Military Medicine最新文献

{"title":"Letter to the Editor for \"Skin Cancer Incidence Among U.S. Navy and Marine Corps Aviators: A Retrospective Cohort Study\".","authors":"Michael N Passarelli, Paolo Boffetta","doi":"10.1093/milmed/usag450","DOIUrl":"https://doi.org/10.1093/milmed/usag450","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112066","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":"A Scoping Review of Inhaled Methoxyflurane for Acute Traumatic Pain.","authors":"Michael T Le, Joshua J Oliver, Julie A Rizzo, Michael S Patzkowski, Michael D April, Steven G Schauer","doi":"10.1093/milmed/usag446","DOIUrl":"https://doi.org/10.1093/milmed/usag446","url":null,"abstract":"<p><strong>Introduction: </strong>Acute pain after trauma remains a major challenge in emergency department, prehospital, and operational medicine settings. Methoxyflurane, an inhaled anesthetic first developed in the 1960s but later withdrawn due to dose-related nephrotoxicity, has been repurposed internationally at substantially lower sub-anesthetic doses as an analgesic delivered via a compact, hand-held inhaler. This review aims to characterize the available evidence regarding its efficacy, safety, and operational applications for adoption in U.S. civilian and military trauma systems.</p><p><strong>Materials and methods: </strong>A scoping review was conducted using the PRISMA-ScR checklist. PubMed and Google Scholar were used to identify relevant literature from 1960 to 2025. Studies were eligible if they reported on the use of methoxyflurane for acute traumatic pain. Our initial search yielded 31 potential studies, of which 22 met inclusion for this review. Of those, there were 5 systematic reviews, 13 randomized controlled trials, 2 prospective observational studies, and 2 retrospective observational studies. There were 2 articles that focused on the pediatric population. Two trials are currently ongoing, 1 a systematic review comparing speed to onset of pain relief of methoxyflurane vs. the usual care and another study analyzing use and effectiveness in prehospital helicopter transport.</p><p><strong>Results: </strong>Across studies, methoxyflurane consistently demonstrated clinically meaningful rapid analgesia onset and greater efficacy than placebo and other standard selected analgesic strategies, particularly within the first 10-20 minutes. Available short-term safety data at contemporary analgesic dosages were reassuring, with few adverse events, primarily mild and transient side effects. Studies also confirmed effective patient self-administration of methoxyflurane with minimal occupational exposure risk.</p><p><strong>Conclusion: </strong>Current evidence suggests that methoxyflurane is an effective, well-tolerated, and rapid-acting analgesic for acute trauma. Current evidence supports short-term, episodic use within approved dosing limits, with favorable safety data in both adult and pediatric populations. The favorable safety profile, ease of self-administration, and non-opioid mechanism make it a potentially valuable therapy in emergency and prehospital settings. Future studies should assess usability, safety, and efficacy of methoxyflurane to define its operational use in the prehospital deployed combat setting.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112084","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":"Military Career Outcomes of Enlisted Sailors and Marines Who Entered Temporary Limited Duty During Their First Active Component Contract.","authors":"Stephanie McWhorter, Cynthia J Thomsen","doi":"10.1093/milmed/usag453","DOIUrl":"https://doi.org/10.1093/milmed/usag453","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Premature loss of enlisted active component personnel is costly and challenges force readiness. Enlisted personnel who experience serious illness or injury during their first contract may be especially vulnerable to negative military outcomes, despite access to additional medical support provided by temporary limited duty (LIMDU) programs. This study is the first to examine post-LIMDU military career outcomes among enlisted Sailors and Marines assigned to LIMDU during their initial military contract.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Archival data included comprehensive records from the Sailor and Marine Readiness Tracker (SMART) as well as military personnel data for personnel who entered LIMDU during their first contract and were in active LIMDU status between fiscal years 2017 and 2022 (N = 22,500). The post-LIMDU military career outcomes examined included the timing of and reason for release or discharge from active duty service. Loss timing was categorized as first-term attrition (before completing first contract), later discharge (after completing first contract but before fulfilling the full 8-year military service obligation [MSO]), or continued MSO (fulfilled MSO or still on track to meet MSO). Loss type was characterized as met requirements, disability, poor performance, or misconduct. Multinomial logistic regression