Bmj Military Health最新文献

Introduction: The prevalence of unintended pregnancy (UIP) in the United States is high among active-duty service women (ADSW).

Objective: To estimate the number of UIPs and the impact these pregnancies have on the ability to meet Women, Peace and Security objectives as measured by maximum potential readiness days lost (mRDL).

Methods: Using data from the Military Health System Data Repository, ADSW aged 18 to 44 years, were identified from fiscal year (FY) 2019 data. Deliveries were identified using Medicare Severity Diagnosis-Related Group codes. The estimated number of UIPs was calculated by multiplying both the number of ADSW and the number of deliveries by age-adjusted rates of UIP. Post partum women do not have to meet height and weight standards or complete a physical fitness test for up to 365 days after a full-term delivery. Lost readiness days were calculated by multiplying the number of UIPs by 365 days. Data were stratified by age, race, rank and branch of service.

Results: A total of 230 596 ADSW were identified in FY2019. Using the number of ADSW, an estimated 12 683 ADSW experienced an unintended pregnancy, resulting in an estimated 4 629 215 mRDL. Using the number of deliveries, an estimated 6785 deliveries were a result of UIPs, resulting in an estimated 2 476 364 mRDL. The highest estimates of UIPs were among ADSW aged 18 to 24 years, of White race, in a Junior Enlisted rank and in the Army.

Conclusion: Estimates of UIPs among ADSW would result in considerable impact on their military career. Dealng with UIPs proactively, by encouraging comprehensive family planning and instituting additional reproductive health policies for service members by ensuring that service members can make informed decisions about their reproductive health while maintaining operational effectiveness, is important for meeting United States Department of Defense Women, Peace and Security objectives.

Introduction: Whole body vibration (WBV) is thought to be associated with low back pain (LBP). To mitigate against this the International Organisation for Standardisation (ISO) have created the ISO 2631 standard, recommending safe dose limits. The aim of this research is to conduct a systematic review of available literature addressing the question, is WBV associated with LBP?

Methods: A literature search was performed from January 1970 until April 2022, including studies focusing on LBP and sciatica in association with WBV, looking specifically for ones reporting on military populations. Studies on populations less than 18 years old or case studies were excluded. We conducted two subgroup analyses on studies that used a validated method to assess LBP and measured an A(8) (daily exposure) or VDV value (highest vibration exposure) as per ISO 2631-1 standard.

Results: 37 studies were included, 11 showed an association between LBP and WBV. 97.9% of the population was male with an average age of 40.2, 47% used a version of the Standard Nordic Questionnaire (SNQ) to assess LBP and 51% used a triaxial accelerometer standard to measure vibration. Two studies reported on military populations.The subgroup analysis for A(8) identified six studies with a total population of 1413. A(8) ranged from 0.17 m/s² to 0.59 m/s² and LBP prevalence from 25% to 66%. The subgroup analysis for VDV identified three papers with a total population of 1239. VDV ranged from 6.84 m/s^0.75 to 14.7 m/s^0.75 and LBP prevalence from 25% to 60.9%.

Discussion: This paper suggests WBV and LBP are associated but there is a research gap for high-level evidence and comparable data. The use of the SNQ was a preferrable method to assess LBP in most included studies. Using this in combination with a protocolised standard for measuring vibration exposure is needed for further research.

Prospero registration number: CRD42022298283.

The traditional approach to resuscitating injured women of childbearing potential (WCBP) with an unknown RhD type is to transfuse RhD-negative blood products. This is to prevent alloimmunisation to the RhD antigen and ultimately prevent haemolytic disease of the fetus and newborn (HDFN) in future pregnancies should she survive. RhD-negative blood products are scarce in both military and civilian blood stocks. It is likely that only RhD-positive blood products are available for a servicewoman injured in combat. This analysis will review the latest models of D-alloimmunisation following transfusion of RhD-positive blood products to injured WCBPs, the subsequent rates of adverse events from HDFN and describe some surveys of WCBPs' preferences for transfusion in emergency situations. These data and opinions all point to the same conclusion: RhD-negative blood products should be the first choice for the resuscitation of women at risk of HDFN, but their absence should never lead to withholding a lifesaving transfusion.

