Bmj Military Health最新文献

{"title":"Military personnel should be fit and move well: emphasising functional movement throughout service careers.","authors":"Sarah J De La Motte, Shelley J Walls, Joanne L Fallowfield","doi":"10.1136/military-2026-003459","DOIUrl":"https://doi.org/10.1136/military-2026-003459","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116727","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":"Care of the dying patient in austere environments: a systematic review.","authors":"Victoria Shaw, William Hutton, Leo Bandurka, Jodie Blackadder-Weinstein, Kate King","doi":"10.1136/military-2026-003388","DOIUrl":"https://doi.org/10.1136/military-2026-003388","url":null,"abstract":"<p><strong>Introduction: </strong>Deployed end-of-life care represents an area of increasing importance amidst near-peer conflicts where air superiority is no longer guaranteed. This complex intersection of medical ethics and battlefield realities is an area where current doctrine is lacking. This leaves soldiers and military clinicians vulnerable to moral injury, without a clear decision-making framework. This systematic review explores the existing literature surrounding end-of-life care, euthanasia, reverse triage and end-of-life decision-making in austere environments.</p><p><strong>Methods: </strong>A systematic search of MEDLINE, CINAHL, Embase and Web of Science databases (inception October 2024) was performed using exhaustive terms, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. The search was limited to English-language publications in peer-reviewed journals. Citation searching of included articles' references was also conducted to identify peer-reviewed publications and applicable grey literature. Papers were reviewed by a minimum of two reviewers to determine inclusion. Each study was assessed for quality and bias.</p><p><strong>Results: </strong>A total of 32 studies were included. Internal factor analysis was structured using the Training, Equipment, People, Infrastructure, Doctrine, Clinical, Organisation, Information, and Logistics framework. Of the framework headings, training was most frequently referenced, resulting in a focus on the practical changes that should be made to the training of our service personnel in preparation for expectant casualty care delivery.</p><p><strong>Conclusions: </strong>End-of-life care in the deployed space is an ethical and operational necessity. With the current move from Battlefield Advanced Trauma Life Support to Tactical Combat Casualty Care within the British military and the resulting review of protocols, there is an urgent need to harmonise doctrinal frameworks across NATO. Developing prolonged casualty care training for medical service personnel and the surrounding logistics and leadership will ensure that dignity and comfort at the end of life is not neglected in the fog of war.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116763","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 ethics meets operations: universal medical obligations and NATO doctrine.","authors":"Daniel J Hurst, Christopher Bobier, Jeanne A Krick","doi":"10.1136/military-2026-003454","DOIUrl":"https://doi.org/10.1136/military-2026-003454","url":null,"abstract":"<p><p>The North Atlantic Treaty Organization's 2025 Allied Medical Publication 8.19: Military Healthcare Ethics standardisation agreement affirms a universal obligation to provide life-preserving, limb-preserving and function-preserving emergency care without discrimination, while cautioning military healthcare personnel against delivering care that exceeds standards sustainable within the local health system or that cannot be followed by appropriate continuity of care. These provisions create unresolved ethical tensions. First, tying permissible care to the capacity of a degraded local health system risks conflating descriptive limitations with normative standards of care. Second, while the companion Allied Joint Medical Publication 6 requires military providers to pursue care through the patient's recovery stage, it simultaneously encourages transfer to civilian providers at the earliest suitable opportunity without defining either endpoint. Third, the doctrine mandates emergency intervention even when clinicians know that necessary rehabilitation, reconstructive surgery, prosthetic services or psychological support will be unavailable, despite warning that sophisticated treatment without follow-up may itself be unethical. Universal medical ethics and operationally bounded military doctrine remain in structural tension, but the resolution of that tension will properly differ according to the specific military mission and the role assigned to military medical services within it.