Bmj Military Health最新文献

{"title":"Prevalence of axial spondyloarthritis among military draft-eligible populations in South Korea: national and regional trends over recent decades.","authors":"Hong Jin Kim, P W Yoon, J Y Yoon, D-H Lee, E Cho, S M Park, S Park, J-K Moon","doi":"10.1136/military-2024-002901","DOIUrl":"https://doi.org/10.1136/military-2024-002901","url":null,"abstract":"<p><strong>Introduction: </strong>Axial spondyloarthritis (axSpA) is a chronic inflammatory disorder characterised by inflammation of the axial manifestations. For the military draftees, there are no epidemiological data on axSpA in nationwide and population-based databases. This retrospective, nationwide and population-based study aimed to assess the national and regional trends in axSpA prevalence among draft-eligible military populations in South Korea between 2014 and 2023.</p><p><strong>Methods: </strong>The study included 3 063 805 males examined by the Regional Military Manpower Administration. The annual nationwide prevalence was presented as the prevalence per 10 000 and a 95% CIs. The severity of axSpA was assessed using radiographic scoring of the sacroiliac joint based on the New York criteria. Regional trends of axSpA were evaluated for Seoul, metropolitan areas and provinces, categorised according to transportation accessibility.</p><p><strong>Results: </strong>The nationwide prevalence of axSpA increased from 10.75 (95% CI 9.68 to 11.81) in 2014 to 21.18 (95% CI 19.37 to 23.00). The prevalence of radiographic axSpA (r-axSpA) followed a similar upward trend, whereas the prevalence of non-radiographic axSpA (nr-axSpA) remained stable. The prevalence of r-axSpA (52.73% in 2015 and 79.52% in 2019) was higher than that of nr-axSpA. Meanwhile, r-axSpA patients with grade 3 sacroiliitis showed the highest prevalence during the recent 3-year follow-up. The mean regional prevalence of nr-axSpA differed significantly among the three regions (p=0.013), whereas there were no differences in the prevalence of r-axSpA (p=0.084).</p><p><strong>Conclusions: </strong>This epidemiological study revealed an increasing trend in the nationwide prevalence of axSpA over the past decade, primarily driven by an increase in moderate-grade r-axSpA. Therefore, early recognition and awareness of axSpA in young males are essential for initiating appropriate treatment options to slow disease progression.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086884","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":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/military-2025-003046","DOIUrl":"https://doi.org/10.1136/military-2025-003046","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080599","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":"Fatigue and management of warfighter mental endurance.","authors":"Arnaud Rabat, J Van Cutsem, S M Marcora, A Lambert, R Markwald, A G Kubala, K E Friedl","doi":"10.1136/military-2025-002963","DOIUrl":"https://doi.org/10.1136/military-2025-002963","url":null,"abstract":"<p><p>Mental fatigue (MF) is a psychobiological state induced by prolonged exertion that has the potential to reduce performance. In military operations, MF coincides with inadequate sleep, circadian disruption and other stressors, further increasing the risk of fatigue-related errors of judgement and reduction in physical and psychological performance. Experienced leaders can detect MF, but multimodal monitoring and assessment technologies still cannot duplicate this capability. Experiments to define signals that cue this human percept could inform future technologies. Countermeasures include engagement strategies, brain endurance training to extend physical endurance, and caffeine and modafinil to temporarily sustain performance. An infrastructure for physiological monitoring and integrated analyses will advance team performance enhancement, along with the use of explainable and interpretable artificial intelligence modelling, refined through iterative experimentation. More precise definitions that distinguish MF from other types of fatigue will help advance the development of monitoring technologies and countermeasures by targeting the right physiological and behavioural metrics.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054600","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":"Illustrative case series of eosinophilia in UK Armed Forces personnel and recommended management for non-specialists.","authors":"Matthew J W Kain, C Hughes, W Nevin, S Defres, A Checkley, M Bailey, M K O'Shea, T Fletcher, N J Beeching, S Woolley","doi":"10.1136/military-2024-002883","DOIUrl":"https://doi.org/10.1136/military-2024-002883","url":null,"abstract":"<p><p>Peripheral eosinophilia (>0.5×10⁹/L) in the full blood count is caused by a variety of infectious and non-infectious aetiologies. Of particular importance to the UK military are parasitic infections, especially in individuals recruited from overseas and those who have deployed to areas that are highly endemic for schistosomiasis, strongyloidiasis and soil-transmitted helminths. These infections may persist for decades without causing symptoms. UK Armed Forces (UKAF) personnel have recently presented with more severe forms of strongyloidiasis, which can be fatal, especially following immunosuppression for chronic non-communicable diseases. Most uncomplicated infections respond to oral ivermectin or oral praziquantel, which are easy to take and generally well tolerated. We present the histories of three UKAF personnel to raise awareness of these infections, and we describe a framework for the initial investigation and management of people found to have eosinophilia in military primary care settings, together with indications for onward referral to infection or haematology specialists. Furthermore, given their relatively unknown prevalence in the UKAF Forces population, increased awareness and seroprevalence studies may be beneficial.