Bmj Military Health最新文献

{"title":"Operationalising prehospital management of exertional heat illness in athletes and team sports.","authors":"Todd Leckie, F Stourton, D Fitzpatrick, R Hemingway, C Kipps, M J Stacey, F Wood, A Hartle, A Boalch, H Pynn, G Jones","doi":"10.1136/military-2025-003116","DOIUrl":"https://doi.org/10.1136/military-2025-003116","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349471","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":"Current perspectives of late-stage rehabilitation and return to duty criteria following lower limb musculoskeletal injury in military personnel: a practitioner survey.","authors":"Robyn P Cassidy, N Masters, R Rodgers, R J Coppack, D Hayhurst, P Ladlow","doi":"10.1136/military-2025-003113","DOIUrl":"https://doi.org/10.1136/military-2025-003113","url":null,"abstract":"<p><strong>Introduction: </strong>Lower limb musculoskeletal injuries (MSKIs) are a leading cause of reduced operational capability and medical discharge in UK military personnel. Late-stage rehabilitation (LSR) is critical for restoring function and readiness for return to duty (RTD) yet remains under-represented in research and clinical guidelines. This service evaluation examines current practices, perspectives and challenges among UK Defence rehabilitation practitioners and physical training instructors (PTIs) in delivering LSR and facilitating RTD for lower limb MSKIs.</p><p><strong>Methods: </strong>A cross-sectional survey was distributed to UK Defence rehabilitation practitioners and Army PTIs. The survey collected demographic, quantitative and qualitative data on LSR exercises, outcome measures, RTD criteria and perceived challenges. Quantitative data were analysed descriptively; qualitative responses were examined using inductive content analysis.</p><p><strong>Results: </strong>157 responses were received across all services and levels of care, with respondents averaging 8 years of clinical experience. LSR commonly included resistance training, plyometrics, running and load carriage. PTIs most frequently reported low cardiovascular fitness as a deficit persisting after rehabilitation. A range of outcome measures was used to guide progression and RTD; however, there was inconsistency regarding their relevance and application across all branches of the UK military. Only 48% of rehabilitation practitioners reported using a formal RTD criteria, while 78% used structured handover tools. Common challenges included time constraints, limited access to resources and low patient compliance and confidence.</p><p><strong>Conclusion: </strong>LSR and RTD practices for lower limb MSKIs are variable across military rehabilitation settings. There is a clear need to balance standardisation with individualised care based on patient needs and occupational roles. Clear role delineation and communication between rehabilitation practitioners and PTIs are essential during the transition phase. Addressing persistent challenges such as limited time, resources, deconditioning, rehabilitation compliance and psychological readiness may improve LSR effectiveness.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349469","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":"Tendinopathy prevalence in US military service members.","authors":"Eric J Shumski, M F Lindow, T C Mauntel","doi":"10.1136/military-2025-003031","DOIUrl":"https://doi.org/10.1136/military-2025-003031","url":null,"abstract":"<p><strong>Introduction: </strong>Overuse musculoskeletal injuries (MSKIs), including tendinopathies, are the most common types of MSKIs experienced by US active-duty military service members (ADSMs). There are limited granular tendinopathy prevalence data in military populations. Thus, we describe tendinopathy prevalence among ADSM and quantitatively compare tendinopathy prevalence by military and demographic factors.</p><p><strong>Methods: </strong>A retrospective cohort study using the Medical Assessment and Readiness System database to identify tendinopathies among newly entering service members between January 2016 and December 2020 (n=2,456,739). All study procedures were exempted from institutional review board oversight. Prevalence ratios and 95% CIs not containing 1.00 were considered statistically significant.</p><p><strong>Results: </strong>A total of 37,434 service members were diagnosed with tendinopathy, representing a crude prevalence of 1.52%. The lower extremity was the most common site of tendinopathy, accounting for 80.33% of all cases, with the majority of diagnoses in the Army and Marines. Prevalence varied most by age, military career and service, with junior enlisted having higher rates of lower extremity tendinopathies. As military careers progressed from enlisted to officer, we noted proportionally more upper extremity diagnoses.</p><p><strong>Conclusions: </strong>Tendinopathy remains a significant burden on the US military population. The lower extremity is the most commonly affected region, particularly in junior enlisted roles. The data highlight key trends related to age, military career and service branch, providing essential information to guide targeted prevention efforts and clinical interventions aimed at reducing the impact of these injuries.