Bmj Military Health最新文献

Background: In the UK, there have been multiple waves of COVID-19, with a five-tier alert system created to describe the transmission rate and appropriate restrictions. While acute mortality decreased, there continued to be a significant morbidity, with individuals suffering from persistent, life-restricting symptoms for months to years afterwards. A remote rehabilitation tool was created at the Defence Medical Rehabilitation Centre (DMRC) Stanford Hall to assess post-COVID-19 symptoms and their impact on the UK military.This study aims to understand changes in post-COVID-19 syndrome between wave 1 and wave 2, identify interactions between alert level and symptoms and investigate any predictive nature of acute symptoms for postacute symptomology in a young, physically active population.

Methods: Cross-sectional study of 458 consecutive remote rehabilitation assessments performed at DMRC Stanford Hall between 2 April 2020 and 29 July 2021. Consultations were coded, anonymised, and statistical analysis was performed to determine associations between acute and postacute symptoms, and between symptoms, alert levels and waves.

Results: 435 assessments were eligible; 174 in wave 1 and 261 in wave 2. Post-COVID-19 syndrome prevalence reduced from 43% to 2% between the waves. Acutely, widespread pain was more prevalent in wave 2 (p<0.001). Postacutely, there was increased anxiety (p=0.10) in wave 1 and increased sleep disturbance (p<0.001), memory/concentration issues (p<0.001) and shortness of breath/cough (p=0.017) in wave 2. Increasing alert level was associated with increased postacute symptom prevalence (p=0.046), with sleep disturbance increasing at higher alert level (p=0.016). Acute symptoms, including fatigue, sleep disturbance and myalgia, were associated with multiple postacute symptoms.

Conclusions: This study reports the overall prevalence and symptom burden in the UK military in the first two waves of COVID-19. By reporting differences in COVID-19 in different waves and alert level, this study highlights the importance of careful assessment and contextual understanding of acute and postacute illnesses for individual management plans.

Since the February 2022 Russian invasion of Ukraine, the prospect of an Article 5 North Atlantic Treaty Organisation collective defence operation in Europe has increased significantly. Were this type of operation to occur, it would present different challenges to the Defence Medical Services (DMS) than those of the era of the International Security Assistance Force in Afghanistan, where air superiority was assured, and combat casualty numbers did not approach the tens of thousands experienced by Russia and Ukraine in the first months following the invasion. This essay examines how the DMS could prepare for such an operation using four key themes: preparing for prolonged field care, training medical personnel for combat, recruiting and retaining medical personnel and planning for post-traumatic stress disorder.

Introduction: The high prevalence of occipital ulcers in UK military casualties observed during the conflict in Afghanistan is a multifactorial phenomenon. However, the consensus is that ulceration is triggered by excessive pressure that is maintained for too long during the use of the general service military stretcher. Thresholds for capillary occlusion are accepted benchmarks to define excessive pressure, but similar thresholds for safe/excessive duration of pressure application do not exist. To address this gap in knowledge, we propose to use the time it takes for a healthy person to feel pain at the back of the head as an initial indication of safe exposure to pressure.

Methods: Healthy military personnel (16 male/10 female) were asked to lie motionless on a typical general service stretcher until they felt pain. Time-to-pain and the location of pain were recorded. To support the interpretation of results, baseline sensitivity to pain and pressure distribution at the back of the head were also measured. Independent samples t-test was used to assess differences between genders.

Results: Twenty participants felt pressure-induced soft-tissue pain at the back of the head. The remaining six participants terminated the test due to musculoskeletal pain caused by poor ergonomic positioning. On average, pain at the occiput developed after 31 min (±14 min). Female participants were significantly more sensitive to pain (t(24)=3.038,p=0.006), but time-to-pain did not differ significantly between genders (p>0.05).

Conclusions: When people lie motionless on a typical military stretcher, the back of the head is the first area of the body that becomes painful due to pressure. The fact that pain develops in ≈30 min can help healthcare providers decide how frequently to reposition their patients who are unable to do this on their own. More research is still needed to directly link time-to-pain with time-to-injury.

There are many similarities in symptoms between postviral conditions, including clinical features such as fatigue, reduced daily activity and postexertional symptom exacerbation. Unfavourable responses to exercise have influenced the wider debate on how to reintegrate physical activity (PA) and exercise while simultaneously managing symptoms during recovery from post-COVID-19 syndrome (or Long COVID). This has resulted in inconsistent advice from the scientific and clinical rehabilitation community on how and when to resume PA and exercise following COVID-19 illness. This article provides commentary on the following topics: (1) controversies surrounding graded exercise therapy as a treatment modality for post-COVID-19 rehabilitation; (2) evidence supporting PA promotion, resistance exercise and cardiorespiratory fitness for population health, and the consequences of physical inactivity in patients with complex rehabilitation needs; (3) population-based challenges for UK Defence Rehabilitation practitioners for the management of postviral conditions; and (4) 'symptom guided PA and exercise rehabilitation' as an appropriate treatment option for managing individuals with multifaceted medical needs.

Introduction: Medial tibial stress syndrome (MTSS) is common in the Armed Forces due to the physical demands placed on service personnel (SP). There are no large studies reporting the extent to which MTSS affects the Armed Forces. A retrospective cross-sectional study design was used to report the annual prevalence of MTSS in the British Armed Forces and in training units and healthcare utilisation.

Methods: Secondary data were sourced from the electronic medical records for all SP with MTSS (20 257) between 1 January 2010 and 31 December 2018. Prevalence was calculated annually across the Armed Forces and in recruits. Healthcare utilisation (number of contacts and days under the care of a healthcare professional) was reported according to characteristics of SP (sex, age, ethnicity, service branch, body composition measurement and medical discharge).

