Bmj Military Health最新文献

{"title":"Neurocognitive consequences of blast injuries in military personnel with mild traumatic brain injury: evaluation with the ImPACT quick test.","authors":"Kateryna Sаrаzhynа, Y Solodovnikova, A Son","doi":"10.1136/military-2025-003012","DOIUrl":"10.1136/military-2025-003012","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"478-479"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765674","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":"Physical health and performance of an ADVANCE subcohort of UK veteran traumatic lower limb amputees 12.5 years post-injury.","authors":"Jose M Frias-Bocanegra, Natalie Masters, Daniel T P Fong, Mark P Lewis, Alexander N Bennett, David J Williams, Sarah A Stapley","doi":"10.1136/military-2026-003323","DOIUrl":"https://doi.org/10.1136/military-2026-003323","url":null,"abstract":"<p><strong>Introduction: </strong>During the Iraq and Afghanistan conflicts, survival following very severe injury increased. Now, more than 10 years since the cessation of hostilities, veterans are living with musculoskeletal (MSK) injury patterns not previously encountered. The ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) study tracks the long-term physical and psychological outcomes of these veterans. This bolt-on study investigates the long-term physical effects of lower limb amputation.</p><p><strong>Methods: </strong>In this cross-sectional study, 31 participants across three cohorts of injured military veterans-unilateral transtibial (UTT), unilateral transfemoral (UTF) and bilateral transfemoral (BiTF) amputees-undertook a functional assessment, including instrumentation and completion of a 6-min walk test (6MWT), synchronously recorded with a three-dimensional motion capture system, force plates and a wireless gas analysis mask to assess metabolic costs. In addition to the three injured cohorts, a group of age-matched controls was assessed for comparison.</p><p><strong>Results: </strong>The results of 41 participants across four groups, including matched controls, demonstrate a high degree of observed maintained fitness, with 6MWT distances covered being 595.8±99.7 m for UTT, 486.6±55.4 m for UTF, 481.7±122.9 m for BiTF and 662.7±80.9 m for controls. The metabolic costs of the BiTF and UTF cohorts were significantly higher than those of the UTT or control cohorts. Ground reaction forces (GRFs) during the gait cycle demonstrate early signs of asymmetry between intact and residual limbs in UTT and UTF groups. The BiTF cohort shows the fewest areas of asymmetry across the gait cycle. BiTF and UTF cohorts demonstrate significant GRF differences from those of the control group.</p><p><strong>Conclusions: </strong>These results provide clinically relevant evidence for sustained functional preservation in veterans after major lower-limb trauma, substantiating the utility of the UK military's post-injury rehabilitation programme in terms of fitness and resilience essential for enduring high function. It also provides some early indications of developing asymmetries within the gait cycle that should be monitored and studied as possible evidence of early MSK disease.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026327","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":"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":"429-434"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","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":"Military health applications of bacteriophage: opportunities and challenges.","authors":"Nicola Reece, Scott J C Pallett, Lucy Lamb, Matthew K O'Shea, Katherine Clay","doi":"10.1136/military-2025-003199","DOIUrl":"10.1136/military-2025-003199","url":null,"abstract":"<p><p>Bacteriophage (phage) is a virus that infects and kills bacteria but not human cells. As phages and bacteria have co-evolved over thousands of years, each phage is highly specific for its host bacteria. Phages were discovered over 100 years ago, with increasing antimicrobial resistance, there has been a resurgence of interest in phage therapy for antibiotic-resistant bacterial infections. Given their ubiquitous nature and high specificity, phages have many advantages as a potential therapy. However, their utility is not limited to treatment and phages can also be useful tools for diagnosis, decontamination and prophylaxis. This article reviews the potential uses for phage and explores the associated opportunities and challenges within a military medical context.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"398-402"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146067649","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":"Orthopaedic burden in disaster: a scoping review.","authors":"Joshua McIntyre, Sarah K Stewart, Arul Ramasamy","doi":"10.1136/military-2025-003157","DOIUrl":"10.1136/military-2025-003157","url":null,"abstract":"<p><strong>Introduction: </strong>Disasters are an increasing challenge to global healthcare systems due to climate change and geopolitical tensions. Traumatic injuries are prevalent in these crises, causing significant mortality and functional impairment. Understanding the burden of musculoskeletal trauma is crucial for enhancing disaster relief and rehabilitation efforts. This scoping review examines the orthopaedic burden in disaster.</p><p><strong>Method: </strong>A scoping review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PUBMED and EMBASE databases. Original studies published from 2003 to 2023 addressing orthopaedic trauma in disasters were included. Data on demographics, the anatomical distribution of injuries and orthopaedic intervention were extracted and analysed.