Bmj Military Health最新文献

The invasion of Ukraine by the Russian Federation in February 2022 has witnessed the first peer-on-peer full-scale European conflict since World War 2. We have noted that the vast majority of injuries affect the extremities. Within that group, injuries to the joints pose a huge clinical challenge. Specifically, 17.1% of all gunshot injuries (GSWs) involved the joints, which represents 22.3% of all limb injuries. 55.6% of all GSW to the joints involved the knee; 10% had a concomitant vascular injury and 15%-20% had a nerve injury.The surgical management of ballistic knee injuries includes initial damage control surgery with debridement of non-vitalised tissue, vascular reconstruction and fasciotomies where necessary, with stabilisation of bone injury with a spanning external fixator. Following repatriation to Role 4 facilities, staged reconstruction is performed with cement spacers followed by autograft, endoprosthesis or arthrodesis. Where reconstruction is not possible, above-knee amputation remains an option.In this paper, based on the analysis of 33 cases, we describe the Ukrainian early experience of the management of gunshot wounds to the knee joint with three clinical case studies as representative examples.

Introduction: Sexually transmitted infections (STIs) are an everlasting health issue globally. The military environment is recognised as a high-risk setting. Human papillomavirus (HPV), Chlamydia trachomatis and Neisseria gonorrhoeae are the most frequent STIs worldwide. This prospective cross-sectional pilot study focuses on the prevalence of selected STIs in the female population of the Czech Republic's Armed Forces.

Methods: C. trachomatis, N. gonorrhoeae and HPV detection and genotyping were performed between August 2020 and December 2022 in 141 women. Participants were divided into three groups according to their military status-recruits (n=72), active soldiers (n=25) and control civilian group (n=44). Cervical smear tests were performed, and data on STI risk factors were obtained through a questionnaire.

Results: A significant difference in the HPV prevalence between recruits (64.5 %) and both active soldiers (46.4 %) and civilians (47.3 %) was found when adjusted for age (p=0.007 and p=0.01, respectively). Lower age of coitarche (median 16; p=0.005) and smaller agglomeration origin (p=0.013) were reported for military recruits. No difference was proven in other researched risk factors. Associations between HPV detection and the higher number of sexual partners (p=0.013), early coitarche (p=0.016) and single marital status (p=0.002) across the groups were observed. Not a single case of N. gonorrhoeae was detected in any of the 141 participants. The prevalence of C. trachomatis did not differ significantly between the three evaluated groups-recruits, control civilian group, and active soldiers (5.6%, 2.3%, 0%, respectively; p=0.567).

Conclusions: This pilot study showed a significantly higher HPV prevalence in female military recruits compared with both active military and civilian women. Recruits reported earlier coitarche which is a strong STI risk factor. Further study is needed to expand on the findings of this pilot study and generate data to support adjustment of STI preventive measures within the Czech Republic Armed Forces.

While there are women represented in some notable positions within the UK Defence Medical Services (DMS), the challenges and barriers to successful female progression have not disappeared. The DMS needs highly talented, motivated doctors working to support operations, yet we struggle to recruit and retain female personnel. This is in clear contrast to the increased proportion of female personnel working within the civilian medical workforce.This article seeks to communicate this problem, illustrated by the lived experiences of DMS female doctors, by exploring the six gender bias barriers ('Glass Walls') that hold women back in the workplace.Cultural change requires a determined effort, driven persistently from the top and at every level of leadership and management. The first step requires recognition and acceptance of the problem. Progress is likely to be slow, or fail, if driven by the female minority alone. While the DMS remains a majority-male organisation, male allies are pivotal in advocating for their female colleagues, to promote change, in an effort to recruit and retain talented individuals.

Personalised medicine is replacing prototypical medical care. Personalised medicine focuses on enhancing patients' functioning and preventing future negative impacts of both medical disease and psychological disorders, and unfolds uniquely for each individual. The military special forces community is a group at higher risk for physical trauma, for example, traumatic brain injuries, as well as psychosocial stressors and traumas associated with combat, high operational tempos and sleep deprivation. From a system's cost-benefit perspective and resonating with community norms of resiliency, personalised medicine offers unique innovative treatments for special operators. In this article, we outline the successful applications of personalised medicine via the multidisciplinary treatment of special operators with comorbid conditions (primarily mild traumatic brain injury and post-traumatic stress disorder).