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054646","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":"Diagnostic accuracy and reliability of equations for the calculation of body fat mass percentage in the Colombian military population: a diagnostic test study.","authors":"Syndy Guarin-Rivera, J Utria-Munive, K Estrada-Orozco","doi":"10.1136/military-2024-002944","DOIUrl":"https://doi.org/10.1136/military-2024-002944","url":null,"abstract":"<p><strong>Introduction: </strong>Body composition is a crucial health indicator, particularly in military settings, where optimal physical fitness directly impacts performance and operational readiness. Accurate assessment of body fat and muscle mass is essential for identifying health risks, such as chronic diseases, and for improving soldiers' physical capabilities.</p><p><strong>Methods: </strong>Study of diagnostic accuracy and reliability. A total of 947 adults belonging to the military forces in Colombia were included through consecutive sampling. People with the whole spectrum of body composition (normal weight, overweight and obesity) participated, recreating their prevalence in the Colombian population. Sensitivity (Se), specificity (Sp) and accuracy of the US Army (E1), Deurenberg (E2), CUN-BAE (E3) and Woolcott (E4) equations were calculated, using bioelectrical impedance analysis (BIA) as reference standard. For test-retest and inter-rater reliability, kappa and weighted kappa were used.</p><p><strong>Results: </strong>Of the total participants, 92% were men, with a median age of 35 years in men and 33 years in women. 65.4% were physically active (150 min per week). Diagnostic accuracy demonstrated the following performance in obesity classification for the equation used in the US military (Se: 100%, Sp: 88.1%; 95% CI 85.3% to 90.6%), E2 (Se: 91.6%; 95% CI 87.5% to 94.7%, Sp: 86.6%; 95% CI 83.7% to 89.3%), E3 (Se: 96.8%; 95% CI 93.8% to 98.6% Sp: 67.9%; 95% CI 64% to 71.7%) and E4 (Se: 96.4%; 95% CI 93.3% to 98.3%, Sp: 57.9%; 95% CI 53.9% to 61.9%). For overweight classification, performance was found in E2 (Se: 71.5%; 95% CI 66.3% to 76.3%, Sp: 72.3%; 95% CI 68.2% to 76.1%) and E3 (Se: 47.9%; 95% CI 42.4% to 53.4%, Sp: 73.8%; 95% CI 69.8% to 77.6%). For normweight classification, E2 was found to perform (Se: 50.2%; 95% CI 44.1% to 56.3%, Sp: 95.7%; 95% CI 93.7% to 97.2%) and E3 (Se: 42.8%; 95% CI 36.8% to 48.9%, Sp: 98.8%; 95% CI 97.5% to 99.5%). For all equations, their reliability is excellent.</p><p><strong>Conclusions: </strong>The US Army equation, when applied to the Colombian military population, presents greater accuracy for classifying obesity when compared to BIA. For the overweight and normal weight category, the Deurenberg equation performs better.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045997","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":"Self-reported hormonal contraceptive use in the British Armed Forces.","authors":"Sarah J Myers, T J O'Leary, R Knight, J P Greeves","doi":"10.1136/military-2025-002960","DOIUrl":"https://doi.org/10.1136/military-2025-002960","url":null,"abstract":"<p><strong>Introduction: </strong>Hormonal contraceptives contain synthetic oestrogens and/or progestogens that can alter the endogenous production of oestradiol and progesterone, which potentially affect aspects of health and performance important for military employment. The nature of military service-operating away from home for prolonged periods, often in austere environments-might influence the choice of hormonal contraceptives of servicewomen. Hormonal contraceptive use and the primary reasons for use in British servicewomen are poorly understood.</p><p><strong>Methods: </strong>All trained servicewomen in the UK Armed Forces (N=14 500) with an active email were invited to respond to an online questionnaire. The questionnaire asked about demographics, current hormonal contraceptive use and reasons for choosing to use hormonal contraceptives. The survey was open for 3 months.</p><p><strong>Results: </strong>A total of 3395 servicewomen completed the questionnaire (23% response rate). Hormonal contraceptives were currently used by 58% of servicewomen. The most common methods were the contraceptive pill (20% of all respondents) and the intrauterine system (17%). The main reasons for using hormonal contraceptives were to prevent pregnancy (78%) and to control or stop the menstrual cycle (61%).