analyses examined demographic, military, medical, and LIMDU-related factors as potential predictors of both loss timing and loss type; interaction effects were included to explore service differences in predictors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The military prematurely terminated enlistment contracts with more than 60% of the sample, 38.04% through first-term attrition and 22.68% through later discharge. The most common reasons for post-LIMDU active duty losses were medical disability (43.30%) and met requirements (39.85%). Poor performance and misconduct losses were most frequently associated with first-term attrition; later discharges were most often because of disability. Although predictors varied across the outcomes considered, being in the Marine Corps and starting LIMDU during a later contract year were strong and consistent predictors of positive outcomes, whereas entering LIMDU for mental and behavioral health or \"other\" medical conditions (vs. injury, musculoskeletal, or pain issues) were among the strongest and most consistent predictors of negative outcomes. Service differences were observed in both predictors and outcomes, and service moderated the impact of several predictors on outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study provides novel information about patterns and predictors of service loss among Sailors and Marines who enter LIMDU during their first term of service, including findings regarding the timing and causes of military attrition, predictors of positive military career outcomes, and service-specific differences in both predictors and outco","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112108","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":"Patient and Provider Perspective of Cranioelectrical Stimulation for the Management of Persistent Mild Traumatic Brain Injury Symptoms in Veterans and Service Members.","authors":"Karen M Skop, Meghan Kern, April Ingram, Tracy Kretzmer, Travis Harvey, Ariana Del Negro, Jacob Marszalek","doi":"10.1093/milmed/usag433","DOIUrl":"https://doi.org/10.1093/milmed/usag433","url":null,"abstract":"<p><strong>Introduction: </strong>Mild traumatic brain injury (mTBI) is a significant public health concern. Individuals with persistent symptoms following mTBI can experience long-term disability. Non-pharmacological interventions such as cranial electrical stimulation (CES) are needed to address chronic symptoms. The purpose of this study is to explore the perspectives of both patients and clinicians on the use of CES for managing persistent mTBI symptoms, evaluate participants' perceptions and usage patterns, identify indications driving use, and assess self-efficacy.</p><p><strong>Materials and methods: </strong>A qualitative, convergent parallel mixed methods design was employed within an inpatient rehabilitation program in a Veterans Affairs (VA) polytrauma rehabilitation center. Interviews were conducted with 81 patients with mTBI post-discharge, and surveys were collected from 23 clinicians. Data were analyzed using thematic analysis and descriptive phenomenology, guided by the Diffusion of Innovation Model.</p><p><strong>Results: </strong>Three major themes emerged: (1) Preparation and Comprehension, (2) Perceived Value and Effectiveness, and (3) Tailored Utilization. Patients used CES to manage anxiety, depression, pain, headache, and sleep disturbances, reporting broad symptom improvements. Seventy-one percent of participants continued device usage post-discharge. Similarly, clinicians prescribed CES for insomnia, anxiety, and headache and non-headache pain. Both groups reported a desire for advanced device use training/education to optimize treatment outcomes for complex symptoms.</p><p><strong>Conclusion: </strong>CES should be considered for nonpharmacologic intervention for managing chronic mTBI symptoms. Enhanced patient education and comprehensive clinician training could improve its effectiveness and adoption. Further research and structured guidance are necessary to maximize the benefits of CES in mTBI care.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112038","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":"Incidence, Healthcare Utilization, and Costs of Gynecomastia Among Active-Duty U.S. Service Members, 2014-2023.","authors":"Jacqueline M Hausner, Meg I Robinson, Amber L Dougherty, Nicholas A Chao, Andrew J MacGregor, Christian S McEvoy, James D Wallace","doi":"10.1093/milmed/usag439","DOIUrl":"https://doi.org/10.1093/milmed/usag439","url":null,"abstract":"<p><strong>Introduction: </strong>Gynecomastia is a common benign enlargement of male breast tissue that can cause pain, functional discomfort, and psychosocial distress. It is frequently observed in active-duty-aged males. However, the epidemiology, operative management, and burden in the Military Health System (MHS) are poorly defined. We aimed to quantify gynecomastia incidence, resource utilization, and associated costs in the MHS.