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349473","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":"Scorpion sting: a narrative review and proposed guidelines for contemporary UK armed forces operations.","authors":"Daniel Wilkins, S Jc Pallett, J Potter, S D Woolley, G Holden, K Chapman, A Kew, D A Warrell, D Lalloo, L Lamb","doi":"10.1136/military-2025-003107","DOIUrl":"https://doi.org/10.1136/military-2025-003107","url":null,"abstract":"<p><p>Scorpions are venomous arthropods with a wide geographical footprint and are endemic throughout all UK Armed Forces operational areas outside of Northern Europe. Scorpion stings are common on military exercises and operations. Here, we present a narrative review summarising epidemiological data pertaining to scorpions in geographical areas of contemporary operational relevance to the UK Armed Forces and suggest evidence-based treatment recommendations suitable for use in a military environment, providing an update to the last detailed review in 2008. The overwhelming majority of stings will result only in local pain and can be managed with analgesia at Role 1 medical treatment facilities. The risk of severe envenoming is greatest in the Middle East. Children and pregnant women are at increased risk of severe envenoming which most commonly manifests as hypertensive crisis. These patients should be evacuated to hospital care and managed supportively in a critical care environment.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349472","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":"Influence of body armour and march loads on posture in German soldiers.","authors":"Patricia Lang, G Dethloff, H-G Palm, K Dallacker-Losensky, B Friemert, M-A Westhoff, H-J Riesner","doi":"10.1136/military-2025-003081","DOIUrl":"https://doi.org/10.1136/military-2025-003081","url":null,"abstract":"<p><strong>Introduction: </strong>Carrying heavy loads and body armour may alter posture and increase the risk of low back pain in military personnel. This observational study aimed to assess how two designs of body armour affect posture and pain in German soldiers following loaded marches.</p><p><strong>Methods: </strong>In this prospective observational study, 20 soldiers (male healthy volunteers) completed three 12-km marches under three conditions: without body armour (control), with old-design armour and with new-design armour featuring a hip belt. Spinal posture (forward trunk lean as primary outcome) and pain were assessed using video rasterstereography and visual analogue scales before and after each march.</p><p><strong>Results: </strong>Significant differences in forward trunk lean were observed with new-design armour compared with control (mean difference 6.1 mm, p=0.006) and old-design armour (mean difference 5.4 mm, p=0.046). Pain increased significantly after marching with old-design armour (lumbar pain: p<0.01; thoracic pain: p=0.01), but not with the new-design armour.</p><p><strong>Conclusion: </strong>Body armour design notably affects spinal posture and pain. Although the new design increased forward trunk lean, it did not significantly increase pain, suggesting potential ergonomic advantages.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349470","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":"GLP-1 receptor agonist use for obesity in service personnel.","authors":"Nicola Jecks, C Hughes, N Macleod, R M Gifford","doi":"10.1136/military-2025-003159","DOIUrl":"https://doi.org/10.1136/military-2025-003159","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276481","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":"Optional sedation during surgical treatment of combat-related limb injury under regional anaesthesia: an observational cohort study.","authors":"Michael Frank, I Kuchyn, K Bielka, Y Klys, I Shukurlu","doi":"10.1136/military-2025-003018","DOIUrl":"https://doi.org/10.1136/military-2025-003018","url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral nerve blocks have been widely used during the Russo-Ukrainian war due to their safety benefits during prolonged unsupervised transportation and opioid-sparing effects that are highly desirable during prolonged treatment that requires multiple surgical interventions. Sedation during minor surgical procedures is optional when regional anaesthesia is used and is often omitted due to its cost and potential adverse effects (respiratory depression, delayed patient mobilisation and risk of agitation). Previous observations suggest that combat casualties may benefit psychologically from sedation during invasive surgical procedures. This prospective observational study sought to assess the difference in stress response and pain following procedures conducted under regional anaesthesia with and without sedation.</p><p><strong>Methods: </strong>A prospective observational study was conducted involving patients undergoing treatment of combat limb injuries. The population comprised two groups according to their preference to nerve block only (R) or nerve block plus sedation (RS). Data on previous experiences with anaesthesia were collected and blood samples were obtained before and after the procedure to measure cortisol and glucose concentrations.