Military Medicine最新文献

{"title":"Educational Interventions to Improve Preparedness for Mass Casualty Incidents and Armed Conflict: A Systematic Review.","authors":"Lars Veldhuis, Joris Verbeek, Mehmet Kaya, Jessica Lantinga, Caspar Muller, Michiel Verhofstad","doi":"10.1093/milmed/usag492","DOIUrl":"https://doi.org/10.1093/milmed/usag492","url":null,"abstract":"<p><strong>Background: </strong>Mass casualty incidents (MCIs), terrorist attacks, and armed conflicts place significant demands on healthcare systems and require rapid triage, effective teamwork, and life-saving interventions under resource-limited conditions. Training and educational programs are widely implemented to improve disaster preparedness among healthcare providers, but the measurable effectiveness of these interventions remains unclear. This systematic review aimed to evaluate the effectiveness of educational interventions on measurable preparedness outcomes among healthcare professionals.</p><p><strong>Materials and methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines. Medline (Ovid), Embase, Web of Science Core Collection, Cochrane CENTRAL, and Google Scholar were used. Studies evaluating pre- and post-intervention outcomes following educational or training interventions for MCIs or war-related scenarios were included. Outcomes of interest included knowledge, clinical skills performance, and triage accuracy.</p><p><strong>Results: </strong>A total of 1,836 records were identified, of which 42 studies met the inclusion criteria. Most studies used single-group pre-post designs (n = 32, 76%), while 6 were randomized controlled trials (14%) and 4 were controlled non-randomized studies (10%). Educational interventions included course-based training, simulation-based training, e-learning, and blended learning approaches. The majority of studies reported significant improvements in knowledge (14/15 studies), hands-on clinical skills (13/14 studies), and triage performance (6/7 studies) following training. Only 4 studies assessed long-term retention.</p><p><strong>Conclusion: </strong>Educational interventions improve preparedness for mass casualty incidents and war-related scenarios. Simulation-based and multidisciplinary training appear most effective. However, the certainty of evidence quality remains limited. Preparedness should therefore be viewed as a continuous process requiring repeated training, objective evaluation, and stronger civil-military collaboration.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149245271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Panama's Infectious Disease Legacy: Implications for Renewed Military Cooperation and Force Health Protection.","authors":"Baxter R Murray, John L Kiley, Ryan B Liberg","doi":"10.1093/milmed/usag495","DOIUrl":"https://doi.org/10.1093/milmed/usag495","url":null,"abstract":"<p><p>Tropical infectious disease is a recurrent threat to Force Health Protection throughout the U.S. military presence in Panama. This article recounts some of the notable contributions of the U.S. military in the discovery, treatment, and prevention of infectious diseases in hopes of informing future risk assessment and mitigation.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149245265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Accountability Exceeds Agency: Executive Moral Injury and Organizational Fragility in Healthcare Leadership.","authors":"Brian F Turner","doi":"10.1093/milmed/usag485","DOIUrl":"https://doi.org/10.1093/milmed/usag485","url":null,"abstract":"<p><p>Moral injury in healthcare is most often discussed in relation to clinicians, but healthcare executives may also experience morally significant distress when they remain accountable for organizational outcomes without sufficient agency, information, trust, or voice. This commentary introduces accountability without agency as a potential pathway to executive moral injury. Drawing on scholarship on moral injury, moral distress, psychological safety, and organizational conditions, it examines how suppressed candor, routine bypassing of accountable executives, and persistent centralization of decision-making can harm leaders and weaken organizational coordination and resilience. Although evidence specific to healthcare executives remains limited, research among healthcare workers demonstrates that moral conflict can have consequences beyond occupational dissatisfaction. The commentary concludes that healthcare organizations can reduce these risks by aligning responsibility with decision rights, protecting executive voice, distributing strategic context, and developing leaders capable of exercising judgment in service of the mission.