</p><p><strong>Materials and methods: </strong>The study population included all male active-duty U.S. service members with gynecomastia in the Military Health System Data Repository (MDR) from January 1, 2014, to December 31, 2023. Those with gynecomastia in the year before study start or a breast cancer diagnosis were excluded. Overall incidence was calculated in person-years (p-y). Surgical procedures, healthcare utilization, and costs were obtained from the MDR.</p><p><strong>Results: </strong>During the study period, 22,103 service members were diagnosed with gynecomastia, primarily under 30 years old, non-Hispanic White, and enlisted. The incidence rate was 2.0 per 1,000 p-y. The Marine Corps had the highest rate overall (2.9 per 1,000 p-y). In total, 8,365 patients (37.8%) had a gynecomastia-related surgical procedure, and most were performed within the first 6 months after diagnosis (71.7%). From 2014 to 2023, there were 76,788 healthcare encounters with a gynecomastia diagnosis (9,139 surgical and 67,649 non-surgical), and most were outpatient (99.4%). In a sub-analysis of outpatient direct care, inflation-adjusted median costs were $12,482 (±$6,365) per surgical encounter and $285 (±$241) per non-surgical encounter. At minimum, the total estimated cost for patients diagnosed with gynecomastia during the study period was $90,028,666, with $76,529,018 attributable to surgical encounters and $13,499,648 to non-surgical encounters.</p><p><strong>Conclusions: </strong>Gynecomastia is common among active-duty service members, with higher incidence and surgical utilization than reported in civilian populations. Within the MHS, one-third of affected service members underwent operative intervention, accounting for a disproportionate share of healthcare utilization and expenditures. These findings establish gynecomastia as a clinically and operationally relevant condition and provide a foundation for future investigation into factors associated with treatment patterns and resource utilization.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112062","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":"Why NATO Matters for Global Health Security.","authors":"Derek R Soled, Vikhyat S Bebarta, Eric Goralnick","doi":"10.1093/milmed/usag455","DOIUrl":"https://doi.org/10.1093/milmed/usag455","url":null,"abstract":"<p><p>The North Atlantic Treaty Organization (NATO) is commonly understood as a military pact, but it is also increasingly a global health security infrastructure. NATO's contribution to health lies not in replacing civilian health institutions, but in reinforcing them with capabilities few other multinational bodies possess: binding commitments, standardized medical interoperability, coordinated logistics, and integrated intelligence.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111820","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":"Military Spouses' Physical Activity and Flourishing.","authors":"Ashley Nicole Lynn, Fred Volk, Amanda Quillin, Mallory Ball, Hannah Murch","doi":"10.1093/milmed/usag440","DOIUrl":"https://doi.org/10.1093/milmed/usag440","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Military spouses' health and well-being are pivotal to a healthy and strong United States military force; therefore, elucidating factors that contribute to spouses' health and well-being is important. Prior research has suggested that military spouses may engage in adequate physical activity for physical health; however, it is unknown how spouses' physical activity may benefit their lives in other ways, especially in light of the military context. Flourishing is a condition in which all parts of life are going well, indicating a more overall assessment of health and well-being. The purpose of this study was to explore the relationships between self-reported physical activity levels and flourishing for female military spouses while considering military contextual factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This quantitative, descriptive, correlational study included 259 female active-duty spouses who completed demographics, the Flourish measure, and the International Physical Activity Questionnaire (categorizing weekly physical activity levels as low, moderate, or high based on frequency/intensity/duration). Before all procedures, approval was obtained through the affiliated Institutional Review Board. Linear regressions were performed to explore relationships between physical activity levels and total flourishing and each flourishing domain. Moderation analyses were performed to explore the moderating roles of duty station deployment status, military department, and rank.