</p><p><strong>Conclusions: </strong>A high proportion of UK servicewomen use hormonal contraceptives, particularly younger women, with the contraceptive pill the most popular method. The high proportion of women using hormonal contraceptives to control or stop menstrual bleeding is likely determined by the unique cultural and environmental barriers of military employment.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025231","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":"Reciprocal relationships between social support and depression among military cadets in Taiwan: findings from a long-term cross-lagged panel analysis.","authors":"Nai-Lin Wang, P L Chiu","doi":"10.1136/military-2024-002929","DOIUrl":"https://doi.org/10.1136/military-2024-002929","url":null,"abstract":"<p><strong>Introduction: </strong>This study examines the reciprocal relationship between social support and depressive symptoms among military cadets in Taiwan, a population facing unique academic and military pressures. While emerging adults are prone to mental health challenges, they encounter additional stressors such as strict hierarchies and separation from family. Social support is known to be a protective factor, yet its long-term effects and bidirectional relationship with depression remain underexplored, particularly in collectivist military cultures where mental health may be stigmatised. Using a cross-lagged panel model with three waves of data, this study also explores whether this relationship varies by gender.</p><p><strong>Methods: </strong>A secondary analysis of longitudinal data was conducted from the \"Career Development of Military Academy Students\" project, which surveyed all Taiwanese military academy students from the 111th class across three waves (W1-W3). The final sample consisted of 898 students (73.2% male, average age=20.9) from six military academies. To analyse the bidirectional relationship between social support and depression, autoregressive cross-lagged panel analysis using structural equation modelling (SEM) was employed. Multigroup SEM was used to assess gender difference.</p><p><strong>Results: </strong>The cross-lagged panel model revealed reciprocal effects between social support and depression in the overall sample, evident only between W1 and W2. From W2 to W3, depression influenced perceived social support, with a stronger effect observed in males than females. These results underscore the unique dynamics of social support and depression in military contexts, particularly for females, where the relationship appears more complex.</p><p><strong>Conclusions: </strong>The findings highlight the need for both systemic support structures and individualised interventions in military settings, considering gender differences and the evolving nature of mental health challenges. By addressing these factors, military leaders and mental health professionals can better support cadets in managing stress and depression, fostering a more resilient and mentally healthy military community.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057309","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":"Initial opioid prescribing practices among providers treating an opioid-naïve US military sample.","authors":"Jenneth Carpenter, R S Adams, A Linton, K B Highland, M Bauer, G Zolotusky, N Moresco, M J Larson","doi":"10.1136/military-2024-002937","DOIUrl":"https://doi.org/10.1136/military-2024-002937","url":null,"abstract":"<p><strong>Introduction: </strong>General opioid prescribing has decreased in response to practice guidelines and policy changes, but information on recent practices in initial opioid prescribing is needed to support interventions to reduce the risk of long-term opioid prescription use.</p><p><strong>Methods: </strong>This cross-sectional study examined Military Health System data between 1 October 2015 and 30 September 2021 to explore initial opioid prescriptions and prescribing practices among providers serving 1.66 million US service members. We compared the characteristics of a subgroup (n=372 960) receiving an initial opioid within 7-24 months after study entry with those of the sample as a whole. We described characteristics of initial opioid prescriptions, including healthcare encounters associated with those prescriptions, prescriber characteristics and opioid prescribing practices.</p><p><strong>Results: </strong>The analytic sample was composed of 1 666 019 service members, 372 960 of whom filled an initial opioid prescription 7-24 months after study entry. The analytic sample was 83% assigned male; 58% white, non-Hispanic, 16% black, non-Hispanic and 15% Hispanic; and had a mean age of 27 (8.02). Initial opioid fills had a median days' supply of four (IQR 3.0-5.0) and milligram morphine equivalents (MME) of 30 (IQR 20-50). 10% of prescribers wrote the majority (64%) of initial opioid fills, representing 67% of total initial opioid MME. Dental encounters were associated with 38% of initial opioid fills, and 19% of fills were associated with musculoskeletal conditions. Dentists were associated with 32% of total initial opioid fills and 25% of total initial opioid MME.