Bmj Military Health最新文献

{"title":"Building interoperability early: international faculty perspectives on multinational military medical education in undergraduate training.","authors":"Sherri L Rudinsky, John Peabody, Price Parker, Rebekah Cole","doi":"10.1136/military-2026-003252","DOIUrl":"https://doi.org/10.1136/military-2026-003252","url":null,"abstract":"<p><strong>Introduction: </strong>As military operations increasingly rely on coalition partnerships, interoperability has become a core competency for medical readiness. Traditionally emphasised in postgraduate or deployment settings, earlier integration of interoperability-focused training in undergraduate medical education (UME) may better prepare physicians for coalition environments. Simulation-based education (SBE) offers an effective platform for developing shared understanding, communication, and trust within multinational teams, with multinational faculty informing best practices in programme design and implementation.</p><p><strong>Methods: </strong>We conducted a qualitative phenomenological study exploring faculty perspectives on multinational SBE during a large-scale, high-fidelity military training exercise. Faculty from multiple North Atlantic Treaty Organization partner nations participated in semistructured interviews and focus groups conducted during or shortly after the exercise. Transcripts were analysed using inductive thematic analysis to identify patterns related to learning outcomes, interoperability and coalition readiness.</p><p><strong>Results: </strong>Four themes emerged: enhanced cultural competence, development of a common operating picture, increased interoperability and a positive outlook on international collaboration. Multinational SBE promoted shared professional identity, reduced cultural and communication barriers and supported development of non-technical skills, including communication, situational awareness and decision-making under pressure. Interoperability was described as extending beyond equipment compatibility to include procedural alignment, shared cognition and mutual trust. International faculty were essential for modelling best practices, identifying operational frictions and supporting curricular transfer across institutions.</p><p><strong>Conclusions: </strong>Multinational SBE is a key enabler of military medical training, fostering competencies required for effective coalition performance. Early integration of interoperability-focused training in UME, supported by international faculty engagement, may strengthen readiness, reduce operational friction and enhance global health security.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844755","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":"Stability of sufentanil sublingual microtablets (Dzuveo) in extreme cold weather conditions: an experimental study.","authors":"David McConnell, Hayley Manners, Paul Sutton, Nicola Gawman, Tim Parham, Jonathon Lowe","doi":"10.1136/military-2026-003278","DOIUrl":"https://doi.org/10.1136/military-2026-003278","url":null,"abstract":"<p><strong>Introduction: </strong>Extreme cold weather environments are challenging for medication storage and delivery, particularly for injectable analgesics vulnerable to freezing and device failure. These risks may compromise pain management in austere or operational settings where temperature control cannot be maintained. Sufentanil sublingual microtablets (sold in the UK as Dzuveo) provide an oral analgesic option with manufacturer-reported sub-zero stability. Evidence describing the effects of sustained extreme cold exposure and repeated freeze-thaw cycling on chemical stability and delivery system function is limited.</p><p><strong>Methods: </strong>We conducted a laboratory study assessing the effect of sustained freezing and repeated freeze-thaw exposure on sufentanil sublingual microtablets (30 µg active pharmaceutical ingredient). Tablets from two production batches (expiry August 2025 and July 2026) were allocated to room temperature control, static freezing at -20°C or -80°C, or repeated freeze-thaw cycling at both temperatures. Freeze-thaw cycling was designed to simulate intermittent carriage in extreme cold environments. Laboratory operators were blinded to sample allocation. The primary outcome was sufentanil mass and concentration measured using liquid chromatography-high resolution accurate mass spectrometry. Secondary outcomes included visual assessment of microtablet integrity and applicator function.</p><p><strong>Results: </strong>60 tablets were analysed, with one weight outlier excluded from concentration-based analyses. There were no statistically significant differences in sufentanil mass or concentration between control samples and those exposed to freezing or repeated freeze-thaw cycling at -20°C or -80°C. Visual inspection identified no evidence of microtablet degradation, and all applicators functioned normally across exposure conditions.</p><p><strong>Conclusions: </strong>Sufentanil sublingual microtablets and their delivery system maintained chemical stability and functional integrity following exposure to extreme cold temperatures and repeated freeze-thaw cycles. This laboratory study provides reassurance regarding formulation resilience in cold environments but does not assess clinical effectiveness. Further research is required to determine the impact on patient outcomes in operational or military settings.