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty-seven percent of female spouses self-reported high-level physical activity (reflecting both intensity and volume of activity reported in the past week). High-level activity was significantly associated with higher total flourishing compared to low-level activity (B = 0.47, P = .015). High-level activity was significantly associated with higher mental and physical health compared to low (B = 0.87, P &lt; .001) and moderate-level (d = 0.33, P = .035) activity. Moderation analyses indicate the effect of activity level on the domain of happiness and life satisfaction was weaker for spouses in duty stations involving deployment (b = -0.87, P = .047). In addition, the effect of physical activity on the physical and mental health domain was stronger for Department of the Navy spouses in comparison to the Department of the Army (b = 0.96, P = .039), although the overall interaction between physical activity level and military department was insignificant. Finally, the relationship between physical activity and the happiness and life satisfaction domain was stronger for officer spouses compared to enlisted spouses (b = 1.22, P =.011). However, the effect of physical activity on total flourishing was not moderated by deployment, department, or rank.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This foundational study explored physical activity levels and flourishing in female military spouses, while considering military","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112055","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 the Mind Gives Out Before the Body: How Psychological Traits Predict Sustained Performance Under Maximal Exertion.","authors":"Kyle S Broekhuis, John J Elshaw, Nicole T Ray, R David Fass, Kyle Collins, Robert Briggs, Adam Strang","doi":"10.1093/milmed/usag454","DOIUrl":"https://doi.org/10.1093/milmed/usag454","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Physical readiness is a critical component of military effectiveness, yet the psychological factors that drive performance under physical duress are not fully understood. Although the link between psychology and exercise behavior is well-established, less is known about how stable personality traits and motivational orientations directly impact maximal physiological output. This study aimed to investigate the association between the \"Big Five\" personality traits, motivational needs from Self-Determination Theory, and objectively measured aerobic capacity, anaerobic power, and muscular endurance in a military population. A secondary aim was to determine if motivation serves as a psychological pathway mediating the relationship between personality and performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This longitudinal study used a sample of 186 active duty U.S. Air Force and Space Force personnel, which involved baseline (pre-intervention) and post-intervention testing separated by a 12-week supervised training program. At baseline, participants completed the NEO Five-Factor Inventory (NEO-FFI) to assess personality and the Basic Psychological Needs in Exercise Scale (BPNES) to measure motivation. Subsequently, they underwent standardized physiological testing to determine VO2max, anaerobic power (Wingate), and muscular endurance. Associations were analyzed using simple linear regression, and mediation analyses were performed to test the indirect effects of personality on performance through motivation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Personality traits were significantly associated with physical performance. Neuroticism demonstrated a consistent negative relationship with aerobic capacity, anaerobic power, and muscular endurance. In contrast, conscientiousness was positively associated with aerobic capacity and muscular endurance. Among motivational factors, only autonomy was a significant predictor, showing a positive association with both aerobic capacity and muscular endurance. Mediation analyses revealed that autonomy functioned as a significant pathway linking neuroticism to endurance performance; the negative effect of neuroticism on aerobic capacity and muscular endurance was nullified when accounting for autonomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study provides compelling evidence that psychological characteristics are systematically associated with objective physical performance in a military cohort. The findings suggest that maximal effort is not purely a physiological event but is significantly influenced by an individual's psychological regulation of effort and discomfort. A key strength is the use of objective, gold-standard performance measures. However, the cross-sectional nature of the mediation analysis and the use of a convenience sample are limitations. These results have direct implications for military training, suggesting that fostering an autonomy-supportive environment may ","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111570","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":"Family Resilience Matters: How Individual and Family Resilience Improve Health Outcomes for Veterans with Complex Conditions.","authors":"Alisa Bedrov, Andrea F Kalvesmaki, Erin P Finley, Mary Jo Pugh","doi":"10.1093/milmed/usag442","DOIUrl":"https://doi.org/10.1093/milmed/usag442","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Veterans with traumatic brain injury (TBI), epilepsy, and other complex comorbidities