones (OR 3.17, 95% CI 1.79 to 5.62). Compared with training, operational jumps caused proportionally more knee injuries (OR 2.73, 95% CI 1.65 to 4.51, p=0.008) but fewer upper limb injuries (OR 0.36, 95% CI 0.17 to 0.74). A physician and/or nurse medically supported 83.3% of airborne operations. Data collection initially differed between paratrooper units until the French Army introduced a harmonised collection tool (Register of Parachuting Incidents (Fiche de Recueil Accident en Parachute)).

Conclusion: Our study highlights a significantly increased injury rate during airborne operations, especially serious ones, likely due to the cumulative effect of well-known parachuting risk factors (eg, unknown or high wind speed, unknown landing ground type, combat load and night drop), justifying surveillance by qualified parachuting health staff.

Introduction: Depression is a common mental health disorder with high morbidity and disability rates. Military personnel are often considered a vulnerable population for depression, but epidemiological studies on the prevalence in veterans are limited. This study explores the relationship between military service and depression risk among American adults using a cross-sectional design based on National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2023.

Methods: This cross-sectional study used data from NHANES collected from 2011 to 2023. Depression was diagnosed based on the Patient Health Questionnaire-9 (PHQ-9) scores. Military service status was determined by responses to the demographic question. Binary logistic regression analysis was conducted to examine the association between military service and depression, as well as the factors influencing depression in veterans.

Results: After data cleaning, a total of 25 949 participants were included, 2407 individuals with military service and 2548 with depression. In the unadjusted analysis there was no significant difference in the prevalence of depression between military service and non-service individuals. However, after adjustment, military service was associated with a 23% reduction in the risk of depression (OR 0.77, 95% CI 0.61 to 0.96). Subgroup analysis showed that, among non-Hispanic Black individuals, married persons, high-income individuals and those without hypertension, hyperlipidaemia or hyperglycaemia, the prevalence of depression was lower in the military cohort compared with the general population. Multivariable logistic regression analysis indicated that female gender and being divorced were risk factors for depression among veterans, while high income and absence of hypertension served as protective factors.

Conclusion: Despite the relatively high prevalence of depression among active-duty and veteran military personnel, this large-sample cross-sectional study does not support the conclusion that military service increases the risk of depression. Furthermore, attention should be given to the depression risk among female and divorced veterans.

Objective: To estimate the prevalence of post-traumatic stress disorder (PTSD) in serving members of the Australian Defence Force (ADF) in the year 2015-2016.

Methods: The electronic health records of serving members of the ADF were screened for the term PTSD over a 12-month period. A 10% sample of these records were examined alongside a randomised matched sample of records. Each record was reviewed by two psychiatrists to verify a diagnosis of PTSD from the file.

Results: The rates of documented PTSD in health records were lower than expected. 802 serving members were identified with clinically diagnosed PTSD during 2015-2016 year, and the prevalence was 0.96%. The rate was higher, 1.33%, when reserve members were excluded. The sample was predominantly of male, non-commissioned officers with the Army having the highest rate of PTSD of the three services.

Conclusions: In this review of a sample of regular and reserve ADF member's electronic health records, a lower-than-expected prevalence of documented PTSD was found. This finding was of particular interest given findings from previous research that the prevalence of PTSD was likely to be higher. Possible explanations for this finding included the role of stigma in delaying or minimising presentations due to fear of adverse impact on career, possible bias in recording of diagnosis and delayed-onset PTSD.