Bmj Military Health最新文献

{"title":"Optimisation of mitochondrial function as a novel target for resuscitation in haemorrhagic shock: a systematic review.","authors":"Laura Cottey, J E Smith, S Watts","doi":"10.1136/military-2023-002427","DOIUrl":"10.1136/military-2023-002427","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic injury is one of the leading causes of death worldwide, and despite significant improvements in patient care, survival in the most severely injured patients remains unchanged. There is a crucial need for innovative approaches to improve trauma patient outcomes; this is particularly pertinent in remote or austere environments with prolonged evacuation times to definitive care. Studies suggest that maintenance of cellular homeostasis is a critical component of optimal trauma patient management, and as the cell powerhouse, it is likely that mitochondria play a pivotal role. As a result, therapies that optimise mitochondrial function could be an important future target for the treatment of critically ill trauma patients.</p><p><strong>Methods: </strong>A systematic review of the literature was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol to determine the potential role of mitochondria in traumatic injury and haemorrhagic shock (HS) and to identify current evidence for mitochondrial optimisation therapies in trauma. Articles were included if they assessed a mitochondrial targeted therapy in comparison to a control group, used a model of traumatic injury and HS and reported a method to assess mitochondrial function.</p><p><strong>Results: </strong>The search returned 918 articles with 37 relevant studies relating to mitochondrial optimisation identified. Included studies exploring a range of therapies with potential utility in traumatic injury and HS. Therapies were categorised into the key mitochondrial pathways impacted following traumatic injury and HS: ATP levels, cell death, oxidative stress and reactive oxygen species.</p><p><strong>Conclusion: </strong>This systematic review provides an overview of the key cellular functions of the mitochondria following traumatic injury and HS and identifies why mitochondrial optimisation could be a viable and valuable target in optimising outcome in severely injured patients in the future.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"269-274"},"PeriodicalIF":1.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9870888","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":"Impact of poor air quality while deployed on respiratory health: a systematic review.","authors":"Lucy G Williams, D Ross","doi":"10.1136/military-2023-002381","DOIUrl":"10.1136/military-2023-002381","url":null,"abstract":"<p><strong>Introduction: </strong>British military personnel deploy internationally to areas with high levels of ambient air pollution. Air pollution can cause acute respiratory symptoms which lead to concern about potential long-lasting health effects. There is a requirement for evidence-based policy on chronic respiratory disease associated with military deployments to areas with poor air quality (AQ). This literature review examines the published evidence relating to the development of chronic respiratory disease in military personnel after exposure to poor AQ while deployed.</p><p><strong>Methods: </strong>A literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Embase, MEDLINE and Global health databases were searched for English language studies published since 2014 examining the respiratory health of military personnel deployed to Southwest Asia since 2001. A quality appraisal of selected articles was conducted using the Critical Appraisals Skills Programme checklist and a descriptive review completed.</p><p><strong>Results: </strong>Eleven studies were found, eight of which had objective outcome measures. Two prospective cohort studies were included; the remainder of the data were retrospective.</p><p><strong>Conclusion: </strong>High rates of respiratory symptoms are reported by personnel who deploy to areas of poor AQ, giving rise to high levels of concern. Spirometry testing has found mild deficits, mostly of an obstructive nature, in a third of those with ongoing symptoms post deployment. These have not been consistently linked with deployment length. An increased risk of asthma appears to be multi-factorial in aetiology and there is no evidence for an increased risk of chronic obstructive pulmonary disease or histological pathology post deployment. At present, there is no definitive evidence of chronic respiratory disease due to exposure to poor AQ while deployed. Further objective longitudinal studies are required to continue to investigate the association, diagnosis and management of those with ongoing symptoms.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"256-261"},"PeriodicalIF":1.