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149245319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptoms, Sensorimotor Function, and Recovery Time Following Law Enforcement Combatives.","authors":"Nathan A Edwards, James A Onate, Gregory C Edwards, Carly R Smith, Enora Le Flao, Joshua A Hagen, Joshua Walters, Scott Paur, Jaclyn B Caccese","doi":"10.1093/milmed/usag484","DOIUrl":"https://doi.org/10.1093/milmed/usag484","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Law enforcement cadets (LECs) complete training that prepares them for the hardest parts of their job. Subsequently, this training can involve possible head impacts (i.e., head acceleration events [HAEs]). There is limited information regarding the effect of these HAEs on acute sensorimotor function or methods that can attenuate the negative consequences of HAEs sustained in training. To fill these gaps, we conducted 2 sequential experiments. Experiment 1 examined the effects of HAEs on symptoms and sensorimotor function in LECs undergoing defensive tactics training. Experiment 2 evaluated the effect of including additional recovery time between boxing training days on reported symptomology of LECs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;For Experiment 1, 29 LECs from a local sheriff's office corrections academy participated in the study (6 women and 23 men; age: 29 ± 8 years). Participants reported concussion-related symptoms and completed sensorimotor assessments before (PRE) and after (POST) 2 training sessions: (1) a defensive tactics assessment (DTA) involving hand-to-hand combat with possible HAEs and (2) a physical abilities test (PAT) without possible HAEs. Sensorimotor assessments included visual-motor reaction time, postural control, timed up-and-go, and countermovement jumps. During DTA, LECs wore instrumented mouthguards to quantify HAE exposure. Generalized estimating equations were used to evaluate changes in outcomes from PRE to POST between the DTA and PAT. Multiple linear regressions examined the association between HAE frequency and magnitude and sensorimotor function changes (ρ ≤ 0.01). For Experiment 2, LECs were recruited from 2 consecutive academy cohorts. Cohort 1 (33 LECs, 6 women and 27 men; age: 29 ± 8 years) completed boxing training on 3 consecutive days, culminating in a boxing tournament on Day 3. Cohort 2 (11 LECs, all men; age: 29 ± 11 years) completed a modified schedule that included 3 days of recovery before the boxing tournament. Generalized estimating equations were used to evaluate the cohort-by-time interaction for total symptom number and severity (ρ ≤ 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In Experiment 1, exposure to HAEs did not affect sensorimotor function. However, the number of symptoms significantly increased from PRE (median = 1, interquartile range [IQR] = 1-3) to POST (median = 3, IQR = 3-5) for DTA but not for PAT (PRE median = 1, IQR = 1-5; POST median = 1 IQR = 1-3) (P = .003). No significant associations were observed between HAEs and sensorimotor outcomes. In Experiment 2, there was a significant increase in symptom number and severity following the boxing tournament for LECs in Cohort 1 (P &lt; .001) but not Cohort 2 (P = .461-0.931).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Exposure to HAEs during law enforcement training did not significantly impair sensorimotor function; however, symptoms did increase. Symptom increases could be attenuated by providing add","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149245283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Laser Vision Correction on Readiness and Operational Performance Among Active Duty Service Members.","authors":"Karina Bostwick, Paramjit K Bhullar, Charisma B Evangelista, Toan M Trinh, Sergei Turovets, Jin B Ha, José E Capó-Aponte","doi":"10.1093/milmed/usag481","DOIUrl":"https://doi.org/10.1093/milmed/usag481","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Optimal visual performance is essential for modern military operations. Traditional forms of vision correction, including spectacles and contact lenses, may present operational limitations during deployment or field training. The Department of Defense established the Warfighter Refractive Eye Surgery Program (WRESP) to provide laser vision correction (LVC) to improve operational readiness by reducing reliance on corrective eyewear among active duty service members (ADSM). This study evaluated ADSMs' perceptions of overall satisfaction, visual outcomes, operational performance, and military readiness following LVC performed at the Joint Base San Antonio (JBSA)-Lackland, Joint Warfighter Refractive Surgery Center (JWRSC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A cross-sectional electronic survey was distributed to ADSM who underwent LVC at the JBSA-Lackland JWRSC between January 1, 2023, and December 31, 2025. The survey link remained active for 2 weeks. Survey domains included perceived visual outcomes, operational performance, confidence in military duties, nighttime operations, marksmanship, and overall satisfaction after laser vision correction. Inferential statistics, including Pearson's Chi-square tests and multivariable logistic regression, were utilized to compare perceived outcomes across surgical cohorts and identify potential predictors of reported performance declines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 1,971 successfully delivered survey invitations, 1,206 ADSM responded. Uncorrected distance vision improved in 99.00% of respondents, with no significant difference among procedures (P = .806). Overall satisfaction was also exceptionally high at 97.34%, which was statistically comparable across PRK (97.4%), LASIK (97.4%), and SMILE (97.2%) cohorts (P = .791). High rates of self-reported performance improvements were