Bmj Military Health最新文献

Introduction: Combat exposure has been associated with the emergence of post-traumatic stress disorder (PTSD) symptoms in military personnel; however, not all veterans are negatively impacted by their operational experience. In many instances, the absence of symptoms following operational service is attributed to resilience. This study explored the construct of resilience by examining the relationship between levels of deployment-related exposures and psychological symptoms, as well as identifying factors that may contribute to resilience and emerging risk.

Method: Participants were special forces personnel who completed self-report questionnaires 1 month before deployment and 4 months post deployment. Subgroups were created based on psychological reactivity to deployment exposures, representing risk, vulnerability and resilience. Regression analysis assessed the contribution of factors that were predictive of risk or resilience groups specifically.

Results: Results showed the overall levels of psychological reactivity in this population post deployment were low; however, differences between risk and resilience subgroups were found. Subthreshold indicators of psychological reactivity, as well as deployment factors such as increased deployment frequency and time spent away from home, were found to contribute to differences between risk and resilient trajectories.

Conclusion: Findings reflect a military population with low psychological symptoms despite high trauma exposure. However, subtle underlying differences between subgroups suggest that the early identification of risk and emerging trajectories is possible. Risk and resilience in military populations needs to consider subthreshold indicators and individual differences over time.

Pharmacological interventions for treating posttraumatic stress disorder in Canadian Armed Forces (CAF) members and Veterans often achieve modest results. The field of pharmacogenetics, or the study of how genes influence an individual's response to different medications, offers insight into how prior knowledge of gene-drug interactions may potentially improve the trial-and-error process of drug selection in pharmacotherapy, thereby improving treatment effects and remission rates. Given the relative recency of pharmacogenetics testing and sparse research in military samples, we used pharmacogenetics testing in a small pilot group (n=23) of CAF members and Veterans who were already engaged in pharmacotherapy for a service-related mental health condition to better understand the associated opportunities and challenges of pharmacogenetics testing in this population. Our preliminary evaluation involved: (1) reporting the prevalence of pharmacogenetics testing 'bin' status according to participants' reports ('green', 'yellow' or 'red'; intending to signal 'go', 'caution' or 'stop', regarding the potential for gene-drug interactions); (2) calculating the percentage of currently prescribed psychotropic medications that were assessed and included in the reports; (3) evaluating whether prescribers used pharmacogenetics testing information according to clinical notes and (4) collecting informal feedback from participating psychiatrists. While pharmacogenetics testing appeared to provide valuable information for a number of clients, a major limitation was the number of commonly prescribed medications not included in the reports.

Microbiomes involve complex microbial communities wherein the micro-organisms interact with one another as well as their associated hosts or environmental niches. Much of the characterisation of these communities and the associations have been achieved through 'omics' technologies, such as metagenomics, metaproteomics and metametabolomics, and model systems. Recent research in host-associated microbiomes has been aimed at understanding the role 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 enabling technologies and environmental microbiomes 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 in 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.

Introduction: The challenges faced by healthcare workers, not least during the response to the COVID-19 pandemic, have been extensively studied, and concerns continue to be highlighted in relation to their long-term mental health. Identifying the need to support their personnel, a leader-led structured programme of reflection: the recovery, readjustment and reintegration programme (R3P) was designed by the UK Defence Medical Services to mitigate the potential stressors associated with this outbreak and enhance the resilience of the workforce.

Methods: 128 military personnel completed an evaluation of R3P. A survey included measures of anxiety before and after the intervention, perceptions of the discussion themes and whether these brought a sense of closure to areas of distress, and attitudes to help-seeking.

Results: Most respondents (86%-92%) rated the five discussion themes either 'helpful' or 'very helpful', 51% of respondents reported a sense of closure about an issue that had been causing distress and 72% of respondents felt better able to seek help should it be necessary. Evaluating the effect R3P had on anxiety, a Wilcoxon signed rank test elicited a statistically significant difference in anxiety pre-R3P and post-R3P; Z=-3.54, p<0.001. The median anxiety rating was 3.5 (IQR 4.75, 95% CI 1.25 to 6.00) before undertaking R3P, which decreased to 3 (IQR 4.75, 95% CI 1.00 to 5.75) after undertaking R3P. 39.1% of participants reported decreased anxiety, 18.8% reported increased anxiety and 42.2% reported no change.

Conclusion: This evaluation has identified several positive aspects to R3P with many personnel reporting a reduction in anxiety, a sense of closure and increased likelihood of help-seeking. Several participants did report an increase in anxiety and the long-term impact of R3P on mental health and well-being is unclear. Further mixed-methods evaluation incorporating a longer follow-up is required.

Introduction: Historically, diseases and non-battle injuries (DNBI) typically stand for 70%‒95% of all medical events during military missions. There is, however, no comprehensive compilation of medical statistics for Swedish soldiers during deployment.

Method: During United Nations Multidimensional Integrated Stabilization Mission in Mali, climate data and medical outpatient health surveillance data were compiled for Swedish soldiers deployed to Timbuctoo, between 2015 and 2019. Correlations between climate data and medical outpatient health surveillance data were analysed.

