Bmj Military Health最新文献

{"title":"Oral tranexamic acid as a preferred administration route for severe trauma in the extreme cold weather environment.","authors":"Jonathon Lowe, M Warner, E Barnard","doi":"10.1136/military-2024-002915","DOIUrl":"10.1136/military-2024-002915","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"184"},"PeriodicalIF":1.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014370","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":"Optimising investigative pathways in military medicine: operational impact of a military cardiopulmonary exercise testing clinic.","authors":"Jennifer Louise Holland, P Cowie, L Gardner, J Mulae, S Richards, D A Holdsworth","doi":"10.1136/military-2024-002872","DOIUrl":"10.1136/military-2024-002872","url":null,"abstract":"<p><strong>Introduction: </strong>Abnormal cardiorespiratory symptoms and investigative findings in service personnel typically result in prolonged investigation and occupational restriction. This analysis aimed to assess the impact of the <i>O</i>xford <i>M</i>ilitary Cardiopulmonary <i>E</i>xercise Testing <i>C</i>linic (OMEC), which investigates such symptoms and findings, on occupational recommendations.</p><p><strong>Methods: </strong>A service evaluation was conducted on all OMEC attendances over a 5-year period. Referral indication and occupational grading, demographics, exercise testing parameters, clinical diagnosis and occupational recommendation were recorded.</p><p><strong>Results: </strong>141 individuals were reviewed. Mean age was 36 (±11.3) years, and 91% were male. Median waiting time for an appointment was 14.4 weeks (cf NHS 17.4 weeks).Individuals were referred for dyspnoea (22.1%), syncope (11.4%), chest pain (8.1%) (referred to as 'higher risk' symptom group), and pre-syncope (8.1%), palpitations (8.1%), and fatigue and/or exercise intolerance (6.0%) (referred to as 'lower risk' symptom group). 34% were asymptomatic with incidental findings on cardiac screening investigations. Reduced exercise capacity was rare, affecting only 11% of individuals, which was borderline/mild at worst.Median peak VO₂ (as a percentage of the predicted peak) was lower in the higher-risk symptom group than in the lower-risk symptom group (97.8% vs 121%; p<0.001). This was also seen for median workload as %PP (82.6% vs 98.0%; p<0.001). 80.5% of patients were given an immediate occupational recommendation; 78% of which were favourable outcomes (ie, a recommended occupational upgrade (72%) or to remain fully deployable (6%)).</p><p><strong>Conclusion: </strong>OMEC is tailored to the unique needs of the military population, providing outcomes that support operational requirements. Despite geographical distribution and operational commitments, OMEC waiting time is equivalent to the NHS, with the great majority of patients upgraded after attendance. These findings establish OMEC as a benchmark for military-specific clinical services based in public (NHS) hospitals, highlighting its role in facilitating rapid and effective occupational management.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"140-147"},"PeriodicalIF":1.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029684","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":"Low physical activity levels of military police officers during day and night radio patrolling.","authors":"Gabriele Zampero, I Trevisan, F Monma, J C Tinti, L P Dos Santos, T C P Lima, R Gorjão, S M Hirabara, T C Pithon-Cur, R Curi, F A Santa-Rosa, D R de Souza","doi":"10.1136/military-2024-002897","DOIUrl":"10.1136/military-2024-002897","url":null,"abstract":"<p><strong>Introduction: </strong>The São Paulo State Military Police officers have a higher mortality rate than the civilian population. The radio patrolling work (RP190) is carried out by pairs of military police officers (MPOs) for 12 hours, using a police vehicle, requiring physical capabilities at any moment. However, whether the activity performed by MPOs during operational work is within the sedentary or the physically active range classification requires investigation. This cross-sectional study measured and compared the number of steps performed by MPOs during night and day shift radio patrolling.</p><p><strong>Methods: </strong>The study participants included 170 MPOs with a median age of 35.0 (IQR: 29.0-43.0) years. All volunteers worked either the day (n=117) or night (n=53) shift and underwent step count analysis during the service shift using a Yamax pedometer (Digi-Walker SW 700, Tokyo, Japan). The data were normalised for pedometer wear time corresponding to the working service period. The MPOs in the radio patrolling programme wore the pedometer for 8.5 hours.</p><p><strong>Results: </strong>The results show that they took an average of 2516 (95% CI 2270 to 2632) and 295.8 (95% CI 278.1 to 313.5) steps during the whole service and per hour of service, respectively. No difference in the number of steps was observed during the day compared with the night shift (2574 (IQR: 1829-3371) vs 2485 (IQR: 1502-2821), p=0.131). However, when normalised for wear time of use, the number of steps was significantly higher in the day compared with the night group (311.7±119.1 vs 260.6±108.6, p=0.009, d=0.44).</p><p><strong>Conclusions: </strong>In conclusion, MPOs working the night shift are less physically active than MPOs working the day shift. Furthermore, MPOs' activity can be classified into the sedentary range independently of their shifts.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"160-163"},"PeriodicalIF":1.