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9667361","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":"Abdominal aortic junctional tourniquet (AAJT-S): a systematic review of utility in military practice.","authors":"Stacey Webster, J E Ritson, E B G Barnard","doi":"10.1136/military-2023-002451","DOIUrl":"10.1136/military-2023-002451","url":null,"abstract":"<p><strong>Introduction: </strong>Haemorrhage is the leading cause of potentially survivable death on the battlefield. Despite overall improvement in battlefield mortality, there has been no improvement in survival following non-compressible torso haemorrhage (NCTH). The abdominal aortic junctional tourniquet-stabilised (AAJT-S) is a potential solution that may address this gap in improving combat mortality. This systematic review examines the evidence base for the safety and utility of the AAJT-S for prehospital haemorrhage control in the combat setting.</p><p><strong>Methods: </strong>A systematic search of MEDLINE, Cumulated Index to Nursing and Allied Health Literature and Embase (inception to February 2022) 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; grey literature was not included. Human, animal and experimental studies were included. Papers were reviewed by all authors to determine inclusion. Each study was assessed for level of evidence and bias.</p><p><strong>Results: </strong>14 studies met the inclusion criteria: 7 controlled swine studies (total n=166), 5 healthy human volunteer cases series (total n=251), 1 human case report and 1 mannikin study. The AAJT-S was demonstrated to be effective at cessation of blood flow when tolerated in healthy human and animal studies. It was easy to apply by minimally trained individuals. Complications were observed in animal studies, most frequently ischaemia-reperfusion injury, which was dependent on application duration. There were no randomised controlled trials, and the overall evidence base supporting the AAJT-S was low.</p><p><strong>Conclusions: </strong>There are limited data of safety and effectiveness of the AAJT-S. However, there is a requirement for a far-forward solution to improve NCTH outcomes, the AAJT-S is an attractive option and high-quality evidence is unlikely to be reported in the near future. Therefore, if this is implemented into clinical practice without a solid evidence base it will need a robust governance and surveillance process, similar to resuscitative endovascular balloon occlusion of the aorta, with regular audit of use.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"262-268"},"PeriodicalIF":1.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9746778","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":"Nine years of surgical activity in the deployed French military role 2 medical treatment facility in Mali.","authors":"Georges Pfister, P Aries, H de Lesquen, L Mathieu","doi":"10.1136/military-2023-002553","DOIUrl":"10.1136/military-2023-002553","url":null,"abstract":"<p><strong>Introduction: </strong>In January 2013, France launched a military operation in Mali, which ended in August 2022. This study aimed to analyse the global activity performed by a surgical team within the role 2 medical treatment facility (MTF) deployed in Gao during this period, in order to adapt medical battlefield support and combat casualty care teaching.</p><p><strong>Methods: </strong>A retrospective study was conducted using the French surgical database OpEX (French Military Health Service) from January 2013 to August 2022. All patients operated on were included.</p><p><strong>Results: </strong>During this period, 1298 patients with a median age of 29 (range: 23-38) years were included. Among them, 229 (17.6%) underwent a combat-related trauma surgery (CRTS), 234 (18.0%) underwent a non-CRTS, 167 (12.9%) underwent a non-trauma-related surgery and 668 (51.5%) underwent a scheduled surgery in the context of medical supply to the population.Among the CRTS group, 195 (85.2%) patients underwent an orthopaedic procedure, 73 (31.8%) required a general surgery. Finally, 15 (6.6%) wounded required a specialised surgery.</p><p><strong>Conclusions: </strong>In line with the activity described in the role 2 MTF deployed in other contemporary asymmetric conflicts, this activity is moderate, especially if only combat-related injuries are considered; medical support to the population occupied most of the surgical activity. For CRTS, most of the traumas are limb traumas. Other traumas are composed of various lesions, which are often life-threatening. This fact imposes the presence of an orthopaedic surgeon with the appropriate equipment, as well as a general surgeon with a wide range of skills, in asymmetric conflicts.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"202-206"},"PeriodicalIF":1.