observed across key operational domains, including marksmanship (67.66%), physically demanding activities (78.36%), near-task performance (83.75%), deployment or field exercises performance (78.11%), tactical confidence (93.03%), and, with no significant differences by procedure type (all P &gt; .05). A perceived decline in nighttime operations was reported by only 5.6% of respondents, occurring in 4.7% of PRK (95% CI: 3.6%-7.2%), 6.9% of LASIK (95% CI: 5.5%-11.8%), and 6.2% of SMILE (95% CI: 4.2%-12.7%) recipients (P = .184). In a multivariable logistic regression adjusting for age, sex, rank, and branch, procedure type was not significantly associated with nighttime decline (LASIK vs. PRK: P = .084; SMILE vs. PRK: P = .339). Additionally, 68.2% of respondents reported that LVC positively influenced their decision to remain in the military with no significant differences by procedure type (P = .661).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;LVC is associated with substantial self-reported improvements in visual readiness and operational task performance, with exceptionally high, comparable sa","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Ongoing Utility of Historical Military Photofluorographs-Tools to Identify Fallen US Soldiers From Past Wars as Cross-Validated by DNA and Dental Data in 180 Cases.","authors":"Carl N Stephan, Kristen Grow, Susan S D'Alonzo Jaques, John E Byrd","doi":"10.1093/milmed/usag490","DOIUrl":"https://doi.org/10.1093/milmed/usag490","url":null,"abstract":"<p><strong>Introduction: </strong>Mass chest X-ray formed a routine part of induction processes to the US armed forces in the 1940-1950s for tuberculosis screening. Today, the skeletal structure recorded in these medical miniature films serves to identify these same soldiers. In the US military's accounting/repatriation setting, chest radiograph comparisons have grown to be a primary identification mechanism alongside DNA and dental records. Identifications are now routinely conducted with contributions from miniature radiographic films. This article reviews the miniature radiographic film as an identification tool and provides the first evaluation of findings (180 cases) against gold standards of DNA and dental analyses for the very same cases.</p><p><strong>Materials and methods: </strong>This article reviews both miniature film photofluorographs and the standardized chest radiograph comparison (CXR) protocol employed by the Defense POW/MIA Accounting Agency (DPAA) for identification. Additionally, all DPAA cases (2010-2025) where radiographic CXR resulted in a match result (280) were reviewed for additional DNA and/or dental record findings, providing 180 cases where dual-modality result existed to cross-validation test the radiographic analyses.</p><p><strong>Results: </strong>For 172 DNA cases, there was no instance of disagreement between the chest radiograph result and the independently acquired Armed Forces DNA Identification Laboratory's DNA result. For 8 dental cases reporting a positive match result, the CXR identity finding was identical (both evidence lines identified the same person). To be conservative, we assume that the next future CXR case to be conducted using miniature films will yield an erroneous result, thereby setting a positive predictive value for radiographic comparison of 99.4% (=180 correct results/181 total decisions).</p><p><strong>Conclusions: </strong>Miniature chest radiographs provide useful identification-relevant information. DPAA casework provides a rare circumstance to evaluate the accuracy of miniature film radiograph comparisons across a large sample, as multiple independent and parallel lines of analysis exist for single cases. Evaluation of these cases (180 in total) reveals that the military miniature films supply the same name associations that DNA and forensic odontology provide. The positive predictive value is high (99.4%), conservatively assuming the next case to be an incorrect one. This confirms the value of the miniature chest film and CXR methods, when DNA and dental records alone are unable to provide definitive answers.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who Is Caring for Male Veterans with Breast Cancer? A National Analysis of Surgical Burden Within the Veterans Health Administration.","authors":"Erin M Bayley, Akiko Chiba, Sarah Colonna, Karen M Goldstein, Kara N Maxwell, Megan Shepherd-Banigan, Michael J Kelley, Haley Moss, Leah L Zullig","doi":"10.1093/milmed/usag483","DOIUrl":"https://doi.org/10.1093/milmed/usag483","url":null,"abstract":"<p><strong>Introduction: </strong>The epidemiology of breast cancer among men is poorly characterized. As the Veterans Health Administration (VA) serves a disproportionally male population, a larger percentage of breast cancer cases diagnosed and treated in VA are among male patients. However, whether current breast oncology operational infrastructure is prepared to address this need is unclear.