Many employers-including the military-are experiencing systemic workforce capacity and capability challenges. This coincides with a time of declining workforce health, especially among military service entrants, where many performance-limiting health conditions are preventable if healthier behaviours are practised. Effectively tackling complex, interconnected health problems demands a multilevel, multicomponent Whole System Approach (WSA). However, despite recognition of the issues impacting international militaries, current policies and practices supporting healthy, performing workforces have failed. To arrest ill-health trends in personnel, military employers must develop transformational ways to support good health. This paper presents a military workplace WSA model, operationalised through COM-B to specifically target diet behaviour, supporting individual good health, promoting human performance and realising organisational benefits. The challenges of a military occupational setting to individual nutrition practices across the career are discussed. Finally, Impact Value Chain analysis is proposed to monitor system delivery and measure the effectiveness of an integrated, organisation-wide WSA.

Theoretically, the serial measurement of biomarkers to monitor physiological responses to military training could be used to mitigate musculoskeletal injury risk and better understand the recovery status of personnel. To date, the cost and scalability of these initiatives have impeded their uptake by defence organisations. However, advances in technology are increasing the accessibility of a range of health and performance biomarkers. This paper presents a synthesises of findings from the literature and discussions with informed stakeholders to provide contextually relevant advice for future efforts to monitor military personnel, together with key considerations to ensure actionable outcomes from the data captured. The aim of this review is, therefore, twofold; first, to demonstrate how wearable devices and biomarkers have been used in defence research to assess the context-specific, occupational demands placed on personnel; and second, to discuss their potential to monitor military workloads, optimise training programming and understand soldier adaptation to multi-stressor environments.

Defence has a significant interest in the use of artificial intelligence (AI)-based technologies to address some of the challenges it faces. At the core of future military advantage will be the effective integration of humans and AI into human-machine teams (HMT) that leverages the capabilities of people and technologies to outperform adversaries. Realising the full potential of these technologies will depend on understanding the relative strengths of humans and machines, and how we design effective integration to optimise performance and resilience across all use cases and environments.Since the first robot appeared on the assembly line, machines have effectively augmented human capability and performance; however, they fall short of being a team member-someone you can ask to give you a hand! Working in teams involves collaboration, adaptive and dynamic interactions between team members to achieve a common goal. Currently, human-machine partnership is typically one of humans and machines working alongside each other, with each conducting discrete functions within predicable process and environments. However, with recent advances in neuroscience and AI, we can now envisage the possibility of HMT, not just in physical applications, but also complex cognitive tasks.This paper provides a holistic review of the research conducted in the field of HMT from experts working in this area. It summarises completed and ongoing studies and research in the UK and USA by a broad group of researchers. This work was presented in the HMT thematic session at the Sixth International Congress on Soldiers' Physical Performance (ICSPP23 London).

Introduction: Musculoskeletal injury is one of the leading causes of medical discharge in the UK Armed Forces. Residential rehabilitation (RR) courses are part of Defence rehabilitation, for service personnel (SP) who do not respond to treatment at primary care. Historically, it was delivered as a 3-week block model. As a quality improvement project, rolling admissions were introduced aiming to improve access to RR and deliver outcomes that met the requirements of primary care referrers.

Method: Clinical outcomes were assessed for SP with either spinal or lower limb pathology using the Musculoskeletal Health Questionnaire (MSK-HQ) on course admission and discharge and the Medical Deployment Standard (MDS) on admission and 6 months post course. Wait times were also recorded. Outcomes were compared with the block admission using retrospective audit data. Referrer feedback was gathered using a questionnaire pre introduction and post introduction of rolling admissions.

