Bmj Military Health最新文献

Introduction: Limited research is available on the bone health of female warfighters graduating from combat leadership courses like the US Army Ranger Training Course since combat roles opened to women in 2015. This investigation aimed to characterise the bone density, microarchitecture and strength of a small cohort of these female elite warfighters (FEW) to aid in understanding the physical resilience necessary for women to succeed in such courses.

Methods: FEW (n=11) were assessed for body composition and whole-body areal bone mineral density (aBMD) and content (BMC) by DXA, bone microarchitecture at two distal tibia sites by high-resolution peripheral quantitative CT (HR-pQCT) and health and lifestyle outcomes by survey. Two female comparison cohorts (CC) of Army basic combat trainees were matched (3:1), to provide context to the FEW.

Results: FEW were similar to CC1 and CC2 in height, and lower in body fat (p<0.05). FEW whole-body aBMD and BMC were higher than CC1 (both p<0.01, Cohen's D=0.233 and 0.785, respectively). HR-pQCT measures demonstrated greater total density (13.4%; p=0.01), bone volume fraction (12.9%; p=0.03) and 26.0% higher estimated failure load (p<0.01) in the FEW compared with CC1 at the metaphysis. At the diaphysis, FEW tibiae had 10.2% higher estimated compressive stiffness and 10.3% higher estimated failure load (both p<0.05) than CC2 with no differences in other bone health measures. Lifestyle and health factors were similar between groups.

Conclusions: Greater BMC and more favourable bone properties at the distal tibia were observed in the FEW compared with basic combat trainees, supplementing previous findings of exceptional body composition of women graduating from elite combat leadership courses. Considering the prevalence of BSI in female warfighters, further study is warranted to determine how bone status affects probability of course success.

Introduction: Musculoskeletal injuries (MSKIs) are a leading cause of medical downgrades and reduced operational effectiveness in the UK military. Initial military training presents a high-risk period for sustaining MSKI but also provides an important opportunity for promoting positive health-related behaviours to mitigate future MSKI risk. Self-determination theory suggests that environments supporting basic psychological needs of autonomy, competence and relatedness can foster intrinsic motivation regulation and positive health-related behaviours. However, this link between environment and behaviour remains underexplored in military populations.

Methods: Weight-related health risk (determined from individual body weight, height and waist circumference) and health behaviours (relative to the Defence Health Behaviour Index) were assessed in 1591 Royal Navy participants (15.6% females; age range 16-61 years), comprising 941 recruits, 190 officer cadets and 460 trained personnel. Participants also completed the Work Behaviour Regulation Questionnaire and Basic Psychological Need Satisfaction and Frustration Scale. Linear regression and Multivariate Analysis of Covariance were used to explore relationships and group differences.

Results: Supporting basic psychological needs in the workplace was positively associated with autonomous motivation (p<0.002), which was also associated with more favourable health behaviours (β=0.119, p<0.001). Frustrating psychological needs were associated with controlled motivation (p<0.001) and poorer health behaviours (β=0.082, p=0.006). Trained personnel reported higher weight-related ill-health risk, poorer health behaviours and greater psychological need frustration than trainees (p<0.001). Recruit trainees had the highest psychological need satisfaction but also the greatest introjected and external motivation regulations (driven by internal pressures or external rewards). Female and trained personnel exhibited greater weight-related ill-health risk (OR=0.51, p<0.001).

Conclusions: The data suggest that creating need-supportive military environments fosters autonomous motivation-promoting positive health-related behaviours. Establishing need-supportive environments during early-career phases could improve effectiveness in supporting positive health behaviours and mitigating MSKI risk.

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.