Bmj Military Health最新文献

Introduction: Despite recognition of increased gambling vulnerability among military veterans, qualitative understanding of veterans' lived experiences of gambling harms, including impacts on family members, remains limited. This study explores the gambling histories, service-related influences, psychosocial impacts and support-seeking behaviours of UK veterans and their affected family members.

Methods: Thematic framework analysis was conducted on semistructured interviews with six male veterans and three female family members recruited through social media and support settings. Participants were screened using the Problem Gambling Severity Index to confirm severity of gambling-related harm.

Results: Four primary themes were identified: gambling histories and trajectories, the role of the Armed Forces in gambling behaviour, psychosocial and financial impacts, and barriers and motivations for seeking support. Veterans' gambling trajectories varied, with military life often seen to normalise gambling behaviours through accessibility, social reinforcement and stress-related coping mechanisms. Severe financial distress, relationship breakdowns, mental health issues and compromised trust characterised gambling's psychosocial impacts. Key barriers to seeking support included stigma, pride, denial and insufficient tailored services. Conversely, family interventions and personal crises were crucial motivators driving veterans towards recovery.

Conclusions: This study highlights the profound and complex impacts of gambling-related harm among UK veterans and their families, emphasising military cultural factors and significant psychosocial consequences. Effective interventions must address both individual gambling behaviours and broader family dynamics. Greater availability of veteran-specific support services and stigma reduction could improve help-seeking. Future research should incorporate diverse samples, including female veterans and male family members, to enhance generalisability and intervention efficacy.

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.

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.

Introduction: The 6 min walk test (6MWT) is a widely used, safe and effective submaximal exercise test. The primary outcome is the distance walked, but additional physiological and patient-reported metrics can be recorded. It is used to assess function and is commonly used within UK Defence Rehabilitation. However, there are no published British military 6MWT data in a non-injured population. This study reports the 6MWT procedure and results from healthy British service personnel.

Methods: A convenience sample of 46 individuals (male n=40) undertook 95 6MWTs over three study visits throughout a year. They were performed on a 20 m straight-line route, administered by an exercise rehabilitation instructor and preceded by anthropometric measurements (height, weight). Physiological measures (HR, oxygen saturations (SpO₂)) and patient-reported measures (Borg shortness of breath (SoB), rate of perceived exertion (RPE) and fatigue) were taken before and after the assessment. Statistical tests were performed between pre-test and post-test measures, and sex and body mass, and concurrent cardiopulmonary exercise tests (CPET) with 6MWT distance.

Results: The mean 6MWT distance was 705.5±86 m; males 709.4±86.9 m and females 685.9±81.9 m (p=0.32), with a median Borg SoB of 1 (IQR: 0-2) and RPE 9 (IQR: 7-11), and a negative correlation between body mass index and 6MWT distance, p=0.007. There were no significant differences between pre-test and post-test measures. Peak workload and VO₂ Max correlated weakly with 6MWT distance (0.336, p=0.01 and 0.375, p=0.09, respectively), but submaximal CPET measures did not.

Conclusion: These results provide a benchmark for British military 6MWT data to guide clinical and research use. However, a larger dataset is required for validation and normative values.