</p><p><strong>Conclusions: </strong>During recent years in the Military Health System, dental care was an important driver of initial opioid receipt among a relatively young population with full dental coverage. Similar populations may benefit from interventions that support dental providers in maintaining within-guideline prescribing practices.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002245","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":"Arboviruses in UK Armed Forces: a review of historical cases and identification of future threats.","authors":"Matthew J W Kain, M Eskell, B Clark, C Lambert, E Weaver, G Holden, M A Dermont, N J Beeching, T Fletcher, S Woolley","doi":"10.1136/military-2025-002987","DOIUrl":"https://doi.org/10.1136/military-2025-002987","url":null,"abstract":"<p><strong>Introduction: </strong>Arboviruses are a diverse group of arthropod-borne pathogens and are emerging global public health threats with no approved therapeutics. Arboviruses are spreading rapidly, posing a health threat to UK Armed Forces (UKAF) service personnel (SP) through deployment to endemic regions. There are limited data on the burden of arboviral infections in UKAF SP.</p><p><strong>Methods: </strong>A retrospective service evaluation of UKAF electronic healthcare records (eHRs) and statutory notifications to the Defence Public Health Unit was conducted. Cases with possible/confirmed dengue, chikungunya or Zika virus infections between 2005 and 2023 were included. eHRs were interrogated and trends analysed.</p><p><strong>Results: </strong>Of 107 suspected infections between 2005 and 2023, 49 (45.8%) were laboratory-confirmed. Dengue fever was the most common (45/49) followed by chikungunya (3/49) and Zika (1/49) virus infections. The average yearly incidence of reported dengue infection increased from 0.51 cases per 100 000 UKAF SP per year in 2009-2011 to 3.85 cases per 100 000 SP per year in 2021-2023. 19/45 (42.2%) cases occurred during operational deployments and 24/45 (53.3%) during non-military activity. Dengue infection was most frequently acquired in Southeast Asia.Using WHO clinical severity criteria, 33/45 (73.3%) had dengue with warning signs and 5 (11.1%) had severe dengue. 23/45 (51.1%) dengue cases were hospitalised (median length of stay 5 days, IQR 3, range 1-9). No dengue fatalities or medical discharges occurred. Occupational impact was significant, with a median of 11 days stood down (IQR 10, range 0-45); 3/19 (15.8%) cases on operations required aeromedical evacuation (AEROMED). One deployed case of chikungunya required AEROMED and a 35-day downgrade.</p><p><strong>Conclusions: </strong>Reports of arboviral infections, particularly dengue, are increasing in UKAF personnel, presenting an emerging health threat. This has implications for UKAF provision of deployed diagnostics and dengue vaccination policy. The rapid spread of arboviruses outside their traditional geographical areas, including into Europe, necessitates further surveillance and requires diagnostic and therapeutic research.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062783","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":"Evolution of suicide in the Guardia Civil over a 39-year period (1982-2020): a retrospective case-control cohort study.","authors":"Lucas Giner, S Sanz-Gómez, A M Moya-Fernández, B J Florido-Vera, A Alacreu-Crespo, J A Guija","doi":"10.1136/military-2024-002908","DOIUrl":"https://doi.org/10.1136/military-2024-002908","url":null,"abstract":"<p><strong>Introduction: </strong>There is a discussion whether military and police corps show increased suicide rates, as the line of work is characterised by both protective and risk factors for suicidality. To examine deaths by suicide rates and trends in the Spanish Guardia Civil as compared with the general population.</p><p><strong>Methods: </strong>This is a retrospective case-control cohort study. Guardia Civil provided data on suicides on the corps and total number of personnel per year for the period 1982-2020. Annual suicide rates were calculated. Suicide rates of age, gender and employment status equivalent control group were calculated for comparison purposes. These data were obtained from the Instituto Nacional de Estadística. Suicide trends for both groups and divided by sex were analysed through joinpoint regression analysis. Differences between groups were assessed through the Wilcoxon signed rank test.</p><p><strong>Results: </strong>An uninterrupted downward trend without joinpoints was estimated for suicides in Guardia Civil during the complete study period. Annual percentage change for the total of Guardia Civil was -1.75, while for men it was -3.02. Suicide rates of men in Guardia Civil were higher than those of men in the active population by 60.7% in the period 1999-2009 (p=0.008). However, no differences between groups were found for the period 2010-2020 (p=0.297).</p><p><strong>Conclusions: </strong>The suicide rate in the Guardia Civil has progressively decreased, now comparable to the active population. This decline may result from suicide prevention programmes and policy changes. Ongoing efforts to identify risk factors and improve interventions remain crucial to further reducing suicidality.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025665","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}