Bmj Military Health最新文献

{"title":"Treatment of ear trauma within the Ukrainian military: organisational requirements and implementation of a three-stage regimen.","authors":"Roman Barylyak, D Horoliuk, I Chervan, P H Skarzynski","doi":"10.1136/military-2023-002624","DOIUrl":"10.1136/military-2023-002624","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"384"},"PeriodicalIF":1.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869969","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 COVID-19 on the veteran population: evidence from the Trends in Scottish Veterans Health study.","authors":"Beverly P Bergman, D F Mackay, J P Pell","doi":"10.1136/military-2024-002677","DOIUrl":"10.1136/military-2024-002677","url":null,"abstract":"<p><strong>Introduction: </strong>There have been few epidemiological studies on the impact of the SARS-CoV-2 (COVID-19) pandemic on the veteran population, other than on specific aspects such as mental health, and none in the UK. We used data from the Trends in Scottish Veterans Health cohort to explore the risk of hospitalisation and death associated with COVID-19 in veterans resident in Scotland in comparison with matched non-veterans.</p><p><strong>Methods: </strong>Retrospective cohort study of 71 000 veterans and a comparison group of 230 000 non-veterans matched for age, sex and geography, using Cox proportional hazard analysis to explore the risk of hospitalisation with COVID-19 and COVID-19-associated death overall and by birth cohort, sex and length of military service.</p><p><strong>Results: </strong>Between 1 January 2020 and 31 December 2021, 564 (0.79%) veterans had been hospitalised with COVID-19 compared with 1728 (0.75%) non-veterans. The Cox model showed no significant difference overall, HR 0.99, 95% CIs 0.90 to 1.11, p=0.800. Subgroup analysis showed increased risk in older, short-serving (<20 weeks) Early Service Leavers (ESL). There was no overall difference in COVID-19-associated deaths, HR 0.99, 95% CI 0.79 to 1.23, p=0.993, but subgroup analysis showed a non-significant reduced risk of death in veterans aged 61-70 years, and a 38% higher risk in veterans aged over 70 years which almost reached statistical significance, p=0.054. This was only partially explained by socioeconomic factors and common comorbidities, although we had no data on domestic circumstances or care home residence.</p><p><strong>Conclusions: </strong>Overall, military service was not a risk factor for either hospitalisation or death associated with COVID-19. Older ESLs were at increased risk compared with non-veterans, but military service is unlikely to have been causal. The risk of death was increased in the oldest veterans and further studies are needed to explain this once census data become available for linkage.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"327-332"},"PeriodicalIF":1.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868299","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":"Evaluating health-related behaviours of armed forces personnel in Kuwait: a cross-sectional study.","authors":"Eiman Alkhezi","doi":"10.1136/military-2024-002668","DOIUrl":"10.1136/military-2024-002668","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence is lacking regarding the health-related behaviours of the military force in Kuwait. This study compared health-related behaviours of active-duty armed forces personnel according to their service branch and rank.</p><p><strong>Methods: </strong>In this cross-sectional descriptive study, an online questionnaire was developed to collect, via text messages, anonymised data from 392 armed forces personnel on their sociodemographics, health status, smoking, physical activity and desire for mental healthcare.</p><p><strong>Results: </strong>Most of the participants were non-officers (80.35%) from 'other' service branch (48.10%), had ≤10 years of military service (64.46%) and were Kuwaitis (79.97%) aged 18-39 years (77.62%) and rated their physical and mental health as 'good', with no chronic diseases (93.28%), although 53.13% were overweight and 8.55% were obese, and the prevalence of obesity increased with age. The survey revealed a high prevalence of physical inactivity (65.48%), which increased with age as well as a high prevalence of smoking (82.66%). Almost half of the respondents (46.21%) believed that seeking mental health help could probably damage their military career, this belief significantly increased with age.</p><p><strong>Conclusion: </strong>Although most of the Kuwaiti armed forces personnel reported having 'good' physical and mental health, with no chronic diseases, there was a high prevalence among them of overweight, smoking and low physical activity levels, with no difference between service branches or ranks. Moreover, the stigma of having mental health problems and the fear of the negative effects of seeking mental healthcare on a career were prevalent among the participants. These data are helpful in informing policy and development programmes that meet the needs of armed forces personnel.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"321-326"},"PeriodicalIF":1.