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.

The human gut microbiome can be impacted by a range of environmental and lifestyle factors including diet, antibiotics, physical fitness and acute and chronic stressors. There is also evidence to suggest that specific compositional and/or functional features of the gut microbiome are mediators of aspects of health and performance including disease susceptibility, cognitive and physical states and the immune response. Therefore, understanding microbe-to-microbe and nutrient-to-microbe interactions in the gut and how they interact with host biology (eg, via the gut-brain axis) could enable better design of interventions aimed at modulating the gut microbiome to improve the health and performance of the military. Accordingly, this review summarises a thematic session hosted at the 6th International Conference on Soldier Physical Performance which provided an overview of military-relevant research related to the gut microbiome. It articulates a timely opportunity to leverage this rapidly advancing area to improve personnel health and military performance.

Introduction: Military personnel must manage a multitude of competing physiological and cognitive stressors while maintaining high levels of performance. Quantifying the external workload and cognitive demands of tactical military field exercises closely simulating operational environments, will provide a better understanding of stressors placed on personnel to inform evidence-based interventions.

Methods: Thirty-one soldiers completing a dismounted 48 hours tactical field exercise, participated in the study. External workload was quantified using a wrist-worn triaxial accelerometer, with cognitive function (Go-/No-Go, N-back, psychomotor vigilance task and subjective workload ratings (NASA-TLX) assessed pre-exercise, mid-exercise and postexercise. Physical activity was described using Euclidian Norm Minus One (mg), with moderate vigorous physical activity (MVPA) and sedentary light physical activity (SLPA) as ≥ or <113 mg, respectively. Changes in general cognitive performance (total accuracy-speed trade-off (ASTO) % change) and function outcome variables (overall mean reaction time, ASTO and number of correct and missed responses) were calculated for each assessment from pre-exercise, to mid-exercise and postexercise.

Results: For the exercise duration (50:12±02:06 hh:mm) participants spent more time completing SLPA compared with MVPA (1932±234 vs 1074±194 min; p<0.001), equating to 33% of the time spent completing MVPA. Overall cognitive performance decreased over the exercise (pre-to-post: -249). However, the largest decrement was observed pre-to-mid (-168). Perceived mental demand associated with the cognitive assessments significantly increased over the duration of the exercise (pre-: 33; mid-: 38 and post-: 51; χ² _F(2) = 26.7, p = <0.001, W=0.477) which could suggest that participants were able to attenuate a further decline in cognitive performance by investing more effort/mental resources when completing assessments.

Conclusion: The study successfully quantified the physical activity, and subsequent impact on cognitive function, in soldiers completing a 48 hours tactical field exercise. Further research is needed to better understand how physiological stressors interact with cognitive function during military operations.

Defence Engagement (DE) has been a core UK Defence task since 2015. DE (Health) is the use of military medical capabilities to achieve DE effects within the health sector to achieve security and defence objectives. DE (Health) practitioners must understand the underlying defence context that shapes these objectives. The strategic context is becoming more uncertain with the return of great power competition layered on enduring threats from non-state actors and transnational challenges. The UK response has been to develop the Integrated Review, outlining four national security and international policy objectives. UK Defence has responded by developing the integrated operating concept, differentiating military activity between operating and warfighting. Engage is one of the three functions of operate activity, which is complementary to the other operate functions of protect and constrain. DE (Health) can play a unique role in engagement, given its ability to develop new partnerships through health-related activity. DE (Health) may be an enabler for other engagements or to enable the protect and constrain functions. This will be dependent on delivering improvement in health outcomes. Therefore, the DE (Health) practitioner must be conversant with both the contemporary defence and global health contexts to deliver effective DE (Health) activities. This is an article commissioned for the DE special issue of BMJ Military Health.

Global health practice is becoming a key enabler within UK Defence and foreign policy. The definition of global health remains debated, though some important themes have been identified including: the multidisciplinary nature of global health, its ethical foundation and the political nature of global health. This paper contributes to the ongoing rational discourse that this important discipline deserves and recommends a framework and principles to apply to military health and care system strengthening in the Defence Engagement (Health) (DE(H)) practitioner role. DE(H) involves complex multiorganisational relationships and processes, and while practitioners should be mindful of the political nature of their role, the broad aims of preventing conflict and building stability mean DE(H) should contribute positively to global health.This paper forms part of a special issue of BMJ Military Health dedicated to Defence Engagement.