</p><p><strong>Materials and methods: </strong>The VA Breast and Gynecologic Oncology System of Excellence (BGSoE) established a tracking dashboard for all incident breast and gynecologic malignancies in VA in 2021. All breast surgery cases within the VA performed on male Veterans for an indication of cancer in 2023 were reviewed and mapped by the Veterans Integrated Service Network (VISN). Operative cases performed for gynecomastia were excluded. To determine the total affected population, incidence of male breast cancer was calculated using data from the Surveillance, Epidemiology, and End Results (SEER) database. Breast surgeries, reported as a fraction of incident cases, were plotted. The number of active surgeons performing breast surgery in 2023 was garnered from the staff surgeon identified in the BGSoE dashboard.</p><p><strong>Results: </strong>Based upon SEER age-adjusted estimates of breast cancer in men nationally and current Veteran census data, there were estimated to be 188 incident cases of breast cancer among male Veterans in 2023. In comparison, 82 (44%) male Veterans underwent surgery for their breast cancers in VA in 2023. The median age of the cohort was 72 years (interquartile range 58-78). Geographic variability in surgical volume was noted, with the number of surgeries performed in each VISN ranging from 0 to 13 cases. VISNs performed between 0% and 112% of the expected number of cancer operations for male Veterans. All VISNs had at least 1 surgeon performing breast surgery among this population in 2023 (range: 1-15).</p><p><strong>Conclusions: </strong>There is wide variation in incident cases of breast cancer among male Veterans treated in VA. Whether these geographic differences are reflective of differential incidence, discrepancies in access, or availability of breast oncology health services is unclear. Although most patients with breast cancer do present with resectable disease, the proportion of incident cases among male Veterans by our estimates with stage IV disease (not amenable to surgery) cannot be ascertained. Future work will be aimed at characterizing availability of multidisciplinary breast cancer care in VA.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Informal Caregiving in Australian Veteran Families: Economic Costs, Caregiver Burden, and Health-Related Quality of Life Spillover Effects.","authors":"Tho T H Dang, Jie Hu, Angeli Tabinga, Rebecca Mellor, Haitham Tuffaha, Camila Guindalini, Son H Nghiem, Miranda Van Hooff","doi":"10.1093/milmed/usag461","DOIUrl":"https://doi.org/10.1093/milmed/usag461","url":null,"abstract":"<p><strong>Introduction: </strong>Military service can have substantial spillover effects on family well-being, particularly in households where informal caregiving is required for injured or ill veterans. Despite increasing recognition of the importance of incorporating caregiver and family outcomes into economic and health service evaluations, there is limited empirical evidence quantifying the economic value and impacts of informal caregiving among Australian veteran families. This study aimed to estimate the economic value of caregiving and examine the impact of informal caregiving for injured or ill veterans on caregiver burden and health-related quality of life (HRQoL) in Australian veteran families.</p><p><strong>Materials and methods: </strong>In a national cross-sectional survey, 245 adult veteran caregivers reported demographics, caregiving intensity and burden (Self-Reported Burden Scale [SRB]), HRQoL (Assessment of Quality of Life 8 Dimension [AQoL-8D]), and care recipient health (EQ-5D-5L). Costs of informal care were estimated using the replacement cost method, with varying wage-rate loadings and intensive caregiving thresholds tested for robustness. HRQoL spillovers were assessed as relative (associations between caregiver and care recipient HRQoL using regression) and absolute (differences between veteran caregivers and matched general population caregivers from the Household, Income, and Labour Dynamics in Australia Survey). Sensitivity analyses using different matching techniques tested the robustness of absolute spillover estimates.</p><p><strong>Results: </strong>Caregivers provided a median of 30 hours/week, with a median caregiving duration of 10 years; nearly half reported needing additional support. The caregiver perceived burden was moderate (mean SRB score 5.7). Median weekly replacement costs were AU$1,052, translating to a median total cost of AU$544,895 per caregiver over their respective caregiving durations. Caregiver HRQoL was positively associated with care recipient HRQoL, caregiver age, and caregiver postgraduate education, and negatively associated with caregiver perceived burden and caregiver number of chronic conditions. Compared with general caregivers, veteran caregivers experienced significant HRQoL losses (0.135 QALYs/year; 95% CI: -0.17 to -0.10). Findings were robust in sensitivity analyses.</p><p><strong>Conclusion: </strong>Informal caregiving for injured or ill veterans is associated with substantial economic, caregiving, and HRQoL burdens on family caregivers. Incorporating caregiver outcomes into economic evaluations, service planning, and policy is essential for a more accurate estimate of intervention value and better inform resource allocation decisions across Defence, Veterans' Affairs, and national disability and mental health systems.