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285034","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":"French mobile neurosurgical unit: a retrospective analysis of 22 years of mission.","authors":"Rayan Fawaz, F L Maison, P Robert, M Fouet, J-M Delmas, R Dulou, N Desse, A Dagain","doi":"10.1136/military-2023-002601","DOIUrl":"10.1136/military-2023-002601","url":null,"abstract":"<p><strong>Introduction: </strong>The French mobile neurosurgical unit (MNSU) is used to provide specific support to remote military medicosurgical units deployed in foreign theatres. If a neurosurgical casualty is present, the Role 2 team may request the MNSU to be deployed directly from France. The deployed neurosurgeon can then perform surgery in Role 2 or decide to evacuate the casualty and perform surgery in Role 4 in France. We provide an epidemiological analysis of MNSU missions between 2001 and 2023 and investigate the value of the MNSU for the French Armed Forces.</p><p><strong>Methods: </strong>We conducted a retrospective case series that included patients managed by the MNSU from 1 January 2001 to 31 January 2023. We collected epidemiological data (eg, age, military or civilian status, delay between transmission and takeoff, origin of the injury and mission location), clinical records (aetiologies of the injury and disease), data on surgical intervention (operator nature and type of surgery) and data on postoperative outcomes recorded at the time of discharge from hospital.</p><p><strong>Results: </strong>51 patients were managed by the MNSU. 36 (70.5%) and 3 (5.8%) patients underwent surgery on Role 2 and Role 4, respectively. 39 (76.9%) interventions were due to traumatic injury, 4 (7.8%) due to hydrocephalus, 4 (7.8%) due to vascular causes, 3 (5.9%) due to tumour and 1 (2%) due to spine degeneration. In 30 (76.9%) of these cases, the first operator was a neurosurgeon from the MNSU, whereas in the remaining 9 (23.1%) cases, procedures were initially performed by a non-neurosurgeon.</p><p><strong>Conclusion: </strong>The MNSU contribution to D1 casualties' strategic evacuation (STRATEVAC) is important. The MNSU provides additional support for STRATEVAC during the reorganisation of French Armed Forces engaged in several fronts. With the return of high-intensity wars, the French MNSU must develop and adjust for the management of massive influxes of casualties.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"369-372"},"PeriodicalIF":1.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433135","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":"Body mass index misclassification of overweight and obesity in Czech military personnel.","authors":"Vladimir Pavlik, B Kupsová, V Šafka","doi":"10.1136/military-2024-002761","DOIUrl":"10.1136/military-2024-002761","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"378"},"PeriodicalIF":1.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307205","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":"Removal of tourniquets: the next step in saving lives and limbs.","authors":"Christian Medby, J Ricks, B Ingram, C Forestier, D Parkhouse, I Gurney, C A Burnett, A Faas","doi":"10.1136/military-2024-002785","DOIUrl":"10.1136/military-2024-002785","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"288-289"},"PeriodicalIF":1.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569937","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":"Long-term impact of combat-related traumatic injury on heart rate variability: findings from the ADVANCE study.","authors":"Rabeea Maqsood, S Schofield, A N Bennett, A Khattab, A Mj Bull, N T Fear, P Cullinan, C J Boos","doi":"10.1136/military-2024-002895","DOIUrl":"https://doi.org/10.1136/military-2024-002895","url":null,"abstract":"<p><strong>Introduction: </strong>Combat-related traumatic injury (CRTI) has been associated with adverse cardiovascular outcomes in veterans. However, the long-term impact of contemporary CRTI on heart rate variability (HRV, a marker of autonomic function) has never been investigated in combat veterans and personnel. This analysis aimed to examine the association between CRTI and short-term HRV in a contemporary cohort of British servicemen.</p><p><strong>Methods: </strong>This analysis used the first follow-up data from the ArmeD serVices trAuma rehabilitatioN outComE (ADVANCE) prospective cohort study. Participants comprised 469 injured (those who sustained serious physical CRTI while on deployment in Afghanistan) and 506 uninjured servicemen [those who were uninjured and were frequency-matched to the injured based on age, sex (male), rank and deployment: Afghanistan 2003-2014 at recruitment]. Resting HRV was measured (5 min ECG) in the supine position. Root mean square of successive differences (RMSSD) and the sympathetic nervous system (SNS) index were reported as measures of parasympathetic and sympathetic activity, respectively. Multiple linear regression models reported the association between CRTI and HRV, adjusting for age, rank and ethnicity.</p><p><strong>Results: </strong>Participants' median age was 37.5 years. The time from CRTI/deployment was approximately 11 years. Median RMSSD was significantly lower in the injured versus uninjured [37.7 ms (IQR: 25.3 to 55.9) vs 41.9 ms (IQR: 27.7 to 62.2); p=0.01]. After confounder adjustment, CRTI was significantly associated with lower RMSSD [geometric mean ratio: 0.92 (95% CI 0.85 to 0.99)] and relatively higher SNS index [coefficient: 0.19 (95% CI 0.05 to 0.34)] in the injured versus uninjured. Blast injury and traumatic amputation were associated with significantly lower RMSSD and greater SNS activity.</p><p><strong>Conclusion: </strong>CRTI is associated with greater relative autonomic imbalance. These findings may help understand the recovery pathway following CRTI in wounded combat veterans and personnel.