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123754","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 assessment of combat-related injury patterns and injury prevention in Ukraine since the Russian invasion.","authors":"Lynn Lieberman Lawry, V Mani, T E Hamm, M Janvrin, L Juman, J Korona-Bailey, J Maddox, O Berezyuk, A J Schoenfeld, T P Koehlmoos","doi":"10.1136/military-2024-002863","DOIUrl":"10.1136/military-2024-002863","url":null,"abstract":"<p><strong>Introduction: </strong>The ongoing invasion of Ukraine by the Russian Federation represents one of the largest ongoing conventional military engagements in the last 20 years. Since the start of the war, an estimated 210 000 Ukrainian soldiers have been injured or killed as a result of combat. This experience could help prognosticate the nature of large-scale combat operations for modern militaries. The aim of this study was to assess current patterns of injuries among military combatants in Ukraine and identify prevention and mitigation methods.</p><p><strong>Methods: </strong>We conducted a series of key informant interviews during the ongoing conflict using an expanded version of the global trauma system evaluation tool. We focused the analysis on injury patterns and prevention of combat-related injuries.</p><p><strong>Results: </strong>We interviewed 36 participants from June 2023 to February 2024. Respondents described complex polytrauma as representing the injury norm, with prominent battle injuries, including blast wounds to the extremities, traumatic brain injuries and spinal cord trauma. The primary source of injury prevention on the battlefield remains combat body armour. Military commanders and the Ministry of Defence were identified as principal bodies for the authorising equipment and tactical changes. Most respondents stated there was no formal process for using data to inform injury prevention initiatives.</p><p><strong>Conclusion: </strong>The current conflict in Ukraine is characterised by a high prevalence of devastating combat-related injury, with limited measures for battlefield injury prevention. We believe that the provision of additional protective gear could mitigate the severity of some combat-related injuries, while the creation of a trauma registry would provide greater insight into prevention, wounding patterns, treatment and outcomes.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"154-159"},"PeriodicalIF":1.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13018771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole System Approach to designing, implementing and measuring health and performance benefits of improving diet behaviour in a military setting.","authors":"Joanne L Fallowfield, J Carins","doi":"10.1136/military-2024-002861","DOIUrl":"10.1136/military-2024-002861","url":null,"abstract":"<p><p>Many employers-including the military-are experiencing systemic workforce capacity and capability challenges. This coincides with a time of declining workforce health, especially among military service entrants, where many performance-limiting health conditions are preventable if healthier behaviours are practised. Effectively tackling complex, interconnected health problems demands a multilevel, multicomponent Whole System Approach (WSA). However, despite recognition of the issues impacting international militaries, current policies and practices supporting healthy, performing workforces have failed. To arrest ill-health trends in personnel, military employers must develop transformational ways to support good health. This paper presents a military workplace WSA model, operationalised through COM-B to specifically target diet behaviour, supporting individual good health, promoting human performance and realising organisational benefits. The challenges of a military occupational setting to individual nutrition practices across the career are discussed. Finally, Impact Value Chain analysis is proposed to monitor system delivery and measure the effectiveness of an integrated, organisation-wide WSA.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"95-102"},"PeriodicalIF":1.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967142","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 residents' industrial action on military trainees.","authors":"Sara-Jane Marjorie Horne, G Davies, C Swain","doi":"10.1136/military-2024-002877","DOIUrl":"10.1136/military-2024-002877","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"185"},"PeriodicalIF":1.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792622","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":"Effects of undertaking defence engagement (health): a survey of serving personnel's experiences.","authors":"Harrison Charles Roocroft, S T Horne, Ian Gurney","doi":"10.1136/military-2024-002878","DOIUrl":"10.1136/military-2024-002878","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"182-183"},"PeriodicalIF":1.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683036","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":"Traumatic injuries and outcomes during the Libyan Civil War: a systematic review.","authors":"Mansour Abdulshafea, V Di Pietro, D Naumann, Z Ahmed","doi":"10.1136/military-2024-002943","DOIUrl":"10.1136/military-2024-002943","url":null,"abstract":"<p><strong>Introduction: </strong>The Libyan Civil War (LCW) is an ongoing internal armed conflict that started as a peaceful protest in February 2011, resulting in a power vacuum after the regime collapsed and an uncontrolled spread of arms, which caused a significant increase in violence and trauma. Our review aims to investigate the war-related epidemiology and mortality in patients who have been injured during this conflict.</p><p><strong>Methods: </strong>A systematic review was undertaken according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Embase, Web of Science and Cochrane Library databases were searched for studies published between February 2011 and May 2024. Studies were included if they involved patients with trauma during the LCW and outcomes of interest were type and anatomical distribution of injuries and mortality. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation.</p><p><strong>Results: </strong>Thirteen studies met the eligibility criteria, with a total sample size of 4665 patients. There were seven studies (n=4378 patients) that reported mortality rate, with 438 (10%) who died. 13 out of the 14 studies documented the mechanism of injury of their participants with a total number of 4543 injuries, most commonly from firearm-related trauma (60.3%). 12 studies recorded the anatomical distribution of their sample of 4123 anatomical sites, with extremities being the most affected part, accounting for 54.5% of injuries.</p><p><strong>Conclusion: </strong>The LCW has caused a high burden of morbidity and mortality among the Libyan population. This review provides an insight into the adverse health consequences of this active war and highlights the difficulties in collecting reliable information on the wounded during conflicts.PROSPERO registration numberCRD42024527289.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"115-121"},"PeriodicalIF":1.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13018792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infantry training outcomes: are they improved with an initial reduction in load carriage mass and additional sprint intensity exercise?","authors":"Herbert Groeller, P Larsen, J R Drain, N Gibson, M Kitcher, L Alfiero, B J Dascombe, J A Sampson","doi":"10.1136/military-2024-002765","DOIUrl":"10.1136/military-2024-002765","url":null,"abstract":"<p><strong>Introduction: </strong>Infantry is a physically demanding trade that is associated with elevated rates of musculoskeletal injury. A 17-week longitudinal intervention assessed the effect of a progressive increase in load carriage mass and sprint-intensity intervals on physical performance, physical complaints, medical encounters, physical activity and sleep in infantry trainees.</p><p><strong>Methods: </strong>91 infantry trainees from 2 separate platoons, randomly assigned as control (CON) or experimental (EXP), provided written voluntary consent. Both completed a 17-week training syllabus that included physical training and military education lessons. Compared with CON, EXP completed a modified regimen that included; a 25%-30% reduction in load carriage mass (weeks 1-4), sprint (weeks 1-7) and 3 min running intervals. Endurance, strength, power and functional performance were assessed (weeks 1, 6-8), physical activity and sleep were recorded using actigraphy (each day of training, weeks 1-17), with daily physical complaints tabulated (weeks 1-7) and frequency of medical encounters retrospectively extracted from defence health records (weeks 1-17).</p><p><strong>Results: </strong>On-time completion of training was attained in 93% and 79% of CON and EXP, respectively. Total load carriage mass (weeks 1-4) was 27% lower in EXP (10.1 kg/hour) than CON (13.9 kg/hour). Push-up repetitions in CON (5 reps) improved compared with EXP, with functional performance improving markedly in both groups (71 m, 23%). All other fitness assessments were similar between groups. No difference in sleep quality and quantity was observed between groups, with 77% and 16% of trainees sleeping <7 hours (suboptimal) and <6 hours (sleep restricted) per night, respectively. Physical complaints in CON were higher (62), despite no difference observed in medical encounters.</p><p><strong>Conclusions: </strong>The reduction in load carriage mass and inclusion of sprint interval training did not modify the adaptative or maladaptive responses to infantry training. Most trainees experienced chronic suboptimal sleep quantity and quality with over 15% classified as sleep restricted.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"134-139"},"PeriodicalIF":1.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014369","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 Defence Rehabilitation consensus agreement for the conservative management of Achilles and patellar tendinopathy: a modified Delphi approach.","authors":"Alice Judd, K Wild, L Puxley, R Barker-Davies","doi":"10.1136/military-2024-002893","DOIUrl":"10.1136/military-2024-002893","url":null,"abstract":"<p><p>Achilles and patellar tendinopathy are common in military personnel due to the repetitive high loads and challenging extrinsic risk factors associated with the demands of their role. Sports medicine is rapidly evolving. Up-to-date evidence-based research is essential, alongside clinical reasoning, to deliver best-practice treatment to service personnel, underpinned by the duty of care to their long-term career.The aim of this research was to develop recommendations on conservative management of Achilles and patellar tendinopathy in relation to the military population. A systematic review was conducted by a multidisciplinary clinical panel from across Defence Rehabilitation. The panel was split into four subgroups (diagnosis and outcome measures, medical, exercise and adjuncts). Each subgroup proposed recommendations for voting across the wider authorship in a modified Delphi process. 28 recommendations achieved substantial agreement following a chaired meeting attended by all authors. A summary infographic was produced to highlight themes relevant to the military patient population.Diagnosis of Achilles and patellar tendinopathy remains clinical. The consensus panel strongly advocates exercise rehabilitation as the primary management of Achilles and patellar tendinopathy. Medical interventions should respect the long-term occupational needs of the military population. Education is advised, but further adjunctive interventions should only be considered on a case-by-case basis. This consensus agreement provides a framework for the development of local guidelines for the management of Achilles and patellar tendinopathy in the UK military population.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"172-177"},"PeriodicalIF":1.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13018847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}