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colophony Detection in Military Footwear and Its Implications for the Management of Allergic Contact Dermatitis in Soldiers.","authors":"Omer Elazar Avital, Tal Berman, Shlomi Abuhasira, Yigal Chechik","doi":"10.1093/milmed/usag477","DOIUrl":"https://doi.org/10.1093/milmed/usag477","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Allergic contact dermatitis (ACD) of the feet is an occupational problem in military populations and may affect soldiers' ability to meet occupational and operational requirements, particularly in roles requiring prolonged use of standard military footwear. Colophony (rosin) is a recognized contact allergen implicated in shoe dermatitis. In the Israel Defense Forces (IDF), standard-issue military boots are considered colophony-free based on manufacturer declarations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This investigation was conducted as a quality-improvement initiative combined with policy implementation within the IDF Medical Corps. Following a recurring clinical pattern of suspected footwear-related ACD in which colophony sensitization was identified during specialist evaluation, laboratory analyses were performed in June and August 2025 at an independent analytical laboratory. The initial assessment included 2 commonly issued boot pairs. The expanded assessment included 9 boot pairs representing footwear types issued by the IDF at the time of testing and multiple manufacturers. Four samples were obtained from each pair from internal regions selected to correspond to the recurring clinical distribution of dermatitis. Samples underwent solvent extraction, methylation, and quantitative gas chromatographic analysis according to Methods for the Determination of Hazardous Substances (MDHS) 83/3. Before formal footwear testing, a preliminary feasibility assessment was performed to confirm extraction of colophony from the footwear matrix; a full footwear-specific validation was not performed. Individual-level clinical data and case counts were not systematically collected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the initial laboratory assessment, 8 samples were analyzed from 2 boot pairs. Five contained quantifiable colophony concentrations above the limit of quantification (3.0 µg/g), ranging from 4.73 to 12.94 µg/g. One additional sample contained 2.1 µg/g, above the limit of detection but below the limit of quantification, and 2 samples were below the limit of detection (&lt;1 µg/g). In the expanded assessment, all 36 samples from 9 boot pairs were below the limit of detection (&lt;1 µg/g). Clinically, a recurring pattern of dermatitis associated with standard military footwear was observed, including improvement during footwear exemption and recurrence following return to standard boots. Colophony sensitization was identified on patch testing during specialist evaluation. These findings contributed to the development of a structured, stepwise footwear replacement protocol.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Colophony was detected in selected military footwear samples, although this finding was not reproduced in the expanded assessment. In soldiers with suspected footwear-related ACD, laboratory findings should be interpreted in conjunction with clinical history and patch test results. A structured, stepwise manag","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved Hold Time, Unproven Benefit: Reassessing the Cervical Endurance Hold as an Outcome Measure in Fighter Pilots.","authors":"Anthony Acevedo, Zachary Zeigler","doi":"10.1093/milmed/usag486","DOIUrl":"https://doi.org/10.1093/milmed/usag486","url":null,"abstract":"<p><p>Improvements in cervical endurance hold (CEH) time have been used as evidence that training interventions reduce neck pain risk in Air Force fighter pilots. This assumes that a longer hold time reflects a meaningfully lower risk of neck pain in this population, an assumption that remains unvalidated. We examine the reliability and validity evidence for the CEH and argue that its use as a surrogate for training success should be reconsidered. The CEH, known as Grimmer's test, shows strong intra-rater reliability but considerably weaker inter-rater reliability, particularly where test cessation depends on subjective examiner judgment rather than pain or exhaustion. No reliability data exist for this test in fighter pilots specifically. Validity evidence in this population was absent until a 2026 study of Royal Air Force Typhoon pilots found no significant correlation between neck flexor endurance and flight-related neck pain, despite high pain prevalence in the cohort. This is the first direct test of the assumption underlying the test's current use as an outcome measure, and it does not support that assumption. Prior evidence further suggests that neck pain in military pilots is more associated with coronal plane strength than the sagittal plane flexion this test assesses, and evidence that training cervical endurance reduces neck pain incidence remains mixed. An improvement in hold time is weak evidence that an intervention reduced neck pain risk. We recommend that the CEH be reported as a measure of endurance, not a proxy for pain outcomes, with future work evaluating coronal plane and extension-based alternatives.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}