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844777","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":"Changes in the functions of the autonomic nervous, hormonal and metabolic systems as a result of military field training.","authors":"Juho Seppänen, Heikki Kyröläinen, Tommi Ojanen","doi":"10.1136/military-2025-003149","DOIUrl":"https://doi.org/10.1136/military-2025-003149","url":null,"abstract":"<p><strong>Introduction: </strong>Military field training causes stress due to individual factors, physical strain, cognitive tasks, environmental factors, sleep deprivation, energy deficit and psychological factors. The purpose of this study was to investigate the stress induced by military field training measured objectively and subjectively in young military conscripts. Associations of the changes in studied variables were also investigated.</p><p><strong>Methods: </strong>Participants' (49 men, age 20±1 years) nocturnal and morning heart rate variability, selected hormonal and metabolic status, physical activity, perceived exertion and amount of sleep were measured before the 3-week military field training, periodically during the training (shooting and combat training periods) and 4-5 days after the end of the training.</p><p><strong>Results: </strong>Nocturnal and morning heart rate, serum cortisol and sex hormone-binding globulin concentrations, creatine kinase activity, rate of perceived exertion and NASA Task Load Index increased, while testosterone, testosterone/cortisol ratio and insulin-like growth factor 1 decreased. The observed associations between the changes of the studied variables were weak.</p><p><strong>Conclusions: </strong>3-week military field training induced changes in the functions of the autonomic nervous, hormonal and metabolic systems and perceived exertion. The changes may indicate increased physiological and/or psychological stress, signifying changes in anabolic-catabolic balance and overreaching state. Thus, subjectively measured stress corresponds with objectively measured stress, although responses and adaptations differed individually between the participants.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844768","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":"Prehospital intraosseous access in combat trauma: a retrospective registry analysis.","authors":"Ofer Almog, Cole D Bendor, Shaul Gelikas, Roy Nadler, Irina Radomislensky, Zivan Beer, Avi Benov, Elon Glassberg","doi":"10.1136/military-2025-003173","DOIUrl":"https://doi.org/10.1136/military-2025-003173","url":null,"abstract":"<p><strong>Introduction: </strong>Intraosseous (IO) devices have become a vital tool in trauma care for establishing rapid circulatory access, particularly in emergency and prehospital environments where peripheral vascular access may be delayed or unsuccessful. In modern combat settings, detailed data on prehospital IO use, indications and outcomes remain limited. We aimed to describe the indications and success rates of prehospital IO access in combat trauma casualties treated by military advanced life support providers during the 2023-2024 Israel-Gaza conflict, and to report any acute complications documented in the prehospital and early hospital phases.</p><p><strong>Study objective: </strong>To evaluate the use and success rate of IO access in trauma casualties treated by military advanced life support providers during the 2023-2024 Israel-Gaza conflict.</p><p><strong>Methods: </strong>This retrospective study analysed data from the Israel Defense Forces Trauma Registry and the Israeli National Trauma Registry. All cases involving prehospital IO access from 27 October 2023 to 27 November 2024 were included. Variables included demographic characteristics, injury patterns, IO device type, insertion sites, success rates, indications and outcomes.</p><p><strong>Results: </strong>83 casualties were included. Most had severe penetrating injuries (94%) and presented with signs of hypovolemic shock (82%). IO access was predominantly used for volume resuscitation with blood products (84%), including low-titre group O whole blood transfusion (67%). The proximal tibia was the most common insertion site (77%). NIO devices were used in most cases with high first-attempt success; overall IO insertion success was 85%. No major acute complications related to IO access were documented.</p><p><strong>Conclusion: </strong>In this cohort of modern combat casualties, intraosseous access was frequently used to enable blood-product resuscitation in severely injured, profoundly shocked casualties, with high first-attempt and overall insertion success and no major acute complications documented. These findings support IO as a feasible and reliable option for circulatory access in austere environments.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844794","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":"Hypothermia as a risk factor for injury outcome: are we really serious?","authors":"Bart Nicolaas van Herwijnen, Colin Smart, Tim Hodgetts","doi":"10.1136/military-2025-003214","DOIUrl":"https://doi.org/10.1136/military-2025-003214","url":null,"abstract":"<p><p>Effective military prehospital care must deliver a warm, non-coagulopathic patient to surgical care, addressing the lethal triad of hypothermia, acidosis and coagulopathy. Despite advances in haemorrhage control, hypothermia prevention remains underdeveloped, with little improvement in incidence over two decades. Renewed focus on European and cold-weather operations highlights the urgent need for improved thermal management during prolonged evacuation.Casualties lose heat through conduction, convection, evaporation and radiation, yet prehospital practice often relies on ineffective foil blankets and inconsistent protocols. Accurate temperature monitoring and standardised, symptom-based staging are needed for North Atlantic Treaty Organization interoperability.This paper advocates the '4Cs' (Consider, Conserve, Create and Continue) and <i>H</i>ypothermia <i>E</i>mergency <i>R</i>esponse <i>A</i>pproach 7 framework to guide effective packaging, insulation and rewarming. Recommendations include adopting common staging systems, measurable insulation standards and equipment optimised for cold environments. Implementing these measures could markedly reduce hypothermia-related mortality in military trauma care.