</p><p><strong>Results: </strong>The search identified 602 studies, with 10 satisfying the inclusion criteria, encompassing 24 621 patients. Earthquakes were the most common disaster type. Extremity injuries accounted for 52-93% of total injuries, with lower limb trauma predominating. In the majority of studies, the most common surgical intervention was wound debridement. The proportion of patients undergoing surgical intervention varied widely from 0.2% to 82.3%. Compartment syndrome when recorded ranged from 2% to 29.9% of cases. The quality of the studies was generally poor, with inconsistent reporting standards and limited outcome data.</p><p><strong>Discussion: </strong>Orthopaedic injuries form the largest component of trauma in disaster settings, emphasising the need for surgical expertise. Standardised reporting is vital for improving the understanding and comparison of injury profile associated with different catastrophes. Future research should focus on comprehensive reporting standards and long-term outcomes associated with disaster response.</p><p><strong>Conclusion: </strong>This review underscores the critical role of orthopaedics in disaster response and the need for universal reporting standards to optimise care in austere environments.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"410-416"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367016","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":"Conflict wounds and antimicrobial resistance: a systematic review on local antimicrobials to prevent infection after extremity open fracture.","authors":"Henry A Claireaux, Scott Jc Pallett, Luke Sp Moore, Andrew M Edwards, Julian R Jones, Matthew K O'Shea, Arul Ramasamy","doi":"10.1136/military-2026-003255","DOIUrl":"10.1136/military-2026-003255","url":null,"abstract":"<p><strong>Introduction: </strong>Contemporary conflict-associated injuries with open fractures are challenged by infection and antimicrobial resistance (AMR), compromising empiric antimicrobials and limiting options for systemic treatment. Local antimicrobials in high concentrations may offer an adjunctive therapy but the evidence and its relevance to conflict settings are unclear.</p><p><strong>Methods: </strong>A systematic review was undertaken using the Medline, Embase and Cochrane databases, searching for evidence relating to the use of local antimicrobials to prevent infection after extremity open fracture. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The review considered evidence for the effect of local antimicrobials across different agents, different causes of infection, AMR and adverse effects. Available evidence was considered in the context of its relevance to conflict injuries and priority research gaps were identified.</p><p><strong>Results: </strong>No studies were identified in conflict or humanitarian settings. Seven civilian systematic reviews and meta-analyses considering different outcomes and four randomised controlled trials (RCTs) were identified. There was low-quality evidence for a reduction in infection when using prophylactic local antimicrobials in addition to systemic antimicrobials, and there was no evidence of adverse outcomes. Evidence skewed towards use for Gram-positive infections. There was a lack of level one evidence and marked heterogeneity across study designs.</p><p><strong>Conclusion: </strong>AMR has emerged as a major challenge for the management of open fractures sustained in conflict. There is an urgent requirement to identify alternative treatment options and adjuncts. Local antimicrobials and biomaterials present potential opportunities. Further evidence from RCTs is required across all settings. In the context of conflict, this must include relevant outcomes, including the impact of delayed surgery, wound contamination and AMR.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"417-422"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150980","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":"Ethical issues and challenges in conducting evaluation of military health engagements.","authors":"Jessica L A Jackson, H Bockhorn, A J Rollings","doi":"10.1136/military-2025-003034","DOIUrl":"10.1136/military-2025-003034","url":null,"abstract":"<p><strong>Introduction: </strong>There are unique ethical challenges faced by evaluators of military health engagement (MHE) activities. Existing ethical frameworks provide important evaluation considerations but are either (1) not applicable to the breadth of activities that MHEs may involve or 2) do not adequately address ethical considerations necessary in a military setting.</p><p><strong>Methods: </strong>The article examines the shortcomings of literature pertaining to existing ethical frameworks and presents a survey of principles that evaluators supporting MHEs may find germane to their work. These principles-accountability and integrity, beneficence, respect, systematic inquiry and competence and undue influence-are drawn from multiple frameworks and were selected for their relevance to evaluation in the context of MHE.</p><p><strong>Results: </strong>When considered in tandem, the five selected principles provide a provisional framework that accommodates the specific needs of evaluators while also addressing the distinct ethical considerations required of the military. Alongside each principle, practical guidance is offered to assist military personnel in navigating ethical dilemmas they may encounter in theatre and ensure their evaluations are rigorous, accurate and unbiased.</p><p><strong>Conclusions: </strong>No single ethical framework sufficiently captures the needs of evaluators supporting an MHE; however, select principles from multiple frameworks will capably aid an evaluator in such a setting. Going forward, those charged with evaluating MHEs should consider the proposed principles when conducting research to make certain that evaluations are both ethically and empirically sound.