</p><p><strong>Results: </strong>Mean change in cortisol was higher in group R: 27 (-3 to 82) vs 192 (111 to 249); p=0.003. There was no difference in glucose (p=0.705) or postoperative pain scores following the intervention (p=0.5), 3 hours (p=0.44), 6 hours (p=0.95) and 9 hours (p=0.1) later. Patients in group RS reported slightly greater satisfaction with anaesthesia (8.12±1.36 vs 9.06±0.92, p=0.03). Previous experiences with specific methods of anaesthesia and ketamine exposure did not affect patient choice. Deep sedation was necessary in 25% of cases in group RS (none in R), increasing the mean cost of anaesthesia by 65%.</p><p><strong>Conclusions: </strong>Short-term pain outcomes were not affected by sedation. Postprocedure cortisol levels were higher with no sedation, with no difference in glucose levels. Satisfaction was statistically higher in patients receiving sedation alongside regional anaesthesia.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259416","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":"Common carotid artery pseudoaneurysm following a ricochet penetrating neck injury.","authors":"Emmanuel Tito, J Cowan, J Moore, R Wein, T Belok, D Anderson, J Weiss","doi":"10.1136/military-2025-003023","DOIUrl":"https://doi.org/10.1136/military-2025-003023","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259446","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":"Inter-rater and intra-rater reliability of hand-held dynamometry of the hip and knee in a military cohort.","authors":"Robyn P Cassidy, K M Lunt, L Gray, R J Coppack, P Ladlow, J L Bilzon","doi":"10.1136/military-2025-003073","DOIUrl":"https://doi.org/10.1136/military-2025-003073","url":null,"abstract":"<p><strong>Introduction: </strong>Hand-held dynamometers (HHDs) are widely used to measure isometric muscle force in clinical practice. However, reliability may be affected when there is a difference in muscle force generation between examiner and patient, raising concerns about accuracy in physically trained populations, such as military personnel. This study aimed to examine the inter-rater and intrarater reliability of HHD for lower limb strength assessment in a healthy military population. Secondary aims were to evaluate the validity of HHD for knee extensor strength compared with fixed dynamometry and explore the impact of assessor and participant characteristics on reliability.</p><p><strong>Methods: </strong>A cross-sectional study with test-retest reliability and concurrent validity design was conducted with 30 healthy military personnel (mean age: 32±6 years; 24 males; 6 females). Peak isometric lower limb force was measured across six positions using HHDs (Lafayette, USA) by three assessors across two sessions. Knee extensor strength was also assessed using an isokinetic dynamometer (Biodex, USA). Intrarater and inter-rater relative reliability were assessed using intraclass correlation coefficients (ICC), and absolute reliability with SEM and minimal detectable change (MDC). Concurrent validity was determined using Pearson's correlation, and systematic bias was analysed through limits of agreement.</p><p><strong>Results: </strong>Intra-rater reliability was good-to-excellent (ICC>0.75; SEM% 2.1%-6.3%; MDC% 5.2%-17.6%) across all positions except one assessor in hip extension (ICC=0.70). Inter-rater reliability was also good-to-excellent (ICC>0.75; SEM% 2.2%-5.5%; MDC% 6.1%-15.4%). HHD demonstrated strong validity compared with isokinetic dynamometry (r=0.80-0.819, p<0.001) despite a systematic bias with lower values. No correlation was found between peak force and inter-rater variability.</p><p><strong>Conclusions: </strong>HHD is a reliable tool for lower limb strength assessment in military personnel. Although absolute values are lower than fixed dynamometry, relative comparisons over time remain valid.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276469","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":"Comparison of army personnel with single versus multiple suicidality events.","authors":"Samantha Hodges, C Meurk, E Heffernan","doi":"10.1136/military-2025-003131","DOIUrl":"https://doi.org/10.1136/military-2025-003131","url":null,"abstract":"<p><strong>Introduction: </strong>Individuals who experience repeated suicidality (ideation, self-harm and attempted suicide) are more at risk of future death by suicide and are often more clinically complex than those with a single suicidality event. Despite this, repeated suicidality appears to be under-researched in military populations.</p><p><strong>Method: </strong>This study compares Australian Army personnel who experience one episode of suicidality to those who experience multiple events using army administrative records from 2012 to 2021. Demographics, event characteristics and outcome variables are presented.</p><p><strong>Results: </strong>While similar demographically, those with multiple events were significantly more likely to engage in: self-harm or suicide attempt, to use alcohol or substances around the event, to avoid military locations and support networks around the event, and were significantly less likely to make a successful return to work.</p><p><strong>Conclusion: </strong>Repeat suicidality represents a key opportunity to reduce suicidality morbidity and mortality in the Australian Army. Enhanced data surveillance, reducing the use of alcohol and substances and targeted management and transition protocols may assist in reducing the incidence. Implications for the army and future research directions are discussed.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233976","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}