Results: Rolling admissions reduced course wait times from an average of 55 days to 19 days. Of SP who attended a rolling admission course with spinal pathology (n=23), 58% showed an increase in MDS, 65% showed an increase of the minimally important change in MSK-HQ. With lower limb pathology (n=35) 57% increased MDS, 49% increased MSK-HQ. For the block model, of those with spinal pathology (n=30) 43% increased MDS, 67% increased MSK-HQ, with lower limb pathology (n=30) 60% increased MDS, 33% increased MSK-HQ. Referrer feedback improved with rolling admissions with feedback most positive in relation to the model's responsiveness for admitting SP onto the course.

Conclusion: Rolling admission provided similar clinical outcomes as the previous block model in a shorter time frame with lower wait times and better met the needs of referrers. Future study recommendations include longer term follow-up and looking at alternative ways to measure the success of RR within the care pathway.

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.

Introduction: On 25 August 2020, 29 British Forces Brunei (BFB) service personnel were hospitalised after being struck by lightning during a company-level training exercise in the Brunei jungle. This paper observes both the initial injury pattern of the personnel and their occupational health status at the 22-month point.

Method: All 29 of the personnel affected by the lightning strike on 25 August 2020 were followed up until the 22-month point, allowing observation of injury patterns and management as well as the long-term outcomes. They were all members of two Royal Gurkha Rifles and received local hospital care and British Defence Healthcare input. Initial data were collected for mandatory reporting processes, and cases were followed up as a routine part of the Unit Health processes.

Results: Of the 29 identified as having lightning-related injuries, 28 returned to Medically Fully Deployable status. Acoustic trauma was the most common injury which was treated in several cases by oral steroids with some receiving intratympanic steroids. Multiple personnel suffered transient or short-lasting sensory changes and pain. 1756 service personnel days were covered by restrictions.

Conclusion: The pattern of the lightning-related injuries was different to that which would be expected from previous reports. This is likely due to the unique nature of each lightning strike, combined with the ample unit support, the fit and resilient cohort and the rapid initiation of treatment, especially with regard to hearing.Brunei is at high risk of lightning strikes, planning for them is now standard for BFB. Despite lightning strikes having the potential to cause mortality and mass casualty events, this case study shows that such events do not necessarily result in severe long-term injury or mortality.

Introduction: On 24 February 2022, the full-scale military invasion of Russia into Ukraine has started, creating one of the largest humanitarian crises in Europe since the World War II. As of 27 July 2022 (by the time when the most of Russian advances have already occurred), more than 900 healthcare facilities in Ukraine were damaged and 127 hospitals were destroyed completely.

Methods: Mobile medical units (MMU) were deployed in the frontline-bordering areas. An MMU included a family doctor, a nurse, a social worker and a driver, and aimed to provide medical help in remote areas. 18 260 patients who received medical help in MMUs in Dnipro (Dnipro city) and Zaporizhia (Zaporizhia city and Shyroke village) oblasts from July until October 2022 were included in the study. The patients were subdivided by month of visit, area of residence and area of MMU operation. Patients' sex, age, date of visit and diagnosis were analysed. Comparison between groups was performed using analysis of variance and Pearson's χ² tests.

Results: Majority of patients were females (57.4%), people aged 60+ years (42.8%) and internally displaced persons (IDPs) (54.8%). The proportion of IDPs increased from 47.4% to 62.8% over the period of study (p<0.01). The most common cause of visit to doctors was cardiovascular diseases (17.9%). The frequency of non-respiratory infections remained stable over the period of study.

Conclusions: In the frontline-bordering areas of Ukraine, females, people older than 60 years and IDPs more frequently sought medical help in MMUs. Causes of morbidity in the studied population were similar to the causes of morbidity before the beginning of full-scale military invasion. Maintaining continuous access to healthcare services may be beneficial for the patient outcomes, especially in terms of cardiovascular disease.