Bmj Military Health最新文献

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.

Introduction: Musculoskeletal injury is one of the leading causes of medical discharge in the UK Armed Forces. Residential rehabilitation (RR) courses are part of Defence rehabilitation, for service personnel (SP) who do not respond to treatment at primary care. Historically, it was delivered as a 3-week block model. As a quality improvement project, rolling admissions were introduced aiming to improve access to RR and deliver outcomes that met the requirements of primary care referrers.

Method: Clinical outcomes were assessed for SP with either spinal or lower limb pathology using the Musculoskeletal Health Questionnaire (MSK-HQ) on course admission and discharge and the Medical Deployment Standard (MDS) on admission and 6 months post course. Wait times were also recorded. Outcomes were compared with the block admission using retrospective audit data. Referrer feedback was gathered using a questionnaire pre introduction and post introduction of rolling admissions.

Results: Rolling admissions reduced course wait times from an average of 55 days to 19 days. Of SP who attended a rolling admission course with spinal pathology (n=23), 58% showed an increase in MDS, 65% showed an increase of the minimally important change in MSK-HQ. With lower limb pathology (n=35) 57% increased MDS, 49% increased MSK-HQ. For the block model, of those with spinal pathology (n=30) 43% increased MDS, 67% increased MSK-HQ, with lower limb pathology (n=30) 60% increased MDS, 33% increased MSK-HQ. Referrer feedback improved with rolling admissions with feedback most positive in relation to the model's responsiveness for admitting SP onto the course.

Conclusion: Rolling admission provided similar clinical outcomes as the previous block model in a shorter time frame with lower wait times and better met the needs of referrers. Future study recommendations include longer term follow-up and looking at alternative ways to measure the success of RR within the care pathway.

While there are women represented in some notable positions within the UK Defence Medical Services (DMS), the challenges and barriers to successful female progression have not disappeared. The DMS needs highly talented, motivated doctors working to support operations, yet we struggle to recruit and retain female personnel. This is in clear contrast to the increased proportion of female personnel working within the civilian medical workforce.This article seeks to communicate this problem, illustrated by the lived experiences of DMS female doctors, by exploring the six gender bias barriers ('Glass Walls') that hold women back in the workplace.Cultural change requires a determined effort, driven persistently from the top and at every level of leadership and management. The first step requires recognition and acceptance of the problem. Progress is likely to be slow, or fail, if driven by the female minority alone. While the DMS remains a majority-male organisation, male allies are pivotal in advocating for their female colleagues, to promote change, in an effort to recruit and retain talented individuals.

Introduction: Discrepancies exist in findings on how varying body mass index (BMI) levels impact physical training-related injuries across different studies. This systematic review and meta-analysis aimed to evaluate the relationship between BMI and physical training-related injuries both qualitatively and quantitatively.

Methods: A comprehensive search of the MEDLINE, Cochrane and EMBASE databases was performed. The study selection followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic review and meta-analysis were conducted using weighted data and a random-effects model. Subgroup analyses were based on gender and military service branches. Heterogeneity among the studies was assessed through the I² statistic, indicating the proportion of total variation in effect size estimates. Funnel plots and Egger's test were employed to assess publication bias.

Results: 33 studies were included in the analysis, with abnormal BMI (underweight, overweight and obesity) identified as a clear risk factor for training-related injuries (overall RR=1.21, 95% CI 1.15 to 1.27; male RR=1.16, 95% CI 1.08 to 1.23; female RR=1.05, 95% CI 1.02 to 1.09). No significant heterogeneity was observed among navy, army and air force personnel (p=0.58), although abnormal BMI remained a notable risk factor in both the army and air force. Meta-regression analysis indicated that the lowest injury risk occurred at a BMI of 23 kg/m². Obese individuals under the age of 27 and underweight individuals over the age of 27 were at high risk. Additionally, the highest injury risk was observed during the first 5 months of military training, with a gradual decline in subsequent months, stabilising by the 12th month.

Conclusion: Findings suggest that abnormal BMI increases the risk of training injuries among military personnel and that this risk varies with age and the duration of training. Emphasis should be placed on risk prevention in the early stages of military training and on enhanced protection for high-risk populations.