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785987","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":"Disorganised Achilles tendon structure, chronic ankle instability and reduced neuromuscular abilities in infantry training.","authors":"Nili Steinberg, Michal Shenhar, Aharon S Finestone, Jeremy Witchalls, Gali Dar, Gordon Waddington","doi":"10.1136/military-2025-003221","DOIUrl":"https://doi.org/10.1136/military-2025-003221","url":null,"abstract":"<p><strong>Introduction: </strong>Optimal ankle function is required for combat soldiers to minimise the risk of injuries. We aimed to examine the relationship between Achilles tendon structure (AT-structure), chronic ankle instability (CAI) and neuromuscular function at commencement and during 22 weeks of infantry training.</p><p><strong>Methods: </strong>179 recruits participated in this cohort study. Participants were screened during PRE, MID and END of infantry training for AT-structure, CAI (including recurrent sprains, perceived instability and mechanical instability) and for neuromuscular ability (proprioception ability, Y-balance test (YBT), heel-raise, hexagon hopping ability and 3000 m run). Multivariate analysis of variance with repeated measures (time×AT-structure×CAI) was conducted for each of the neuromuscular abilities.</p><p><strong>Results: </strong>25.1% of the soldiers were diagnosed with disorganised AT-structure, 21.2% with CAI and 9.5% with both. A significant <i>time×AT-structure interaction</i> was found for YBT (F_{(2, 316)}=4.401, η²=0.027, p=0.013); and <i>time×CAI interaction</i> for proprioception ability (F_{(2, 300)}=5.917, η²=0.038, p=0.003). <i>AT-structure×CAI interactions</i> were found for YBT (F_{(2, 316)}=4.059, η²=0.025, p=0.046); and for the hopping hexagon-ability (F_{(2, 316)}=4.412, η²=0.027, p=0.037). All of the significant interactions indicated an association between disorganised AT-structure, CAI and reduced neuromuscular abilities.</p><p><strong>Conclusions: </strong>Soldiers who commence infantry physical training with both disorganised tendon structure and with CAI had significantly lower dynamic postural balance and reduced hopping agility compared with those with organised tendon structure (regardless of whether they had CAI). These limitations in ankle structure and function may reduce the ability of a soldier to match the training performance of their peers. Pre-recruitment screening is recommended for identifying ankle limitations which could lead to reduced functional abilities.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730223","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":"Cardiopulmonary exercise testing after exertional heat stroke in a French military population.","authors":"Julien Leroux, Pierre-Laurent Massoure, Arnaud Xavier Jouvion, Nicolas Cazes, Emmanuel Sagui","doi":"10.1136/military-2025-003205","DOIUrl":"https://doi.org/10.1136/military-2025-003205","url":null,"abstract":"<p><strong>Introduction: </strong>Exertional heat stroke (EHS) is a life-threatening emergency. However, little is known about factors that predict the occurrence and recurrence of EHS or the 'return to play' protocol after an EHS. The occurrence of an EHS in military personnel is not exceptional. The cardiopulmonary exercise test (CPX) has never been studied in military personnel or in athletes recovering from an EHS. Thus, this study aimed to analyse the CPX parameters in military personnel evaluated following an EHS.</p><p><strong>Methods: </strong>Data were collected from 172 French military personnel prospectively included between 2014 and 2021, who underwent a CPX within 6 months of an EHS (162 cases without critical care requirement, 10 severe forms defined as a stay in intensive care and five recurrences).</p><p><strong>Results: </strong>The average maximal oxygen consumption (VO2max) was 44.4±7.70 mL/kg/min, that is, 111.4% of the predicted VO2max. The maximal aerobic power was 267.10±44.633 W, that is, 100.7% of the predicted value. The first ventilatory threshold was observed at 73.30%±11.44% of VO2max. The respiratory quotient was 1.10±0.10, and the ventilatory reserve was measured at 24%±24% at peak exercise. CPX did not reveal any respiratory or cardiac abnormality. The indirect value of VO2max estimated by the pre-morbid Cooper's test was 55.7 mL/min/kg. Despite the absence of specific abnormal CPX pattern in this population, post-EHS CPX suggested physical deconditioning.</p><p><strong>Conclusion: </strong>This is the first study to report CPX results in a military population recovering from an EHS. The CPX results were consistent with those expected in recreational athletes, and CPX provided an objective evaluation of the level of deconditioning after EHS. This study suggests the absence of specific maladaptation to exercise in military personnel who experienced EHS. After EHS, these patients should undergo gradual, supervised retraining to prevent significant physical deconditioning.