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116854","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":"Use of forward mounted radiology in an arduous military training environment.","authors":"Lucy Hammett, Jacob Henry Matthews, Noa Docherty, Daniel J Bond","doi":"10.1136/military-2026-003478","DOIUrl":"https://doi.org/10.1136/military-2026-003478","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116872","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":"Qualitative insights on war-related abuses and health consequences: perspectives from Ukrainian veterans and former prisoners of war.","authors":"Lynn Lieberman Lawry, Bharathi Radhakrishnan, Kimberly T Johnson-Boua, Vivitha Mani, Amandari Kanagaratnam, Olena Nesterova, Olga Gvozdetska, Dmytro Martsenkovskyi, Anastasiia Bibikova, Christine Dahl, Jana Asher","doi":"10.1136/military-2026-003437","DOIUrl":"https://doi.org/10.1136/military-2026-003437","url":null,"abstract":"<p><strong>Introduction: </strong>The Russian invasion of Ukraine in February 2022, following the conflict in 2014, resulted in indiscriminate shelling, systematic torture and conflict-related sexual violence (CRSV), suggesting possible war crimes and crimes against humanity (WCCAH). This study explores the experiences of Ukrainian veterans and former prisoners of war (POWs) since 2014 to systematically document reported abuses and inform accountability.</p><p><strong>Methods: </strong>We conducted a series of semistructured key informant interviews (KIIs) of 40 Ukrainian veterans and former POWs (20 male, 20 female) from the 2014 and 2022 invasions between August and November 2025. The KII instrument contained 32 open-ended questions covering demographics, abuses, psychological impact and justice. Data analysis involved qualitative thematic analysis with quantitative descriptors from coded interviews.</p><p><strong>Results: </strong>Participants reported numerous abuses consistent with previously documented WCCAH including attacks on civilian infrastructure; systemic torture, beatings, electrocution, starvation, denied medical care, deliberate targeting of Ukrainian nationality, unlawful killings of civilians and hors de combat; and CRSV targeting both male and female captives and civilians. Internally, female veterans reported facing discrimination, restrictive roles and military sexual assault. Self-reported trauma symptoms consistent with post-traumatic stress disorder, anxiety, depression, sleep disturbances and moral injury were cited as major consequences of the wars.</p><p><strong>Conclusions: </strong>Reported incidents appear deliberate and widespread and may constitute violations consistent with WCCAH. Psychosocial barriers undermine protection and prevention efforts for justice. Stigma, particularly for male survivors of CRSV, and fear of harming loved ones still in captivity obstruct evidence-gathering and truth-telling. Self-reporting of severe trauma symptomatology necessitates an immediate humanitarian response prioritising recovery of veterans and former POWs through structured, accessible, long-term psychological and psychiatric services. Restrictive roles, discrimination and military sexual assault reveal a need to establish mechanisms that combat internal sexual violence and reinforce professional military hierarchy.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116866","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":"Hypothalamic thermoregulatory dissonance: vertical temperature gradients may increase peripheral cold weather injury risk in deployed medical facilities.","authors":"Isabel S Austin, Jonathon Lowe","doi":"10.1136/military-2026-003493","DOIUrl":"https://doi.org/10.1136/military-2026-003493","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082341","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":"Difference in the prevalence of metabolic syndrome components between male pilots of the Republic of Korea Air Force and the general Korean male population: a cross-sectional comparative study.","authors":"Boncho Ku, Du Hyun Song","doi":"10.1136/military-2026-003444","DOIUrl":"https://doi.org/10.1136/military-2026-003444","url":null,"abstract":"<p><strong>Introduction: </strong>Military pilots are selectively healthy, yet face unique aeromedical stressors. Their metabolic risk has rarely been compared with a contemporaneous, age-matched national male cohort.</p><p><strong>Methods: </strong>This cross-sectional study compared male Republic of Korea Air Force (ROKAF) pilots who underwent routine pilot health examinations (2021-2022) with men from the 2022 Korea National Health and Nutrition Examination Survey (KNHANES); metabolic syndrome (MetS) was defined by combined criteria for Asian men. Logistic regression was used to determine crude and adjusted ORs for overall MetS and for each of the five individual MetS criteria, adjusting for age, smoking, alcohol consumption and exercise.</p><p><strong>Results: </strong>We analysed 2604 ROKAF pilots and 1093 men from KNHANES. MetS prevalence was 11.1% in pilots versus 37.1% in KNHANES (adjusted OR 0.30 (95% CI 0.24 to 0.36), p<0.001). Four of five components were less prevalent in pilots (adjusted ORs 0.18-0.79, all p≤0.009); the elevated-blood-pressure component was paradoxically more prevalent (47.7% vs 38.8%; adjusted OR 2.12 (95% CI 1.80 to 2.52), p<0.001). The lower MetS risk in pilots was robust across age strata and component-variable quartiles. After full adjustment for age, lifestyle, body mass index (BMI), and cardiometabolic medication use, four biomarkers retained significantly stronger associations with metabolic syndrome (MetS) in pilots: fasting glucose (Δβ 0.98, p<0.001), urate (Δβ 0.27, p=0.009), low-density lipoprotein cholesterol (LDL-C) (Δβ 0.24, p=0.022), and total cholesterol (Δβ 0.20, p=0.049).