Global Health Engagement is one method employed by the Australian Defence Force (ADF) in pursuit of its objectives to shape Australia's strategic environment and to deter actions against Australia's interests. Two recent examples of such engagements are malaria mitigation programmes led by the ADF Malaria and Infectious Disease Institute in partnership with the Vietnam People's Army and the Papua New Guinea Defence Force. Both programmes were designed with extensive collaboration with host nation stakeholders, empowered local institutions and governance systems, built the capacity of the host nation with the aim of achieving independence from Australian support and met the strategic policy requirements of all nations involved. Process and outcome measures were built into both programmes, providing partner nations with the necessary assurance that funding was being used effectively. The long-term nature of each programme engendered personal trust between individuals and cultural understanding between military units. Recognising the value of formal education in the design and conduct of such programmes, ADF officers participate as students and instructors in the US Uniformed University of the Health Sciences course in Global Health and Global Health Engagement. Critically, this educational opportunity is afforded to future leaders in all professions related to health, including clinicians, military health planners and commanders. While an essential prerequisite to Global Health Engagement Programmes is their technical viability and validity, the most important key to success in the military context is a widespread understanding of how they achieve desired strategic effects for all involved.

Introduction: Defence Medical Services personnel regularly deploy overseas to deliver training activities as part of defence engagement (DE) to positively influence partners and others. There remains scope for medical planners to enhance our understanding of how to optimally use medical staff and assets for DE. We aimed to develop a tool to improve planning for DE activities delivering first aid training.

Methods: We used nominal group technique to conduct a focus group with UK experts in planning first aid training DE activities to identify and prioritise important planning considerations within a conceptual framework based on the Defence Lines of Development. We validated and refined this framework with international experts from partner nation militaries to help strengthen the final planning tool.

Results: We developed a detailed tool covering training curriculum and logistical and infrastructure requirements to deliver safe and effective DE training activities. First aid training engagement priorities include being tailored to the training audience and in harmony with the national or military healthcare services of that country. Messaging around the women, peace and security agenda should be integrated into training packages at conception to be effective.

Conclusions: We propose a planning tool to aid in designing first aid training that considers the necessary components to support meaningful education and effective engagement in support of UK's strategic goals. We welcome the use of and feedback on this tool and its impact to those planning first aid training activities as part of DE operations.

The 2014 West Africa Ebola virus disease outbreak prompted the deployment to Sierra Leone of non-governmental organisations and the UK Joint Inter-Agency Taskforce including personnel from the UK Defence Medical Services (DMS). Some of these military personnel partnered with the Republic of Sierra Leone Armed Forces (RSLAF) as an example of Defence Healthcare Engagement (DHE).UK DMS mentors assisted RSLAF to plan and upscale Ebola treatment units. Use of military analysis and planning tools facilitated robust and flexible plans to be produced while under significant time and resource constraints. Macrosimulation exercises enabled large numbers to be trained and standard operating procedures to be developed.Fundamental to success was a mutual respect between the DHE partners while maintaining host nation primacy throughout. DHE in this example offered advantages over non-governmental organisations. Transferable lessons for future DHE from the RSLAF-UK DMS partnership are described in this paper.

Militaries have an important and inevitable role in global health and will interface with existing health systems on deployments. While the primary concern of militaries is not global health, there are clear, and increasingly frequent, circumstances when global health activities align with the interests of defence. Recognising this link between global health and security warrants thoughtful consideration and action where concerns affecting both intersect. In addition to providing medical support to military personnel on operations, advantageous effects can be achieved directly from military medical activities as part of Defence Engagement. While there are limitations and ethical boundaries to the role of militaries in global health, further training, research and conceptual development are warranted to optimise military medical activity at the intersection of security and global health to deliver advantageous effects. This paper forms part of a special issue of BMJ Military Health dedicated to Defence Engagement.