often face increased risks of long-term physical and mental difficulties. Prior research has highlighted benefits of individual resilience among Veterans with respect to maintaining positive health outcomes in the face of stress and adversity. However, 1 area that has been underexplored is how family resilience may also contribute to better well-being post-deployment, especially when facing complex conditions like TBI or other post-traumatic sequelae. Considering the efforts of the Department of Defense to increase family resilience training as part of the Military Family Readiness System, there is a need to understand how family resilience factors into long-term outcomes. The current study examined how individual and family resilience were each associated with physical and mental well-being among Post-9/11 Veterans.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;We conducted a secondary data analysis with N = 2603 Veterans (Mage = 42.02, 66.2% White, 69.3% men, 66.1% Army) who had previously received Veterans Health Administration (VHA) care and had diagnoses of TBI and/or epilepsy. Surveys were administered between September 2017 and February 2019 and included measures of individual resilience (Connor-Davidson Resilience Scale; CD-RISC2); family resilience (Family Resilience Scale for Veterans; FRS-V); the Veterans RAND 12-item Health Survey (VR-12); and Quality of Life after Traumatic Brain Injury Overall Scale (QOLIBRI-OS). Primary analyses consisted of multiple linear regression analyses with individual resilience, family resilience, and their respective interaction as simultaneous predictors of well-being (physical and mental health components of the VR-12 and QOLIBRI-OS). Subsequent linear regression analyses sequentially added different blocks of covariates: (a) health comorbidities (i.e., TBI/epilepsy status, PTSD); (b) military history (i.e., combat exposure, branch, component, rank); and (c) demographics (i.e., age, sex, race/ethnicity, education level, marital status). This study received Institutional Review Board (IRB) approval as minimal risk (IRB #00107411).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For the VR-12, our results showed that higher individual resilience, but not family resilience, was associated with better self-reported physical health, but that both individual resilience and family resilience were positively associated with better self-reported mental health. There was also a significant interaction, such that the positive association between individual resilience and mental health was greater at higher levels of family resilience. The same pattern of results was seen for the QOLIBRI-OS. All results held after controlling for health status, military history, and demographic covariates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;These results suggest that high individual resilience combined with high family resilience","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112044","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":"Pivmecillinam for Shigellosis With Limited Oral Therapeutic Alternatives: A 3-Case Series and Narrative Review of Published In Vivo Clinical Evidence.","authors":"Pierre-Louis Conan, France Charton, Dinaherisoa Andriamanantena, Cécile Ficko, Aurore Bousquet","doi":"10.1093/milmed/usag451","DOIUrl":"https://doi.org/10.1093/milmed/usag451","url":null,"abstract":"<p><p>Shigellosis remains highly relevant to military medicine because acute diarrheal illness during travel and deployment can impair operational readiness, reduce physical performance, and increase lost duty days. At the same time, oral treatment options are increasingly constrained by antimicrobial resistance, intolerance, contraindications, and occasional supply limitations in operational or austere settings. We report 3 adults with microbiologically documented shigellosis treated with oral pivmecillinam at our institution and summarize the limited published in vivo clinical evidence. In all 3 cases, pivmecillinam was used as a susceptibility-guided oral strategy when standard oral options were restricted. Clinical improvement occurred within 48 hours in each patient, and no immediate treatment escalation was required. Published evidence consists mainly of small, older randomized trials, most of them conducted in children, suggesting clinical activity of pivmecillinam against historical comparators, although 1 pediatric trial found ciprofloxacin to be bacteriologically superior. These findings suggest that pivmecillinam may represent a pragmatic oral alternative in selected cases of shigellosis when usual oral agents cannot be used. In military and other operational settings, its potential value lies in preserving an oral treatment pathway and reducing reliance on parenteral therapy. Contemporary comparative studies, especially in adults and in the context of current resistance patterns, are needed to better define its role.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112072","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}