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643900","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":"Medicine in the drone age: prehospital emergency care under the threat of enemy UAS.","authors":"Conor Spilsbury, J Miles, A Hamer, D Ferraby","doi":"10.1136/military-2025-002969","DOIUrl":"10.1136/military-2025-002969","url":null,"abstract":"<p><p>The Ukraine-Russia conflict has seen unprecedented use of uncrewed aircraft system (UAS), leading to significant changes in injury patterns and medical evacuation constraints. This article examines the mechanisms of injury caused by UAS, the epidemiology of these injuries and the challenges faced by medical teams in evacuating and treating casualties. The prevalence of UAS has resulted in a higher incidence of head, neck and acoustic injuries, necessitating minimally invasive surgeries and advanced imaging techniques. The ability of Russian forces to sustain long-range UAS operations has severely restricted casualty movement and increased the risk to medical providers. This article highlights the need for enhanced force protection measures, including the use of counter-UAS technology, improved personal protective equipment and innovative evacuation strategies such as uncrewed ground vehicles. The findings underscore the importance of adapting medical practices to the evolving threat landscape and ensuring the safety and effectiveness of medical teams operating in high-risk environments.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585329","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":"Regional anaesthesia in combat settings: a position paper from military physicians.","authors":"Philippe Laitselart, S Hellander, F Josse, G Nordmann, N Ribaud, N Carbonnel, P Pasquier","doi":"10.1136/military-2025-002988","DOIUrl":"https://doi.org/10.1136/military-2025-002988","url":null,"abstract":"<p><p>Regional anaesthesia (RA) is a powerful tool in combat casualty care. As contemporary warfare evolves towards major engagements and delayed evacuations, the need for effective, durable and logistically feasible pain management has become critical. RA offers significant clinical and tactical advantages by providing sustained analgesia without impairing consciousness. Despite this, its use remains largely restricted to anaesthetists due to training gaps and institutional inertia. This position paper supports the integration of RA into the standard combat medical toolkit and the training of non-specialist military physicians in its use. Drawing on data from recent military studies and field experience, we explore the benefits of RA in austere settings, the current barriers to its widespread adoption, and the required steps to institutionalise its practice-including doctrinal changes, structured training and strategic support tools such as telemedicine and artificial intelligence. Implementing this position could contribute to improving pain control on the battlefield and preserving operational capacity.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561591","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":"Enhancing combat casualty care in military medicine: the potential of early warning systems and wearable biosensors in large-scale warfare.","authors":"Quentin Mathais, H De Malleray, C Nguyen, L-L Weghel, S Boussen, J Bordes","doi":"10.1136/military-2025-002977","DOIUrl":"https://doi.org/10.1136/military-2025-002977","url":null,"abstract":"<p><p>The management of war casualties has evolved significantly. Tactical tourniquets, early surgical haemostasis and massive transfusion protocols have all contributed to a significant decrease in war casualties' mortality. Large scale combat scenarios pose new and major challenges, as the volume of casualties is predicted to exceed available resources. Combat Medical Early Warning Systems (CMEWS) and wearable biosensors could present promising solutions in this context. An Early Warning System consists of three key components: data collection of vital signs, analysis through an Early Warning Score and a corresponding medical response. Biosensors, on the other hand, enable continuous monitoring of physiological parameters. Their miniaturisation, connectivity and reliability make them promising tools, though challenges such as accuracy, cost and data integration remain. Integrated CMEWS, combining biosensors with automated decision-making algorithms, could revolutionise the management of war casualties. These systems would assist in the early identification of severe war casualties and triage, assisting health services in casualty flow management. They have the potential for providing a shared, real-time overview of casualties' status for all healthcare providers. Additionally, the integration of these systems into the battlefield would facilitate improved coordination across medical and command structures, enhancing patient management even in remote or high-risk environments. However, the adoption of integrated CMEWS and biosensors faces challenges, including data security concerns, infrastructure limitations and the need for significant investment and training. Despite these hurdles, their potential to enhance casualty care, particularly in high-intensity conflict settings, is evident and could transform both military and civilian emergency medical care.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561589","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}