</p><p><strong>Conclusions: </strong>ROKAF pilots have a substantially lower MetS prevalence than the general male Korean population in the same working-age range, consistent with a strong healthy-worker effect. Yet their MetS phenotype is asymmetrical; pilots fulfil MetS criteria predominantly through elevated BP and glycaemic pathways rather than adiposity or dyslipidaemia. Urate is informative in pilots but not in the general population, supporting targeted aeromedical screening of BP, fasting glucose and urate.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082403","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":"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":"435-441"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","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":"Reach-back to subject matter experts improves healthcare quality, influences the decision to evacuate and reduces costs: an observational study of the UK Defence Medical Services Deployed Telemedicine System.","authors":"Richard J Booker, A Hunter, D Sharpe, M Claydon, O Bartels, D N Naumann","doi":"10.1136/military-2024-002941","DOIUrl":"10.1136/military-2024-002941","url":null,"abstract":"<p><strong>Introduction: </strong>The UK Defence Medical Services (DMS) have used the medical instant messaging application Pando (Forward Clinical, London) since 2019. This application is used to deliver a deployed telemedicine system comprising a wide range of specialist advice teams. We report an 18-month evaluation of workload, user experience and military effect.</p><p><strong>Methods: </strong>Server data pertaining to the 'Ask Advice' function from 1 January 2023 to 30 June 2024 were analysed retrospectively. During the same period, a voluntary online, anonymous survey was offered to all requestors of advice, evaluating the impact of advice on evacuation decision-making, estimations of costs saved and healthcare quality.</p><p><strong>Results: </strong>There were 833 eligible advice conversations during the study period. The three most frequently consulted specialties were trauma and orthopaedics, hand surgery, and ear, nose and throat. There were 274 responses to the survey. 168/274 (61%) responses reported that telemedicine had changed the evacuation priority. 102/274 (37%) responses reported cost savings and 245/274 (89%) responses said that the quality of healthcare was improved.</p><p><strong>Conclusions: </strong>The DMS Deployed Telemedicine System is used most days, and users report improvement in healthcare quality for patients. There has been a meaningful impact on the decision to evacuate service persons, with the likelihood of significant cost savings. Benefits may be realised during warfighting activity if assured bearers and bandwidth can be provisioned to military medical services.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"423-428"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701857","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 defence-focused mental health curriculum for GPs: a Delphi study.","authors":"Adrian Mark Hucks, Luke Baker, Toby James Holland","doi":"10.1136/military-2025-003174","DOIUrl":"10.1136/military-2025-003174","url":null,"abstract":"<p><strong>Background: </strong>The role of a Defence General Practitioner (DGP) is beyond the scope of an NHS GP due to their extended role that includes clinical leadership, pre-hospital emergency medicine, occupationally focussed primary care, operational medicine and force health protection.</p><p><strong>Aim: </strong>To develop a Defence-specific mental health (MH) curriculum for DGPs.</p><p><strong>Methods: </strong>This study is a two-step process using DGPs and Defence psychiatrists: step one developed a draft curriculum based on Royal College of General Practitioners (RCGP) guidance with supplemental material from the literature and internal Defence policy. Step two used a Delphi process to reach a consensus on the final curriculum.</p><p><strong>Results: </strong>A 43-point curriculum comprising seven learning objectives (LOs), each with explanatory training objectives (TOs), was produced. One proposed objective was removed in the last round of the Delphi. Round one had 87 responses, with 23 objectives agreed. Round two had 25 responses and 10 objectives agreed. Round three saw the remaining 10 objectives agreed by 16 responses. These objectives represent a consensus of what is expected of DGPs in the management of MH problems.</p><p><strong>Conclusion: </strong>The defined DGP MH curriculum differs from the core RCGP curriculum. It will aid the development and delivery of DGP education, supporting the MH treatment options within Defence.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"471-475"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145543312","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}