The invasion of Ukraine by the Russian Federation in February 2022 has witnessed the first peer-on-peer full-scale European conflict since World War 2. We have noted that the vast majority of injuries affect the extremities. Within that group, injuries to the joints pose a huge clinical challenge. Specifically, 17.1% of all gunshot injuries (GSWs) involved the joints, which represents 22.3% of all limb injuries. 55.6% of all GSW to the joints involved the knee; 10% had a concomitant vascular injury and 15%-20% had a nerve injury.The surgical management of ballistic knee injuries includes initial damage control surgery with debridement of non-vitalised tissue, vascular reconstruction and fasciotomies where necessary, with stabilisation of bone injury with a spanning external fixator. Following repatriation to Role 4 facilities, staged reconstruction is performed with cement spacers followed by autograft, endoprosthesis or arthrodesis. Where reconstruction is not possible, above-knee amputation remains an option.In this paper, based on the analysis of 33 cases, we describe the Ukrainian early experience of the management of gunshot wounds to the knee joint with three clinical case studies as representative examples.

Proteins control individual patient's response to pharmaceutical medication, be they receptors, transporters or enzymes. These proteins are under the control of genes. The study of these genes and the interplay between multiple genes is pharmacogenomics, with individual genes being termed pharmacogenes. The greatest understanding of pharmacogenetics is of the drug metabolising enzymes, the cytochrome P450s. Almost the entire UK population is likely to have at least one genetic variant that controls these P450s and thus the phenotype for metabolic competence. This means two patients receiving the same medication and dose may have very different responses, from adverse reaction to being ineffective. An individual military person's response to medications can be predicted from their pharmacogenetics, as an example; the response to the commonly prescribed 'pain killers', codeine, tramadol, hydrocodone or oxycodone. These opioids are metabolised into their active forms by the cytochrome 2D6. Four phenotypes classify an individual's metabolic competency: ultra-rapid, extensive, intermediate or poor. A poor metaboliser is at risk of ineffective pain relief from one of the opioids listed, whereas an ultra-rapid metaboliser is at risk of overexposure and subsequent dependency or abuse. In white European populations, the prevalence of the phenotypes is well known and may be used to guide prescribing; however, in other populations such as Nepalese or Pacific Islander the distribution of these phenotypes is unknown. Genotyping provides a framework for the precise treatment of patients and cost-effective use of medication for the UK Armed Forces, as well as potentially providing equity for minority groups.

Introduction: Antarctic expeditions present exceptional physiological and mental challenges. Research data are lacking on psychological aspects of such endeavours. The aim of our study is to provide data on changes in mood, well-being, personality traits and personal experiences during an Antarctica crossing.

Methods: This is a study of a 33-year-old female British Army officer (height 175 cm; weight 75 kg; body mass index 24.49 kg/m²; VO_2max 49 mL/kg/min) who completed the longest, solo, unsupported, one-way polar ski expedition. The expedition started at Hercules Inlet and finished at Ross Ice Shelf, lasting 70 days and 16 hours covering 1484.53 km, with temperatures estimating from -12°C to -50°C and wind speeds of up to 60 miles per hour. The adventurer pulled all equipment and nutrition in a pulk (sled), weighing approximately 120 kg. Five psychometric questionnaires were completed pre post and during the expedition, including the International Personality Item Pool - Neuroticism, Extraversion and Openness-60, Brief Assessment of Mood, Positive and Negative Affective Schedule, Profile of Mood States, Wellness questionnaire, as well as an unstructured open questionnaire.

Results: Mood generally deteriorated, particularly positive affective mood. Scores for fatigue and muscle soreness increased, with a reduction in sleep times. Personality traits of openness, agreeableness, and conscientiousness remained stable throughout the expedition, with some reduction in extraversion and an increase in neuroticism. Personal accounts give a unique insight into the increasing demands on the mental and physical impact of the expedition.

Conclusions: Meticulous preparation and planning may have led to a successful expedition, including physical preparation, prior on-field experience, and psychological preparedness and resiliance. Some of these strategies may be applicable to a range of settings, including future Antarctic expeditions, expeditions in extreme environments, or missions within a military context.