Bmj Military Health最新文献

Introduction: Non-surgical management of non-neurological thoracic or lumbar spine (TL) fractures seems to provide good results in the civilian population, leading to return to work in most cases. However, data on the military population are limited, particularly regarding return to duty. This study aimed to describe a population of French military patients with traumatic non-neurological TL fractures and the outcomes of non-surgical management regarding operational capacity.

Materials and methods: This retrospective single-centre observational study used data from military patients followed for non-neurological TL fractures, from the date of the trauma or after treatment in another civilian or military care facility. Medical fitness status at 1 year was the primary outcome. Medical fitness status at 1 year was defined as unrestricted resumption and restricted resumption in cases of return to duty in a different role or in the previous role with restrictions.

Results: Between January 2010 and December 2020, 93 patients presented with non-neurological traumatic TL fractures at Sainte-Anne National Military Hospital. Fifty-four records met the inclusion criteria. Falls from high heights (27.8%, n=15) and road accidents (24.1%, n=13) were the most common traumatic mechanisms. The remaining 77 injuries were compression fractures, predominantly at the thoracolumbar junction. One year after trauma, 90.7% of patients (n=49) had returned to duty, and 77.8% (n=42) were free from medical restriction. The median duration of incapacity (MDI) was 173 days. Age significantly affected medical fitness at 1 year (p=0.019); however, it did not affect the MDI. Polytrauma was significantly associated with a lower resumption rate at 1 year (53.3%, p=0.007).

Conclusion: Non-surgical management of non-neurological TL fractures allowed unrestricted return to duty in this population. These clinically relevant trends have led to perspectives for defining non-surgical treatment indications, means and goals.

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: Abnormal cardiorespiratory symptoms and investigative findings in service personnel typically result in prolonged investigation and occupational restriction. This analysis aimed to assess the impact of the Oxford Military Cardiopulmonary Exercise Testing Clinic (OMEC), which investigates such symptoms and findings, on occupational recommendations.

Methods: A service evaluation was conducted on all OMEC attendances over a 5-year period. Referral indication and occupational grading, demographics, exercise testing parameters, clinical diagnosis and occupational recommendation were recorded.

Results: 141 individuals were reviewed. Mean age was 36 (±11.3) years, and 91% were male. Median waiting time for an appointment was 14.4 weeks (cf NHS 17.4 weeks).Individuals were referred for dyspnoea (22.1%), syncope (11.4%), chest pain (8.1%) (referred to as 'higher risk' symptom group), and pre-syncope (8.1%), palpitations (8.1%), and fatigue and/or exercise intolerance (6.0%) (referred to as 'lower risk' symptom group). 34% were asymptomatic with incidental findings on cardiac screening investigations. Reduced exercise capacity was rare, affecting only 11% of individuals, which was borderline/mild at worst.Median peak VO₂ (as a percentage of the predicted peak) was lower in the higher-risk symptom group than in the lower-risk symptom group (97.8% vs 121%; p<0.001). This was also seen for median workload as %PP (82.6% vs 98.0%; p<0.001). 80.5% of patients were given an immediate occupational recommendation; 78% of which were favourable outcomes (ie, a recommended occupational upgrade (72%) or to remain fully deployable (6%)).

Conclusion: OMEC is tailored to the unique needs of the military population, providing outcomes that support operational requirements. Despite geographical distribution and operational commitments, OMEC waiting time is equivalent to the NHS, with the great majority of patients upgraded after attendance. These findings establish OMEC as a benchmark for military-specific clinical services based in public (NHS) hospitals, highlighting its role in facilitating rapid and effective occupational management.

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.

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: 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.