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647094","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":"Oxidative stress response to simulated altitude training: a longitudinal study of the biomarker variation and the contributing factors.","authors":"Yen-Chiao Huang, Shu-Yu Wu, Chia-Tung Liao, Wun-Wei Huang, Hsin Chu, Min-Yu Tu, Yi-Chang Lin, Chung-Yu Lai","doi":"10.1136/military-2025-003189","DOIUrl":"https://doi.org/10.1136/military-2025-003189","url":null,"abstract":"<p><strong>Introduction: </strong>Hypobaric exposure reduces nitrogen solubility in body tissues, leading to the formation of microbubbles. Previous research has shown that a high-altitude environment significantly increases oxidative stress. This study aims to investigate the oxidative stress responses and associated factors in aircrew personnel undergoing hypobaric chamber training.</p><p><strong>Methods: </strong>A longitudinal study design was employed to recruit 47 participants (13 females), comprising aircrew from the tri-service branches and inside observers from the Aviation Physiology Research Laboratory in Taiwan. Participants underwent the hypobaric chamber training profiles with maximum simulated altitudes of 25 000 or 35 000 feet (ft). Urine samples were collected at baseline, 30 min and 120 min post-training. Oxidative stress biomarkers assessed included 8-hydroxy-2'-deoxyguanosine (8-OHdG), malondialdehyde and Trolox equivalent antioxidant capacity (TEAC). Data analyses were performed using SPSS V.21.0.</p><p><strong>Results: </strong>All biomarkers exhibited a similar temporal pattern, with an increase at 30 min followed by a decline at 120 min post-training. However, only the TEAC showed a statistically significant change, decreasing from 6.22±2.75 to 5.12±2.29 mmol/g creatinine (p=0.012). Females exhibited higher baseline 8-OHdG levels than males (2.40±1.29 vs 1.63±1.19 µg/mg creatinine; p=0.039), while male levels remained relatively stable. Participants exposed to a maximum simulated altitude of 35 000 ft demonstrated significantly lower post-training TEAC than those trained at 25 000 ft (5.70±2.51 vs 7.21±3.01 mmol/g creatinine; p=0.001). People who smoke exhibited higher 8-OHdG levels than people who do not smoke at 120 min post-training (p=0.010).</p><p><strong>Conclusions: </strong>This non-invasive, longitudinal study demonstrated that hypobaric chamber training transiently alters oxidative stress biomarkers, particularly TEAC. Oxidative stress responses varied according to sex, training altitude, chamber position and smoking, highlighting the individual differences in the physiological adaptation to hypobaric exposure.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515902","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":"NPWT in combat-related extremity vascular injuries: a case series and safety algorithm.","authors":"Iurii Sivash, Boris Koval","doi":"10.1136/military-2025-003192","DOIUrl":"https://doi.org/10.1136/military-2025-003192","url":null,"abstract":"<p><strong>Introduction: </strong>Combat extremity vascular injuries are frequently associated with extensive soft-tissue loss and contamination, increasing the risk of infection, graft thrombosis and erosion-related bleeding (ERB). Negative pressure wound therapy (NPWT) is widely used to manage complex combat wounds, but evidence regarding its use after vascular reconstruction remains limited.</p><p><strong>Methods: </strong>We retrospectively analysed 69 patients with combat-related vascular injuries who underwent NPWT at a Role IV (Echelon of Care in the Military Medical System) facility in Ukraine during 2022. NPWT applications were categorised into two predefined groups: an interface group-NPWT applied adjacent to exposed vascular reconstructions using a protective multilayer system (n=28); and a covered group-NPWT applied over established soft-tissue or muscle flap coverage (n=41). Outcomes included ERB, graft thrombosis, infectious complications and limb loss. NPWT was applied as part of staged wound management following debridement and revascularisation.</p><p><strong>Results: </strong>ERB occurred exclusively in the interface group (9/28, 32.1%) and was not observed in the covered group (0/41). ERB events were observed only prior to stable soft-tissue or flap coverage. Graft thrombosis (14.3% vs 4.9%), wound infection (10.7% vs 2.4%) and secondary amputations (7.1% vs 0%) were more frequent in the interface group. Overall limb salvage was 97.1%. Two ERB risk windows were observed: postoperative days 7-10 (mechanical) and 18-30 (infection-related).</p><p><strong>Conclusions: </strong>NPWT may be incorporated into staged wound management following combat-related extremity vascular reconstruction; however, outcomes differed according to the soft-tissue coverage strategy employed. Application of NPWT near exposed vascular repairs was associated with a higher ERB rate and should be considered a short-term temporising strategy when immediate definitive coverage is not feasible, and only within a controlled Role IV environment. Early definitive soft-tissue or muscle coverage remains the preferred protective strategy whenever feasible.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515963","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":"Feasibility of a 1-day course to teach cold water immersion to medical practitioners.","authors":"Felix Wood, P Gimson, T Leckie, G Jones, R Hemingway, A Hartle, C Kipps, M J Stacey","doi":"10.1136/military-2024-002866","DOIUrl":"10.1136/military-2024-002866","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"188-189"},"PeriodicalIF":1.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053857","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}