Results: Battle injuries accounted for 0.4% of the visits to healthcare, while diseases accounted for 53.6%, and non-battle injuries for 46%, the majority being musculoskeletal injuries. The combination of high temperature, humidity, sun radiation and good visibility, during summer rotation weeks, caused more events of injuries and heat stress than any other period.

Conclusion: Musculoskeletal injuries were the major cause for visits to the Swedish camp hospital. Injuries and heat stress increased during periods of high temperature, humidity, sun radiation and good visibility. Lack of medical data, i.e. unknown number of unique patients seeking healthcare, cause codes not always connected to a primary diagnosis, and revisits not being connected to a diagnose, complicated interpretation of health risk factors.

Introduction: Military operations place high demands on many cognitive functions, and stressful events characterise the military work environment. The study aimed to examine the relationship between cardiorespiratory fitness, stress response, cognitive function and military performance during prolonged military exercise.

Methods: 66 army cadets were included in the study. The subjects participated in a 4.5-day military winter training in northern Sweden. Maximal oxygen uptake (VO₂max) was estimated from a cycle test. Cognitive tests (design fluency, DF test) and measurements of heart rate variability (HRV) were conducted before and after the exercise. Assessment of military performance as an individual soldier (P-ind) and performance as a team leader (P-lead) was carried out during the final day of the exercise. Pearson's coefficient of correlation (r) and Spearman's rho were used to evaluate correlations, and linear regressions were used to examine the relationships between VO₂max, HRV, DF test scores and military performance. Simple mediation analyses were performed with DF test scores and military performance (P-ind, P-lead) as dependent variables, VO₂max as a predictor and HRV as a mediator.

Results: Post-exercise HRV was related to military performance (P-ind: r=0.40, p<0.01; P-lead: r=0.32, p<0.05). Absolute VO₂max was positively correlated with P-ind (r=0.28, p<0.05), and the effect of VO₂max on military performance was mediated by HRV. Post-test DF scores were negatively correlated with post-exercise HRV (total correct designs: r=-0.26, p<0.05; total incorrect designs: r=-0.27, p<0.05).

Conclusions: Results suggest that high absolute VO₂max predicts military performance by reducing the stress response to prolonged military exercise. Aerobic capacity may provide a meaningful effect on the ability to preserve military performance. Future studies need to identify thresholds for this capacity.

Pre-registration: The protocol was retrospectively registered at OSF (https://osf.io/), registration DOI 10.17605/OSF.IO/ND6XM.

Introduction: Emergency resuscitative thoracotomy (ERT) is a resource-intensive procedure that can deplete a combat surgical team's supply and divert attention from casualties with more survivable injuries. An understanding of survival after ERT in the combat trauma population will inform surgical decision-making.

Methods: We requested all encounters from 2007 to 2023 from the Department of Defense Trauma Registry (DoDTR). We analysed any documented thoracotomy in the emergency department and excluded any case for which it was not possible to distinguish ERT from operating room thoracotomy. The primary outcome was 24-hour mortality.

Results: There were 48 301 casualties within the original dataset. Of those, 154 (0.3%) received ERT, with 114 non-survivors and 40 survivors at 24 hours. There were 26 (17%) survivors at 30 days. The majority were performed in role 3. The US military made up the largest proportion among the non-survivors and survivors. Explosives predominated in both groups (61% and 65%). Median Composite Injury Severity Scores were lower among the non-survivors (19 vs 33). Non-survivors had a lower proportion of serious head injuries (13% vs 40%) and thorax injuries (32% vs 58%). Median RBC consumption was lower among non-survivors (10 units vs 19 units), as was plasma (6 vs 16) and platelets (0 vs 3). The most frequent interventions and surgical procedures were exploratory thoracotomy (n=140), chest thoracostomy (n=137), open cardiac massage (n=131) and closed cardiac massage (n=121).

Conclusion: ERT in this group of combat casualties resulted in 26% survival at 24 hours. Although this proportion is higher than that reported in civilian data, more rigorous prospective studies would need to be conducted or improvement in the DoDTR data capture methods would need to be implemented to determine the utility of ERT in combat populations.

Musculoskeletal injuries (MSKI) are one of the biggest challenges for military services globally, contributing to substantial financial burdens and lost training and working days. Effective evidence-based intervention strategies are essential to reduce MSKI incidence, and research has shown the positive effect of both nutritional interventions and physical training (PT) interventions on reducing MSKI incidence. Levels of vitamin D metabolites have been associated with MSKI and bone stress fracture risk, while calcium and vitamin D supplementation has been shown to reduce the incidence of stress fractures during military training. Protein and carbohydrate supplementation during arduous military training (high volume, high intensity) has also been shown to reduce MSKI risk and the number of limited/missed duty days. PT has played a key role in soldier development to meet the occupational demands of serving in the armed forces. Paradoxically, while PT is fundamental to enhancing soldier readiness, PT can also be a major contributor to MSKI; emerging evidence suggests that the nature of the PT being performed is a risk factor for MSKI. However, strategies like reducing training load and implementing PT programmes using evidence-based training principles can reduce MSKI incidence among military service members by 33-62%, and reduce the financial burdens for military services. This review provides a summary of effective MSKI reduction interventions and provides strategies to enhance the success and adoption of such interventions.