Results: Over 9 years, 20 257 SP were seen for MTSS. Prevalence of MTSS decreased across the Armed Forces, from 2.19% (95% CI 2.12 to 2.26) in 2013 to 1.61% (95% CI 1.55 to 1.68) in 2018. The prevalence of MTSS was 2.7 times higher in recruits, affecting 4.34% (95% CI 4.00 to 4.69) in 2018. In 2018, the prevalence in female recruits was over four times higher (7.03%, 95% CI 5.74 to 8.32) than trained female SP (1.60%, 95% CI 1.39 to 1.81) and higher than male recruits (4%, 95% CI 3.65 to 4.35). Comparing service branches, royal marines had the least healthcare input (median contacts (IQR): 3 (1-7.5)) over the least number of days (median days (IQR): 17 (0-154)), with the royal air force receiving the most (median contacts (IQR): 5 (2-13)) over the greatest number of days (median days (IQR): 76 (4-349)).

Conclusion: The prevalence of MTSS has reduced; however, it remains high in subsections of the Armed Forces, particularly in female recruits. There is a large variation in the amount and duration of healthcare input SP received for MTSS.

The evolving landscape of battlefield medicine forces medical planners to prepare for large-scale combat operations (LSCO) against peer adversaries, requiring reassessment of recent medical strategies. Despite lacking medical backing, the term 'golden day' has been used by senior military leaders to link the resuscitative benefits of the 'golden hour' to prolonged medical care through similar nomenclature. Pseudomedical terminology can easily enter the lexicon of commanders as attractive soundbites. However, articulating the evidence-based factors influencing mortality on the battlefield is critical to effectively articulate risk to commanders. The challenges of LSCO will be significant with increased casualty numbers and treatment constraints. Realistic medical and operational planning is critical to maximising survival, with a clear understanding of what can and cannot be achieved. Recent improvements in trauma care, such as early haemorrhage control, advanced prehospital care and rapid evacuation to surgical care, have significantly reduced mortality rates. Given the predictability of when casualties die from significant injuries, the absence of timely clinical interventions will increase avoidable battlefield deaths. If evacuation to surgical care is extended to 24 hours, many more casualties will die from potentially survivable injuries. Medical planners must recognise the potential challenges associated with LSCO including contested, delayed evacuation which predicts a tripling of mortality rates from 10% to 30%. Leaders must appreciate the unchanging human physiologic response to injury and historical combat casualty statistics when preparing commanders and politicians for the excess in mortality during LSCO. Without candour, plans will be unrealistic, causing non-medical leaders and the public to be unprepared.

The number of in-water mass casualty incidents has increased in recent years and provides significant challenges to rescuers. Existing triage systems require the rescue of immersed (in water) casualties before triage is undertaken. A tool that enables triage to be undertaken before rescue, and therefore the prioritisation of that rescue, should improve the efficiency, efficacy and survival rate associated with the management of such incidents.In this paper, we describe the rationale and development of a proposed novel 'in-water mass casualty triage tool (IWMCTT)' to assist in the swift and effective triage of those in the water in mass casualty situations before they are rescued, based upon the likelihood of survival after immersion. The tool is based on a review of the literature related to the hazards associated with immersion, most notably drowning.The IWMCTT employs a sequential approach to streamline the identification and prioritisation for rescue of immersed individuals; it considers factors such as hazards, visibility constraints, purposeful swimming, moving or floating, airway position, availability of flotation assistance and flotation device effectiveness. It categorises casualties from W1 (high) to W4 (low) priority for rescue.The proposed IWMCTT offers a potential solution to some of the challenges faced during water-based mass casualty incidents; providing rescue assets (rigid-hulled, inflatable boats, ships and helicopters) with a rapid and effective approach to assess and prioritise individuals for rescue and medical attention, hopefully thereby reducing mortality and morbidity. The IWMCTT requires further evaluation and validation.

Background: Despite robust reports in the literature concerning the effect of exposure to combat on mental health, there is a paucity of studies in the Nigerian Air Force (NAF) using a longitudinal design. This study was designed to determine the incidence of mental disorders among a cohort of NAF personnel exposed to combat and highlight its association with psychosocio-religious variables.

Methods: It was a follow-up study using a total population sampling in which all the 290 deployed personnel participated. Data was collected at two intervals: Baseline and 6 months after with sociodemographic questionnaire, Brief Coping Orientation to Problems Experienced Inventory, the Brief Religious Coping, the Oslo Social Support Scale and the Big Five Inventory, General Health Questionnaire (GHQ-12) and the Mini-International Neuropsychiatric Interview (MINI-Plus). A two-staged process involving screening with the GHQ and a further diagnostic interview using MINI-Plus for participants with a GHQ score of 2 and above.

Results: The incidence of any mental disorder was 243.1 per 1000 person-years. The top three priority conditions were: Substance use disorder (94.1 per 1000 person-years), major depressive disorder (43.8 per 1000 person-years) and post-traumatic stress disorder (PTSD) (41.6 per 1000 person-years). Being deployed in early adulthood was a risk factor for developing a mental illness (adjusted OR (AOR), (95% CI): 2.89, (1.28, 6.50), p=0.01) while longer duration in the military service was a protective factor (AOR, (95% CI): 0.95, (0.91, 0.99), p=0.03). Social support, personality traits, religious coping and other coping strategies did not significantly predict mental disorders in this population (p>0.05).

Conclusion: The incidence of any mental disorder among NAF personnel exposed to combat was huge. The three top priority conditions were substance use disorder, major depressive disorder and PTSD. These findings are useful in identifying priority conditions for interventions in the NAF population.