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50163302","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":"UK Armed Forces female hygiene in the austere environment.","authors":"Ruth Guest, A S Willman, V Kinkaid, T Holland, K King","doi":"10.1136/military-2023-002626","DOIUrl":"10.1136/military-2023-002626","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"282-283"},"PeriodicalIF":1.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724551","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":"Continuous rise in oxygen consumption during prolonged military loaded march in the heat with and without fluid replacement: a pilot study.","authors":"Courtney E Wheelock, J Stooks, J Schwob, D Hostler","doi":"10.1136/military-2023-002573","DOIUrl":"10.1136/military-2023-002573","url":null,"abstract":"<p><strong>Introduction: </strong>V̇O₂ drift, the rise in oxygen consumption during continuous exercise, has not been adequately reported during prolonged military marches. The purpose of this study was to analyse V̇O₂ and energy expenditure (EE) during a loaded march with and without rehydration efforts. Second, the study aimed to compare EE throughout the march with predicted values using a validated model.</p><p><strong>Methods: </strong>Seven healthy men (23±2 years; V̇O_2max: 50.8±5.3 mL/kg/min) completed four 60 min loaded marches (20.4 kg at 50% V̇O_2max) in a warm environment (30°C and 50% relative humidity). Three were preceded by hypohydration via a 4-hour cold water immersion (18°C). The control (CON) visit was a non-immersed euhydrated march. After water immersion, subjects were rehydrated with 0% (NO), 50% (HALF) or 100% (FULL) of total body mass lost. During exercise, V̇O₂ and EE were collected and core temperature change was calculated. To determine if EE could be accurately predicted, values were compared with a calculated estimate using the US Army Load Carry Decision Aid (LCDA).</p><p><strong>Results: </strong>At the start of exercise, there was no difference between conditions in V̇O₂ (ALL: 24.3±0.3 mL/kg/min; p=0.50) or EE (ALL: 8.6±1.0 W/kg; p=0.68). V̇O₂ (p=0.02) and EE (p<0.01) increased during exercise and were 12.3±10.0% and 12.8±9.5% greater, respectively, at 60 min across all trials and were not mitigated by rehydration amount. There was an effect of core temperature change on V̇O₂ for each condition (CON: r=0.62; NO: r=0.47; HALF: r=0.70; FULL: r=0.55). LCDA-predicted values were different from measured EE during exercise.</p><p><strong>Conclusion: </strong>V̇O₂ drift occurred during loaded military marches and was associated with increases in EE and core temperature change. Pre-exercise hypohydration with water immersion followed by rehydration did not influence the degree of drift. LCDA prediction of EE may not agree with measured values during prolonged loaded marches where V̇O₂ drift occurs.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"221-226"},"PeriodicalIF":1.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906659","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":"What is the medical requirement for a quick release system in a body armour vest?","authors":"John Breeze, D Bowley, J Russell, H Ej Pugh","doi":"10.1136/military-2023-002661","DOIUrl":"10.1136/military-2023-002661","url":null,"abstract":"<p><p>A quick release system is a method by which personal armour can be rapidly doffed by the disconnection of structural components using little force. There are slight variations in the design of quick release systems available in different personal armour systems worldwide, including the position of the activation device, how many points on the vest are released at one time and how many constituent parts the vest dismantles into. Limited evidence exists, however, to justify each of these differences. We believe the medical requirements for a quickrelease system include reducing mass and bulk for rapid escape in confined areas or when transporting casualties, optimising rapid medical assessment and fully enabling medical assessment and treatment. The aim of this paper is to provide multidisciplinary evidence to support the medical requirements for this component and thereby facilitate innovation and the optimisation of future body armour design.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"193-197"},"PeriodicalIF":1.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630332","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":"'Whether it's your weapon or not, it's your home': US military spouse perspectives on personal firearm storage.","authors":"Marian E Betz, K Meza, K Friedman, J Moceri-Brooks, M L Johnson, J Simonetti, J C Baker, C J Bryan, M D Anestis","doi":"10.1136/military-2023-002591","DOIUrl":"10.1136/military-2023-002591","url":null,"abstract":"<p><strong>Introduction: </strong>In the USA, an estimated 45% of veterans personally own firearms. Firearm access increases the risk of suicide, so suicide prevention efforts in the US Department of Defense (DoD) focus on lethal means safety, including reducing firearm access. Spouse input may enhance effective messaging and intervention delivery of lethal means safety. This study used qualitative methods to explore the perspectives of military spouses or partners on personal firearm storage, including at-home decisions, on-base storage and existing messaging from the DoD.