Microbiomes involve complex microbial communities where the microorganisms interact with one another as well as their associated hosts or environmental niches. The characterisation of these communities and associations have largely been achieved through 'omics' technologies, such as metagenomics, metaproteomics and metametabolomics, and model systems. Recent research in host-associated microbiomes have been aimed at understanding the roles microbes may play in host fitness or conversely how host activities/conditions may perturb the microbial community, which can further affect host health. These studies have led to the investigation of detection, intervention or modulation methods, which may serve to provide benefits to the host and advance our understanding of microbiome associations. With the clear implications on human health and disease, the US Department of Defense (DoD) has made microbiome research a priority, with the founding of the Tri-Service Microbiome Consortium (TSMC) to enhance collaboration, coordination and communication of microbiome research among DoD organisations and partners in academia and industry. DoD microbiome research focuses mainly on the following themes: (1) Human health and performance; (2) Environmental microbiomes; and (3) Enabling technologies. This review provides an update of current DoD microbiome research efforts centred on human health and performance and highlights innovative research being done in academia and industry that can be leveraged by the DoD. These topics were also communicated and further discussed during the fifth Annual TSMC Symposium. This paper forms part of the special issue of BMJ Military Health dedicated to Personalised Digital Technology for Mental Health in the Armed Forces.

Biomarkers have been of considerable interest in military medicine as a strategy to identify objective measures of resilience in the context of the cumulative trauma exposure of combat as well defining the emerging neurobiological dysregulation associated with post-traumatic stress disorder (PTSD). This body of work has been driven by the imperative of developing strategies to optimally manage the long-term health outcomes of personnel and finding novel treatment approaches. However, the challenge of defining the relevant phenotypes of PTSD and in the context of the multiplicity of biological systems of interest has hampered the identification of biomarkers that have clinical utility. One key strategy to improve the utility of precision medicine in military settings is to use a staging approach to define the relevant phenotypes. A staging model of PTSD captures the progression of the disorder and the transitions from being at risk to subsyndromal disorder and the path to chronic disorder.A staging approach addresses the longitudinal course of PTSD and the fluidity of the disorder across time. Staging describes how symptoms evolve into more stable diagnostic syndromes and the stepwise changes in clinical status which is key to the identification of phenotypes that can be tied to relevant biomarkers. When a population is exposed to a trauma, the individuals will be at different stages in the emergence of risk and the development of PTSD. The staging approach provides a method of capturing the matrix of phenotypes that need to be demarcated to study the role of multiple biomarkers. This paper forms part of the Special issue of BMJ Military Health dedicated to personalised digital technology for mental health in the armed forces.

Military service members need to be able to operate under conditions of extreme stress to ensure the success of their team's mission; however, an acute stress reaction (ASR) can compromise team safety and effectiveness by rendering an individual unable to function. Building on an intervention originally developed by the Israel Defense Forces, several countries have developed, tested, and disseminated a peer-based intervention to help service members manage acute stress in others. This paper reviews how five countries (Canada, Germany, Norway, the UK and the USA) adjusted the protocol to fit their organisational culture while retaining essential elements of the original procedure, suggesting there can be interoperability and mutual intelligibility in the management of ASR by military allies. Future research should examine the parameters of effectiveness for this intervention, the impact of intervention on long-term trajectories, and individual differences in managing ASR.

Veterans are not a demographically homogenous group, yet minority groups continue to be under-represented in research and report feeling less able to access clinical services to seek support. While veteran-specific healthcare has responded to the needs of the majority, the success of veteran mental health services is contingent on serving the whole veteran population. Key to the personalisation of healthcare is the question of access and a need to address specific inequalities and barriers to help-seeking behaviour. In this paper, we explore the issues of access to veteran healthcare at three levels: those barriers common to all veterans; those common to all minority groups of veterans; and those relevant to specific minority groups of veterans. Stigma, military attitudes and culture (eg, stoicism), and access to services and professionals with veteran-specific knowledge are universal barriers across veteran groups. Minority groups report a heightening of these barriers, alongside being 'othered' in veteran care settings, a lack of representation of them or their experiences in service descriptions and advertising, a lack of professional cultural competencies on specific issue, and the veteran environment potentially being retraumatising. Finally, barriers specific to individual groups are discussed. Attending to these is essential in developing holistic approaches to personalised healthcare that meets the needs of all veterans.

While substantial investment has been made in the early identification of mental and behavioural health disorders in service members, rates of depression, substance abuse and suicidality continue to climb. Objective and persistent measures are needed for early identification and treatment of these rising health issues. Considerable potential lies at the intersection of biology, wearables and artificial intelligence to provide high accuracy, objective monitoring of mental and behavioural health in training, operations and healthcare settings. While the current generation of wearable devices has predominantly targeted non-military use cases, military agencies have demonstrated successes in monitoring and diagnosis via off-label uses. Combined with context-aware and individualised algorithms, the integration of wearable data with artificial intelligence allows for a deeper understanding of individual-level and group-level mental and behavioural health at scale. Emerging digital phenotyping approaches which leverage ubiquitous sensing technology can provide monitoring at a greater scale, lower price point and lower individual burden by removing the need for additional body-worn technology. The intersection of this technology will enable individualised strategies to promote service member mental and physical health, reduce injury, and improve long-term well-being and deployability.