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"393-397"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410449","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":"Medical evaluation of pelvic anatomy coverage provided by the UK armed forces pelvic protection system.","authors":"John Breeze, R N Fryer, D M Bowley, T-L Appleyard, J Jeevaratnam, D D Keene, A Ramasamy, A Hepper, E Lewis","doi":"10.1136/military-2025-003002","DOIUrl":"10.1136/military-2025-003002","url":null,"abstract":"<p><strong>Introduction: </strong>Pelvic and perineal injury from buried improvised explosive devices were responsible for substantial mortality and long-term morbidity of UK armed forces personnel in recent conflicts. The pelvic protection (PP) system is provided as three separate garments (Tiers 1, 2 and 3), with each offering successively increased coverage and level of ballistic protection to potentially mitigate such injuries.</p><p><strong>Method: </strong>Each tier of PP was imported into the Coverage of Armour Tool and superimposed over the female and male anatomical structures in the pelvis deemed as essential or desirable coverage. This enabled both visualisation and objective determination of the coverage provided by PP from a range of orientations.</p><p><strong>Results: </strong>Tier 1 PP covers 75% and 76% of the essential anatomical structures, for the female and male geometries, respectively, against narrow azimuths (representing ground-based threats). Tier 2 PP provides less coverage than Tier 1 PP (58% and 55%, respectively). The coverage increases to 88% and 89% when Tier 3 PP is worn in conjunction with the Tier 2 PP. A coverage gap between the bottom of the VIRTUS scalable tactical vest and the top of PP was identified.</p><p><strong>Conclusions: </strong>This is the first review of the PP coverage since its initial development and fielding in 2010. This review has determined the extent of coverage provided by the current PP and has identified the anatomical structures that are not covered by the PP design. While the PP system has been shown to be effective, its suitability for current and future combat operations is required. Practical recommendations are provided to optimise the coverage of the current and future PP.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"465-470"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477386","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":"Importance of strength training to prevent secondary lower limb musculoskeletal injury in military personnel.","authors":"Peter Ladlow, Russell J Coppack, Robyn P Cassidy, Rachel Rodgers, Robert Barker-Davies, Paul Comfort, Nicholas J Ripley, Christopher Bramah, Colin Suffield, Debra Hayhurst, Marina De Vecchis, Samual R Higgins, Alexander N Bennett, Oliver O'Sullivan","doi":"10.1136/military-2025-003201","DOIUrl":"10.1136/military-2025-003201","url":null,"abstract":"<p><p>Considerable operational and financial costs are associated with musculoskeletal injury (MSKI) across military organisations. Following an MSKI, reaching 'medically fully deployable' status is often contingent on meeting physical employment standards. Strength training has a critical role to play in military physical preparation, injury mitigation and guiding rehabilitation practice. Low levels of muscle strength are associated with increased MSKI risk, and previous MSKI is a leading risk factor for re-injury. When an MSKI does occur, it is essential that all attempts to mitigate the risk of secondary MSKI are met. Maximal force (muscle strength) and rapid force (rate of force development and reactive strength) production have been identified as important strength characteristics requiring targeted training interventions and assessment prior to returning to operational roles. This review investigates the importance of strength training and its assessment during late-stage rehabilitation to inform return-to-duty exit criteria, meet physical employment standards and mitigate secondary MSKI.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"403-409"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214533","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":"Bridging the gaps in prolonged casualty care: the Prolonged Evacuation Transport Team (PETT) programme.","authors":"Benjamin James Ingram, P Parker, G Kucaba, J Silcox, P Guła","doi":"10.1136/military-2025-003052","DOIUrl":"10.1136/military-2025-003052","url":null,"abstract":"<p><p>In response to Ukrainian-identified training gaps in the Ukrainian Armed Forces Special Operations Forces (UAF SOF) medical evacuation chain, NATO SOF medical elements developed the Prolonged Evacuation Transport Team (PETT) training programme. The PETT programme provides critical knowledge and skills to Ukrainian SOF medical personnel to increase survivability and decrease morbidity during contested or prolonged evacuation. The bespoke 3-week curriculum uses components of existing US Joint Trauma System products. Medical professionals, such as paramedics, feldshers and nurses, excelled in the full curriculum, resulting in requests for serial iterations of the programme. However, those with limited medical training (1-3 weeks) faced a steeper learning curve. This finding revealed a requirement for the development of a truncated version of PETT, termed Prolonged Critical Lifesaving Skills. The PETT programme successfully advanced UAF SOF's medical capabilities and established a model for future standardised training in contested environments with prolonged evacuation timelines.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"389-392"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145368819","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}