</p><p><strong>Materials and methods: </strong>Qualitative data were obtained using 1:1 interviews and focus groups with spouses/partners of US military service members (active duty, Reserve, National Guard, recently separated from the military) and representatives from military support organisations. Sessions focused on personal firearm storage (at home or on military installations) and military messaging around secure firearm storage and firearm suicide prevention. Data were analysed using a team-based, mixed deductive-inductive approach.</p><p><strong>Results: </strong>Across 56 participants (August 2022-March 2023), the themes were variability in current home firearm storage and spousal participation in decision-making; uncertainty about firearm storage protocols on military installations; mixed awareness of secure firearm storage messaging from the military; and uncertainty about procedures or protocols for removing firearm access for an at-risk person.</p><p><strong>Conclusion: </strong>US military spouses are important messengers for firearm safety and suicide prevention, but they are currently underutilised. Tailored prevention campaigns should consider spousal dynamics and incorporate education about installation procedures.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"227-232"},"PeriodicalIF":1.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138886272","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":"History of childbirth as a potential risk factor for musculoskeletal injury in military personnel.","authors":"Chris Margaret Edwards, K B Adamo","doi":"10.1136/military-2023-002620","DOIUrl":"10.1136/military-2023-002620","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"277"},"PeriodicalIF":1.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138488797","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":"Psychometric properties, predictive utility and diagnostic capacity of the Persian version of the Scale of Resilience to Suicide Attempts in army conscripts.","authors":"Alireza Rashtbari, A M Rahnejat, A Taghva, L Jamil, A Sheykholeslami","doi":"10.1136/military-2023-002602","DOIUrl":"10.1136/military-2023-002602","url":null,"abstract":"<p><strong>Introduction: </strong>Suicide among army conscripts represents a poorly understood and complex public health issue that has escalated in recent decades. The early identification of individuals at risk holds the potential to significantly contribute to the effective prevention of suicide attempts. To address this, the Scale of Resilience to Suicide Attempts-18 (SRSA-18) has been developed to assess protective factors related to suicide attempts. The present study aimed to develop a Persian version of SRSA-18 (P-SRSA) and examine its psychometric properties and predictive utility within a sample of the Iranian Army.</p><p><strong>Methods: </strong>The initial study sample consisted of 400 male conscripts from the Iranian Army grand forces (M=19.86, SD=1.40). Subsequently, for the follow-up stage, 296 participants (M=19.83, SD=1.39) were recruited. The participants were assessed using various measures of resilience, social support, suicide and hopelessness at baseline and a 6-month follow-up.</p><p><strong>Results: </strong>In contrast to the original version, both exploratory and confirmatory factor analyses supported an 18-item two-factor model of the P-SRSA (root mean square error of approximation=0.076; 95% CI (0.069 to 0.086), comparative fit index=0.943, Tucker-Lewis index=0.936). P-SRSA strongly correlated with convergent/divergent measures and demonstrated satisfactory internal consistency (α=0.82). Furthermore, regression analysis revealed that the P-SRSA significantly predicted suicide reattempts at baseline and during a 6-month follow-up period.</p><p><strong>Conclusion: </strong>The study confirms that the P-SRSA, comprising a two-factor, 18-item solution, is a reliable measure of resilience, displaying robust discriminant and predictive validity. These findings provide substantial support for implementing P-SRSA in samples from the Iranian Army, highlighting its potential to identify suicidal conscripts effectively.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"233-238"},"PeriodicalIF":1.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139058932","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}